Health
WHO Africa Regional Health Cost Atlas 2023 – World
Over the past decade, African countries have experienced slow progress in mobilizing resources for health, despite facing ongoing challenges. In revised estimates published in 2017, Stenberg et al. developed two cost scenarios, “progressive” and “ambitious,” aiming to enhance comprehensive health service delivery towards achieving SDG 3 and universal health coverage in low- and middle-income countries (Stenberg et al., 2017). On average, only eight of the 47 countries in the WHO African Region met the recommended benchmark of spending a minimum of US$249 per capita on health in the period 2012–2020. In 2020, only five countries achieved this outcome, while the remaining countries spent less than US$249 per capita, with health expenditures ranging from US$16.4 to US$236.6, highlighting large disparities across the region.
We noted a gradual improvement in domestic general government health spending as a share of total government expenditure. This indicates that several countries are allocating more resources from domestic sources to health, reflecting an increasing priority given to health by African governments. Despite this improvement, only one country, South Africa, achieved and maintained the Abuja Declaration target of allocating and spending at least 15% of government expenditure on health between 2014 and 2020. In 2020, domestic general government health spending as a share of total government expenditure ranged from 2.1% to 12%, highlighting the wide variation across countries and the limited capacity to raise public funds for health in many African countries.
The status of out-of-pocket (OOP) payments in current health expenditures varies widely among countries in the region. Although evidence suggests that out-of-pocket payments should not exceed 15-20% of current health expenditures to ensure that health services are affordable and available to all (Xu et al., 2010), from 2012 to 2020, out-of-pocket payments accounted for an average of 35.8% of current health expenditures. This indicates that out-of-pocket payments remain the main source of financing health expenditures, increasing the risk of financial difficulties, especially for vulnerable populations.
The magnitude of other private domestic health expenditure (excluding out-of-pocket payments) in the African region is relatively modest, ranging from 7% to 10% of current health expenditure throughout the period 2012-2020. This highlights countries’ limited capacity to engage the private sector in financing health and establishing prepayment systems, a crucial element in the pursuit of universal health coverage and social health security.
External funding remains a key financial pillar for the region: in half of the countries, it accounted for more than 20% of current health expenditure between 2012 and 2020. This heavy reliance on external funding raises concerns about the sustainability of health outcomes, especially in the context of the COVID-19 pandemic, other emerging and re-emerging infectious diseases, and epidemiological transitions.
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