African governments still underfunding health, warns UN watchdog

Twelve years after African governments pledged in the Abuja declaration (pdf) to allocate at least 15% of their annual budgets to healthcare by 2015, just six countries have met this goal.

Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia have hit the target, and five other countries are spending at least 13% of their annual budgets on health, according to data compiled by the UN World Health Organisation (WHO).

While on aggregate spending on health has increased, up to 10.6% from 8.8%, about a quarter of African Union (AU) member states have regressed and are spending less than in 2001, the data shows.

Recently, the AU held another special summit on HIV and Aids, tuberculosis (TB) and malaria in Abuja, Nigeria, dubbed Abuja+12, which provided an opportunity for African governments and other stakeholders to review progress made and to discuss what should be done to ensure health funding targets are met before 2015.

The HIV and Aids experience

"A renewed and bold commitment here in Abuja is essential as, drawing from experiences in the Aids response, we know that smart investments will save lives, create jobs, reinvigorate communities and further boost economic growth in Africa," said Michel Sidibé, the executive director of UNAids, in a press statement.

At present, funding for healthcare remains short of requirements and is unevenly spread across countries. According to UNAids, an additional $31bn (£20bn) per year will be needed to meet the continent's 15% health funding targets.

As of 2011, at least 69% of the world's 34 million people estimated to be living with HIV and Aids were in sub-Saharan Africa. But there are encouraging signs. The number of new HIV infections fell to 25% in 2011 compared with a decade earlier.

"The main challenge in the fight against HIV and Aids globally is how to ensure universal access to prevention, treatment, care and support, and ... ensuring zero transmission of new HIV infections in children," Ghana's president, John Dramani Mahama, wrote in a blog in May.

Among 21 priority countries in Africa, the number of children newly infected with HIV has fallen by 38% since 2009, according to a joint AU-UNAids report (pdf) launched at Abuja+12.

Malaria and TB burden

Africa is also lagging behind in reducing cases of - and deaths from - TB and malaria.

Globally, Africa is the only region not on track towards halving TB deaths by 2015, and it accounts for almost a quarter of the global caseload, according to the WHO.

Inadequate TB detection and drug-resistant strains of the disease, which can be 100 times more expensive to treat, pose significant challenges in Africa. About 40% of TB cases in Africa go undetected, says the WHO.

Malaria is also a serious health problem. Some 80% of the world's cases, and 90% of malaria-related deaths, occur in Africa.

The Liberian president, Ellen Johnson-Sirleaf, in a statement to the Global Fund, said: "We are at a turning point for making historical gains in Liberia's health sector - where no child dies of malaria and every mother living with HIV can give birth to HIV-negative children while living healthy lives themselves."

Liberia allocates 18.9% of its annual budget to healthcare, the second highest proportion in Africa; Rwanda spends 23.7%.

Health for development

According to the AU-UNAids Abuja+12 report, there is an economic case to be made for further investment in healthcare: for every year that life expectancy rises across the continent, it argues, GDP will increase by 4%. The average life expectancy in Africa is 54.4 years, the lowest globally.

Mahama said: "A sick population cannot generate the productivity needed to maintain the acceleration of our economy.".

More funding for health could also mean more jobs within the health sector. In 2012 for example, the AU approved a business plan to increase the output of the local pharmaceutical industry.

"Focusing on three things that Africa needs to do urgently - decrease dependency by growing African investments, deliver quality-assured drugs sooner to the people who need them, and leadership - the blueprint will help African countries to build long-term and sustainable solutions," Mustapha Sidiki Kaloko, the AU commissioner of social affairs said in the runup to the Abuja+12 summit. "Africa's health and our prosperity are inextricably linked."