Health funding in Africa: How close is the AU to meeting Abuja targets?

More than a decade after the African Union drew up the Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, how have governments fared in their commitments to increase domestic health spending and scale up local efforts to fight these infectious diseases?

Health spending in AU governments has increased exponentially, from just $30.7 billion in 2001 to $106.6 billion in 2011, according to a report jointly produced by UNAIDS and the African Union and released ahead of the Abuja+12 summit in mid-July.

But despite significant growth in annual expenditure, the share of private and public spending has remained largely the same. In 2001, general government spending on health accounted for 44 percent of total health expenditure in the Africa Union. After a decade, its contribution to the bloc’s annual health budget increased only 4 percentage points.

Further, despite pledging in Abuja to commit 15 percent of their annual budgets to public health spending, nearly one-third of AU governments have reduced health expenditure since 2001. Mozambique, which had the second-highest health spending among AU governments in 2001, cut health spending from 14.8 percent of its annual budget to just 7.8 percent in 2011. More alarmingly, Chad, where incidences of HIV and tuberculosis remain high, slashed health spending 76.3 percent from 13.8 percent in 2001 to a meager 3.3 percent in 2011.

But some countries have made significant progress toward meeting this goal. The Democratic Republic of the Congo, for instance, boosted health spending 286.7 percent from just 2.8 percent in 2001 to 10.8 percent in 2011. While still a few percentage points shy of the target, the DRC is likely to meet this goal provided public health spending increases at the current rate.

As of 2011, six countries have been able to meet and surpass the 15 percent target: Rwanda (23.8 percent), Liberia (18.9 percent), Malawi (18.5 percent), Zambia (16 percent), Togo (15.4 percent) and Madagascar (15.3 percent). Four countries are clearly on their way to meeting the Abuja target: Swaziland (14.9 percent), Ethiopia (14.6 percent), Lesotho (14.6 percent) and Djibouti (14.2 percent).

In general, AU governments have increased public health spending as a share of their annual budgets by 69 percent. Higher domestic spending has helped reduce new HIV infections in sub-Saharan Africa by 25 percent, and cut AIDS-related deaths by one-third. Further, the number of children who become newly infected with HIV dropped at least 50 percent in Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia. Save for Botswana, whose health spending dropped from 9.6 percent in 2001 to 8.7 percent in 2001, all of these countries boosted public health expenditure in 2011.

But African governments need to scale up public health spending to drastically reduce its infectious disease burden. As of 2011, at least 69 percent of people living with HIV and AIDS and 90 percent of malaria-related deaths are in sub-Saharan Africa. In addition, nearly a quarter of incidences oftuberculosis, 80 percent of TB cases among people living with HIV and another 80 percent of instances of malaria are in Africa.

The joint report set out a number of recommendations to help the bloc achieve not only the targets set in the Abuja Declaration, but also “to improve health and well-being” in the continent through 2030.

The two overarching themes of the recommendations are to find more innovative sources of funding and ways of investing these resources to ensure maximum impact, and to be more inclusive in planning and implementing health programs. The report suggests, for instance, that the African Union should push to produce more of Africa’s medicinal needs within the continent. It also recommends including not only health partners in decision-making processes, but also vulnerable and marginalized populations.

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