The latest report from the AU and UNAIDS on African governments’ spending on health makes depressing reading.  It was produced as part of the Abuja+12 meeting held in the eponymous Nigerian capital last week to look at progress since the original Declaration made in 2001.

A key commitment of the 2001 Abuja Declaration was the commitment to allocate at least 15% of public spending on health by 2015. Over the last five years, overall health spending in Africa has risen by about 10% annually. However, spending is well behind where it needs to be.

Of the 50 AU countries with available data:

  • 12 countries have reduced their health budgets as a percentage of government spending over the last 12 years
  • 8 have made no progress
  • 30 have made some progress; and
  • only 6 countries have achieved the target (Liberia, Madagascar, Malawi, Rwanda, Togo, and Zambia).

According to UNAIDS, an additional US$ 31 billion is required to close the funding gap.

Looking at the 12 who have reduced their budgets over the last dozen years, there are some unlikely laggards – ‘donor darlings’ such as Mozambique (down from just under 15% in 2001 to ~7.5% in 2012) and Kenya (spending down a third from ~9% to ~6%) are close to the top of the list in terms of reduction in spend on health (source: WHO).

There are other surprises, too – why is a wealthy middle-income country like Botswana reducing its health budget, now down to about 8% of government funding? It may reflect the passing of the acute phase of the HIV/AIDS crisis, which hit that country particularly badly, but with a PPP-adjusted GNI per capita income of US$14,550 (more, for instance, than EU member Bulgaria) surely they can afford it?

The other notable absence of the Abuja+12 announcement is a deluge of criticism from development NGOs directed against those African governments who are making no attempt to hit the Abuja targets. Sustainable basic health systems in a rapidly growing Africa need increased government funding. Often too little pressure is put on them to achieve that aim.