African governments will miss health development goals unless spending prioritises the poorest, most vulnerable groups

Investments in the health sector by sub-Saharan African governments have seen significant improvements in life expectancy and general overall health, according to the ONE Campaign’s Africa DATA Report launched on 23 August 2016. The bad news is that the region is lagging furthest behind on health-related sustainable development goals.

This year’s Africa DATA Report, titled “Health Financing, Outcomes, and Inequality in sub-Saharan Africa”, focuses on a critical building block of development investment: health. Perhaps no other intervention is so critical to achieving the Sustainable Development Goals (SDGs). Health and nutrition interventions save lives; they also help to achieve better educational outcomes, build a more productive workforce and drive economic gains.

For Africa, a continent with a burgeoning youth population, there will need to be an increased focus on investing in human capital to drive greater development progress. Ensuring that these dividends are focused on the poorest and most vulnerable groups, and on creating decent healthcare for everyone, will be the key to achieving the Global Goals.

This report presents the latest snapshot of progress in sub-Saharan Africa on key health-related SDG indicators, both between and within countries. It highlights comparisons of outcomes and interventions across countries and the depth of inequality between the poorest 20% of the population and the richest 20%, on each health indicator assessed.

The report shows sub-Saharan Africa has the highest rates of child mortality, and faces the highest risk of malaria, accounting for roughly 90% of cases and deaths globally. Income inequality has also had a substantial effect in the region as progress in health outcomes in key areas has been faster for the wealthy compared to the poor.

In the 15 years since the Abuja Declaration, in which African governments committed to spend 15% of their budgets towards health, less than half of these African countries have met this target in any given year. On average, between 2012 and 2014, only Malawi, Swaziland, and Ethiopia met this target.

Crucially, investing in health has been shown to save lives and grow the economy. A study found that for every 10% increase in government health expenditure per capita, there has been a 25% reduction in under-five mortality and a 21% reduction in infant mortality. A 2013 study found that, between 2000 and 2011, upwards of 5.7% of GDP growth in sub-Saharan Africa was attributable to improved health.

Also, a recent 2016 study showed that for every US dollar invested in immunising children in low and middle-income countries, $16 is expected to be saved in healthcare costs in the future.

The report shows that in order to achieve the SDGs, and improve the health and well-being of everyone, African governments should:

• Increase domestic investments in the health sector, working towards the Abuja commitment of spending 15% of government budgets on health, but more importantly increase per capita spending on health to a level that can provide essential services to all;

• Ensure that investments in health maximise impact for all citizens, working towards implementation of universal health coverage (UHC), but particularly that they focus greater attention on the needs of the poorest people;

• Improve transparency and accountability of government spending and procurement in health, and collect better disaggregated data on results to aid in decision making.

ONE is calling on sub-Saharan African governments to:

• Ensure that the poorest 20% of the population are prioritised in health interventions;

• Introduce and scale up social protection programmes that benefit the poorest and most vulnerable, such as child care grants and cash-transfers;

• Utilise information and communications technology (ICT) and management information systems (MIS) to reach the poorest and most vulnerable, and to improve access to health services and service delivery;

• Make their budgets transparent and procurement processes open to close out opportunities for corruption; and

• Invest in health data collection and systems so that outcomes can be monitored and evaluated.

Chapter 1 begins by analysing the latest domestic spending data on health in sub-Saharan Africa, noting that very few countries have ever met the Abuja commitment to spend 15% of government budgets on health. Further, even countries which have met the commitment, or have come close, often have such small government budgets that per capita spending on health rarely breaks $50 a year, which is significantly below the target calculated as necessary to provide basic crucial health services.

As Chapter 2 shows, in many cases this leads to poor and stagnating health outcomes and interventions. However, some countries, such as Ghana and Rwanda, have shown tremendous innovation and efficiency in their health spending and, combining this with effective policies, are reaping the results.

In Chapter 3, ONE profiles six African countries that together account for more than one-third of sub-Saharan Africa’s GDP and also more than one-third of the region’s extreme poor – Kenya, Mali, Nigeria, Rwanda, Senegal and Tanzania.

In Chapter 4 we showcase some of the health programming and interventions that target and reach the poorest people – including broader social protection policies and movements towards UHC.

Lastly, budget transparency, accountability and data availability are key challenges to contend with when analysing this type of data, as noted in Chapter 5. We do not hide these shortcomings, and recognise that all findings, from spending levels to reported results, are only as accurate as the data behind them, and thus must be scrutinised and continually refined. The data revolution launched in September 2015 during the UN General Assembly is driving greater investments to ensure better data collection and accessibility.