African countries need to allocate more of their budgets to health, says WHO

BMJ 2011; 342 doi: (Published 30 March 2011) Cite this as: BMJ 2011;342:d1992
  1. John Zarocostas
  1. 1Geneva

Many African governments are not allocating enough funds from their annual budgets to health, says a study by the World Health Organization. Without additional resources, vital health goals will not be achieved, it says.

In the 10 years since heads of state of African Union countries met in Abuja, Nigeria, and pledged to set a target of allocating “at least 15%” of their annual budget to improve the health sector, only Rwanda and South Africa have reached the objective, says WHO.

Overall, WHO says, 27 countries have increased the proportion of government funds allocated to health and are making progress towards the Abuja target; seven have reduced spending on health, including Benin, Guinea, and Togo; and in 12 spending has remained the same.

In the past decade the median level of real terms, per capita government spending from domestic resources on health rose from $10 (£6.3; €7.1) to $14.

WHO says that 32 African Union governments currently spend less than $33 per capita on health—or about half of the expected health expenditure needed to meet the United Nations’ health related millennium development goals in poor countries.

If spending stays at this level there is very little chance of achieving the health goals even if countries spend 15% of their annual budget on health, analysts say.

David Evans, director at WHO’s department of health systems financing, told the BMJ: “There’s a long way to go. Adequate funding is critical if African countries are to reduce maternal and child mortality and combat AIDS, tuberculosis, and malaria. Donors and countries themselves share responsibility for finding that funding.”

WHO’s analysis concludes that only eight countries are on track to meet the goals relating to child and maternal mortality rates and to HIV prevalence. These countries include Eritrea, Rwanda, and Madagascar. It adds that 38 countries are off track, achieving less than half the gains needed to reach the health goals by 2015, with advances on maternal health “being particularly slow.”

The study emphasises that with funding targets being missed—with respect to domestic resources and to official international assistance—the level of funds available is well below what is needed.

WHO says that some African Union countries need to increase their own investment in health through reallocation within their general budgets. Enhancing efficiency and limiting waste in domestic health spending resources and in aid funds are also crucial, say WHO officials.

With concern that the lingering financial crises in rich donor countries could reduce disbursements until their economies pick up again, WHO also supports innovative funding sources to supplement traditional bilateral aid.


Cite this as: BMJ 2011;342:d1992