Editorial (June 2006)

More Money Spent Wisely

The health challenges faced by the developing world are formidable. Africa, with 10 percent of the world’s population, accounts for 25 percent of the global disease burden, 60 percent of people living with HIV/AIDS, and the highest morbidity and mortality from TB and malaria. Yet, spending on health care in Africa accounts for less than 1 percent of global health expenditure.

Addressing this imbalance will cost a lot, much more than is currently spent by countries in the Africa region and donors. It will require better spending. And it will involve improved management of financial risk.

In 2001 Heads of State of the Africa Union passed a resolution which set a target of 15 percent of public spending on health by member countries (the Abuja Declaration on health care financing). These are good intentions. But have they been translated into action on the ground?

A review of health spending in the Africa region since 2001 tells a troublesome story:

• Since 2001 only a few countries have made progress towards the Abuja health financing target and only two have actually reached the goal

• Many governments are spending less today than they were in 2001

• Some countries have a very low execution rate with a little as 20 percent of the planned budget actually reaching the Ministries of health

• In most countries, even if the Abuja target was reached this would yield less resources than the US$34 per capita spending needed to reach the MDG goals

• To reach the internationally agreed spending level of US$34 some many countries would have to spend more than 50 percent of their public budget on the health sector, sometimes as much as 80 percent.

Something is clearly wrong. Governments are not spending what they say they will. And the spending targets set by the international donor community are not realistic. In addition, many donors and NGOs are prescribing the wrong medicine.

Low spenders are being rewarded by more donor money. Countries that are trying to supplement their health budgets with other sources of income are being pressured to abolish user fees and not introduce mandatory or voluntary insurance mechanisms.

On May 2-4, 2006 the Africa Union convened a special Summit on Aids, TB and Malaria. At the time of this meeting, a special resolution was once again tabled and passed by the Heads of State. It reaffirmed earlier commitments by member countries to a 15 percent spending target. It also called on countries to become less reliant on donor money. And it called for increased insurance coverage to deal with the financial risk of illness.

Time will show if this time countries and donors alike will take the health financing agenda seriously. This requires matching lofty proclamations with action on the ground which includes more attention and financial resources devoted to health care financing.