Are African countries meeting the health spending targets?

There is no hiding place for non-performing government or health ministry in Africa. Countries are expected to track and publish more data on their MDG spending, and make these data more easily accessible to their citizens.The Government Spending Watch Report tagged ‘Putting Progress at Risk? MDG Spending in developing countries’ released in May 2013 by […]

There is no hiding place for non-performing government or health ministry in Africa. Countries are expected to track and publish more data on their MDG spending, and make these data more easily accessible to their citizens.
The Government Spending Watch Report tagged ‘Putting Progress at Risk? MDG Spending in developing countries’ released in May 2013 by Development Finance International and OXFAM was very instructive on the progress made by developing countries especially Africa  which  should be used to engage governments on health spending.
By May 2013, 32 months was left until the 2015 deadline set by world leaders for reaching the Millennium Development Goals (MDGs). This Government Spending Watch (GSW) report is the first ever to track how much developing countries are spending on the MDGs. It is based on data compiled by Development Finance International (DFI) and Oxfam, covering 52 low- and lower-middle income countries. The data have been compiled from country budget documents and other published sources.
They covered seven sectors – agriculture/food, education, environment and climate change, gender, health, social protection, and water and sanitation – from 2008 to 2015 (including medium-term forecasts). They examined planned and actual spending, disaggregated by type (recurrent or capital) and funding source (government or donor).
The report observed that many developing countries are spending more in real terms than ever before on the MDGs. This is a laudable achievement and a sign of their governments’ and citizens’ strong commitment to achieving the MDGs. This level of spending partly explains the rapid progress made towards achieving the MDGs in many countries. However, other countries are seeing stagnant or reduced spending and making much less progress. In addition, all targets and cost estimates for reaching the MDGs have been set using spending as a proportion of GDP or total government spending. Yet MDG spending has risen by only 0.5 per cent of GDP, and has fallen by 1 per cent of total spending, since 2008.
For all the MDGs, the vast majority of developing countries are spending much less than they promised, or than international organisations have estimated is needed. Most sectors show increases in real spending, but these are woefully insufficient. No spending target is on track in all countries: only one-third of countries are meeting promised or needed levels for health, one-quarter for education, and one-fifth for agriculture and WASH. Trends for each MDG sector show that spending is either stagnant or falling back from promised or needed levels.
There is no progress on spending in areas which will be crucial to any post-2015 ‘sustainable development’ goals. These include social protection to reduce inequality, agriculture to reduce hunger and increase the incomes of smallholder farmers, and programmes to combat environmental degradation and climate change. In addition, there is no sign of increased spending on the broader empowerment of women (beyond equal access to education) to reduce gender inequality.
Are African countries meeting the health spending targets?
Health is the most prominent sector in the MDGs, with its spending responsible for three goals:
1.      Infant mortality, with MDG Target 4: aiming to reduce by two-thirds the under-five mortality rate.
2.      Maternal mortality, with MDG Target 5 aiming to reduce by three-quarters the maternal mortality ratio; target 5 and also aiming to achieve universal access to reproductive health.
3.      Combating key diseases, with MDG Target 6. aiming to have halted and begun to reverse the spread of HIV and AIDS; target 6.B aiming to achieve universal access to treatment for HIV and AIDS for all those who need it; and target 6.C aiming to have begun to reverse the incidence of malaria and tuberculosis.
Health spending has two clear sets of targets. In 2001, at a Special Summit on HIV/ AIDS, Tuberculosis and Other Infectious Diseases held in Abuja, Nigeria, African Union Heads of State committed themselves to allocating a minimum of 15 per cent of government expenditure to health. At the global level, the World Health Organization (WHO) Commission on Macroeconomics and Health estimated that the cost of essential interventions to avoid preventable deaths was $30-40 per capita in 2004, on the basis of spending levels in low-income countries with good health outcomes.
Of the 32 African countries covered by GSW, only Malawi has succeeded (in 2011) in allocating more than 15 per cent of its spending to health. Ten countries (Burundi, Central African Republic, Comoros, Djibouti, DRC, Lesotho, Liberia, Rwanda, Tanzania, and Zambia) spend more than 10 per cent, and six (Burkina Faso, Ghana, Mali, Mozambique, Sierra Leone and Uganda) are close to 10 per cent. However, three (Côte d’Ivoire, Nigeria and Senegal) only spend around 5 per cent – well below the Abuja target.
In relation to the WHO target, only 6 of 32 African countries (Angola, Cape Verde, Congo, Djibouti, the DRC, and Lesotho) exceed it ; Ghana and Zambia are within the spending range ($30-40 per capita); and the other 22 countries all spend $20 or less per capita on health. Eight countries (Central African Republic, Ethiopia, Guinea-Bissau, Madagascar, Niger, Sierra Leone, The Gambia, and Uganda) spend less than $10 per capita on health via the government’s budget.
With these challenges  of not meeting the health MDGs spending in many African countries, it is important that we continue to spread the message to our leaders and empower civil society organisations to coherently voic out these issues and engage various governments in expenditure tracking and advocacy on health spending.
All comments to Dr Aminu Magashi at [email protected]