Role of Abuja Commitments in Responding to the UHC Challenge

During the last decade, some African countries experienced unprecedented economic growth. Our objective was to look ahead at the region’s health financing by projecting domestic health spending per capita to 2020.

We established a baseline level of domestic health spending for 43 sub-Saharan African (SSA) countries using data from National Health Accounts and the World Health Organization Global Health Observatory. Our policy-relevant question evaluated domestic health spending trajectories under economic growth and until the Abuja commitments are met. The cost of an essential package of health services was used as a financing target to achieve universal health coverage (UHC).

Total health expenditure (THE) in SSA equaled $9.7 billion in 2000, increased to $68.7 billion in 2010 and is projected to grow to $123 billion by 2020.  Assuming health expenditure continues to increase with economic growth and that governments meet the Abuja commitment, 31 out of 43 countries would reach the target by 2020. Government expenditures as a share of THE would increase from 37% in 2010 to 51% by 2020. Twelve countries would not reach the spending target; notoriously, Democratic Republic of the Congo, Ethiopia, Madagascar, Malawi, and Niger.

The analysis suggests that in less than a decade, more than half of SSA countries (72%) would be able to pay for essential low-cost and high-impact priority health services by fulfilling their political commitments. Complementary governance actions including efficient allocation to essential health services and underserved populations should be considered towards achieving UHC.