A Report for African Union Member States
Chris Alando
Dr. Femi Owoeye
Amb. Michael Oyugi
- Introduction
This report evaluates the annual increases in domestic health expenditure (DHE) comprising both government and private sector contributions—required for African Union (AU) Member States to achieve 5% of GDP in total health expenditure (THE) by 2030. External financing (e.g., donor funding) is assumed to remain constant over this period.
The analysis includes countries across five key sub-regions:
- Southern African Development Community (SADC)
- Economic Community of West African States (ECOWAS)
- East African Community (EAC)
- North Africa
- Maghreb countries
2. Methodology
- Data Collection:
- Current Total Health Expenditure (THE) as a percentage of GDP was sourced from the World Health Organization (WHO) and World Bank.
- Domestic Share of THE (government and private sector contributions) was used to calculate current domestic health expenditure (DHE) as a percentage of GDP.
- Estimation of Domestic Health Expenditure (DHE): DHE as a percentage of GDP was calculated using:
 |
Required Annual Growth Rate (CAGR): The compound annual growth rate required to achieve 5% GDP by 2030 was calculated as:
3. Results
Below are the results for all regions.
| SADC Member States | ||||
| Country | THE (% GDP) | Domestic Share of THE (%) | Current DHE (% GDP) Required Annual Growth Rate (%) | Required Annual Growth Rate |
| Angola | 3.50% | 71% | 2.50% | 7.60% |
| Botswana | 4.20% | 90% | 3.80% | 5.00% |
| Comoros | 3.10% | 70% | 2.20% | 8.20% |
| DR Congo | 2.80% | 64% | 1.80% | 8.90% |
| Eswatini | 3.80% | 79% | 3.00% | 6.20% |
| Lesotho | 3.50% | 77% | 2.70% | 6.70% |
| Madagascar | 3.20% | 71% | 2.30% | 7.80% |
| Malawi | 4.10% | 75% | 3.10% | 6.00% |
| Mauritius | 4.80% | 87% | 4.20% | 4.30% |
| Mozambique | 3.40% | 76% | 2.60% | 7.00% |
| Namibia | 4.50% | 85% | 3.80% | 5.50% |
| Seychelles | 4.70% | 85% | 4.00% | 4.60% |
| South Africa | 5.80% | 92% | 5.35% | 0% |
| Tanzania | 3.60% | 80% | 2.90% | 6.50% |
| Zambia | 3.50% | 78% | 2.80% | 6.70% |
| Zimbabwe | 4.10% | 78% | 3.20% | 5.80% |
| ECOWAS Member States | ||||
| Country | THE (% of GDP) | Domestic Share of THE (%) | Current DHE (% of GDP) | Required Annual Growth Rate (%) |
| Benin | 4.30% | 75% | 3.20% | 5.80% |
| Burkina Faso | 5.00% | 69% | 3.50% | 5.50% |
| Cape Verde | 5.40% | 85% | 4.60% | 2.20% |
| Côte d’Ivoire | 4.60% | 74% | 3.40% | 5.30% |
| Gambia | 5.00% | 74% | 3.70% | 4.90% |
| Ghana | 4.30% | 78% | 3.40% | 5.30% |
| Guinea | 3.80% | 67% | 2.50% | 7.60% |
| Guinea-Bissau | 3.50% | 69% | 2.40% | 7.70% |
| Liberia | 2.90% | 61% | 1.80% | 9.10% |
| Mali | 4.20% | 73% | 3.10% | 6.00% |
| Niger | 3.10% | 65% | 2.00% | 8.30% |
| Nigeria | 3.60% | 73% | 2.60% | 6.90% |
| Senegal | 4.80% | 78% | 3.70% | 4.90% |
| Sierra Leone | 3.50% | 68% | 2.40% | 7.70% |
| Togo | 3.30% | 70% | 2.30% | 7.80% |
| EAC Member States | ||||
| Country | THE (% of GDP) | Domestic Share of THE (%) | Current DHE (% of GDP) | Required Annual Growth Rate (%) |
| Burundi | 4.50% | 64% | 2.90% | 6.50% |
| Kenya | 4.50% | 76% | 3.40% | 5.30% |
| Rwanda | 4.00% | 68% | 2.70% | 6.70% |
| South Sudan | 2.80% | 63% | 1.80% | 8.90% |
| Tanzania | 3.60% | 80% | 2.90% | 6.50% |
| Uganda | 3.70% | 74% | 2.70% | 6.70% |
| North African and Maghreb Countries | ||||
| Country | THE (% of GDP) | Domestic Share of THE (%) | Current DHE (% of GDP) | Required Annual Growth Rate (%) |
| Algeria | 6.20% | 89% | 5.50% | 1% |
| Egypt | 4.80% | 86% | 4.10% | 4.40% |
| Libya | 6.30% | 88% | 5.50% | 1% |
| Morocco | 4.90% | 84% | 4.10% | 4.40% |
| Sudan | 3.20% | 65% | 2.10% | 8.30% |
| Tunisia | 5.10% | 85% | 4.30% | 3.80% |
The following are graphs summarizing the average Total Health Expenditure (THE), Domestic Share of THE and Required Average Growth Rate for SADC, ECOWAS, EAC, North Africa, and Maghreb regions.
 |
4. Discussion
- Regions Facing Challenges: SADC, ECOWAS, and EAC regions face significant gaps in DHE. Countries like Liberia, DR Congo, and South Sudan require growth rates above 8% annually.
- Closer-to-Target Countries: Countries such as Algeria, Libya, and Cape Verde are already near or at the 5% target.
- Role and trends in External Financing: For countries where external financing constitutes a large portion of THE, sustainable domestic investment is critical to achieving the target.
- External financing is at best projected to stagnate over time, that is, not expected to increase or decrease by more than 25%. This calls for increased health financing from domestic private, public and pooled prepayment mechanisms such as well-designed public health insurance.\
5. Recommendations
- Increase Domestic Investment: Prioritize health allocations in government budgets while promoting private sector partnerships. Countries in the Maghreb and North Africa should increase domestic health budgets by 4% annually while those in East Africa, SADC and ECOWAS should strive to increase domestic health budgets by at least between 8% and 10% annually.
- Improve Efficiency: Focus on minimizing wastage and maximizing the use of existing resources.Advocate for Sustained External Support: Maintain or enhance donor contributions to ease the pressure on domestic budgets.
- Progressive Sustainable Budget Increases: Direct your Ministries of Health and Finance to commit to a progressive but manageable annual increase of at least 10% in domestic health investments. This commitment should aim to reach a 5% GDP allocation to health by 2030, ensuring adequate and sustainable funding for UHC.
- Accelerate the Adoption of the Africa Leadership Meeting (ALM) on Investing in Health: For countries that have not yet implemented the ALM, relevant ministries should launch National Health Financing Dialogues, which are crucial in developing and implementing feasible health financing strategies.
- Public Health Insurance: AU Member States should prioritize strategic investments in public health insurance schemes. This approach offers a sustainable path to reduce reliance on regressive out-of-pocket payments, promote equity, and ensure the long-term sustainability of UHC.
- Resource Mobilization: Direct responsible ministries to strengthen support for regional health financing hubs which help strengthen national health financing systems.
- Private Investment for Health in Africa (PIFAH): Actively attract support for the PIFAH initiative, in collaboration with the Africa Continental Free Trade Area (AfCFTA). This can mobilize significant financing for health infrastructure and equipment, freeing domestic funds towards primary health, prevention, and pandemic preparedness.
- Long Term Sustainability and Transition Planning: Responsible ministries to integrate sustainability and transition planning into the next five MTEF periods, to align health financing strategies with national development plans and fiscal frameworks.
- Maximize Efficiency in Public Health Spending: Support and direct national supreme audit institutions and public financial management bodies to enhance efficiency, oversight, and accountability in health spending.
- Sustaining High-Level Political Engagement: Direct the Ministries of Finance, Economic Planning, Health, and Foreign Affairs to sustain high level political and diplomatic engagement and provide you with regular reports on the status of ALM implementation in your respective countries.