Health investment from African Finance Ministers

African Ministers of Finance, Planning and Economic Development have recently reaffirmed the continent’s desire to boost health spending to 15% of national budgets as envisioned by the 2010 Head of State Declaration on Maternal, Infant and Child Health and Development.

Making the agreement at a recent joint conference of African Union ministers of finance, planning and economic affairs, and the U.N. Economic Commission for Africa, held in Addis Ababa,Ethiopia, the ministers noted that the importance of investing in human development broadly and health more specifically was a prerequisite for sustainable and equitable development.

In line with the 2000 Abuja commitment, only 6 countries out of 52 in a continent with 11% of the world’s population, have achieved the 15% target.

According to the 2010 health financing scorecard created by the Africa Public Health Alliance and 15%+ Campaign, only six countries, Rwanda, 18.8%, Botswana, 17.8%, Niger, 17.8%, Malawi, 17.1%, Zambia, 16.4% and Burkina Faso, 15.8% are spending at least 15% of their national budgets on health .

Additionally, 32 out of 53 AU member states invest less than half of WHO recommended $40 per person. 11 of these countries are invest a mere $5 or less per capita.

Sub-Saharan Africa accounts for 53% of maternal deaths, 50% of under-five child deaths and 67% of HIV/Aids cases.

Experts attribute the current weak health systems to insufficient and inefficient health spending among most African countries.

They lament that only 32 out of the 53 African countries invest less than the WHO-recommended US$40 per person on health.

Poor social and physical infrastructure, political crises, lack of partner alignment in their health and development assistance efforts and poor regional production capacity also contribute to suboptimal health of populations.

At a special parallel session for health and finance ministers, African Union Commissioner for Social Affairs, Bience Gawanas said “Africa’s wealth is its people… Human development is a crucial component of economic growth and development, and we must invest in the health of our populations”.

UNAIDS, Executive Secretary, Michel Sidibe said “95% of Africans receiving treatment for HIV/AIDS on the continent are receiving those treatments because of donor support. It is important for Africa to increase its investments in health to ensure that we able to care for our own, especially now in light of the financial crises and other constraints faced by donor countries.”

Essimi Menye Lazare, the Minister of Finance of Cameroon, said “while we recognize the importance of investing in health, we must ensure that health spending is efficient. To this end institutions have a role to play in promoting regional capacity to produce drugs and commodities and/or reducing the price of commodities to countries by facilitating economies of scale and increasing bargaining power.”

Rotimi Sankore, the coordinator of the Africa Public Health Alliance and 15+ Campaign, notes that “currently health financing trends on the continent are worrisome.

He says: “Even in many countries where per capita investment is higher, performance is poor because of inadequate investment in key social determinants such as clean water and in some countries where percentage based on spending is high, actual per capita investment is low.”

While it is crucial for health investment to increase, officials say it is important to ensure that this increase is efficient and anchored on evidence based health planning accompanied by equally important investments in the social determinants of health. “Without clean water and sanitation among others, efforts to improve health are compromised,” says Sankore.

Africa’s current economic growth can be improved if concerted efforts are made to improve the continent’s health care systems, a new study reveals.

Recent findings on the impact of health – as measured by life expectancy – on economic growth, suggest that one extra year of life raises GDP by 4%.

The 2010 World Health report notes that globally between 20 and 40% of health system spending is wasted with poorer countries wasting an even higher proportion.

While the WHO recommends a minimum of 2.3 doctors per 1000 people to achieve 80% skilled attendance at delivery, Sub-Saharan Africa is grossly understaffed at 1.15 health workers per 1000.

This shortage of health workers is compounded by issues of quality, motivation and distribution. There are 61 countries with a critical shortage of healthcare workers – 41 of them in Africa. Niger only has one health worker for every 6,000 people, Sierra Leone has one for every 5,000. By comparison, in the UK there is one health worker for every 119 people

The United Nations Secretary General’s Global Strategy for Women’s and Children’s Health notes that an additional 2.5 to 3.5 million health workers will be needed to achieve millennium development goals 4 and 5 in the 49 low income countries (33 of which are in Africa).

A recently published Save the Children report entitled Missing Midwives notes that a global shortage of 350 000 midwives contributes to poor health outcomes for many women and children. A report entitled The State of the World’s Midwifery – developed by 21 partners – will be launched in June 2011 at the International Confederation of Midwives Triennial Congress and will provide an overview of the state of midwifery in countries.

Some countries in the region have focused on health workforce, as a means of improving their health outcomes.

In Ethiopia where 85% of the population lives in rural areas and has traditionally been underserved, the Ministry implemented a Health Extension Programme aiming to train 30,000 new Health Extension Workers (HEWs) to work at local health posts and to provide a package of essential interventions to meet needs at this level.

While 18 African countries that committed to the Global Strategy in September 2010 accounted over US$8.5 billion, 11 of these countries made specific commitments related to increasing and improving their health workforce, for instance Rwanda committed to train five times more midwives (increasing the current ratio from 1/100,000 to 1/20,000).

Source – ASNS News