(Washington, DC) African governments are falling far short of their commitments to prioritize public spending on health care, contributing to widespread inequalities in health care access and outcomes, said Human Rights Watch and the Initiative for Social and Economic Rights (ISER) Kampala. today. As the 23rd anniversary of the African Union, the historic engagement of states, approaches, new data reveal alarming stagnation, rising regional inequalities and the need for course correction.
On April 27, 2001, African Union (AU) governments adopted the Abuja Declaration, in which they set the goal of allocating at least 15 percent of their national budgets to improving care healthcare But the recent analysis of two decades of data found that only two of the AU’s 55 member countries, Cape Verde and South Africa, met that target by 2021, the most recent year for which data is available.
It is disappointing that African countries have not met the health spending targets that were set, said Allana Kembabazi, director of the ISER programme. The impact of this is felt in lives lost as a result of poor quality and underfunded public health systems. Covid-19 has underlined that it is more important than ever for governments to fund health care.
Despite a global increase in public health spending amid the pandemic in 2021, African governments on average spent just 7.4 percent of their national budgets on health care, less than half of what they had promised 20 years earlier . Overall, about 95 percent of people in Africa lived in a country that did not meet that spending target that year.
Despite a clear commitment to prioritize national public health spending in 2001, African governments’ allocations to health care grew minimally over the following two decades, at about one-third of the global average. By 2021, Africa’s regional average had become the lowest in the world.
When adjusted for inflation, seven AU countries spent less per person on public health care in 2021 than in 2000, the year before the Abuja Declaration. Madagascar effectively reduced its spending per person by 62% during this period, followed by Benin (-62%), Eritrea (-55%), Central African Republic (-44%), Chad (-37%), Sudan ( -36%). percent) and Cameroon (-8 percent).
Under international human rights law, including the African Charter on Human and Peoples’ Rights, states have a duty to use the maximum of their available resources for the realization of economic, social and cultural rights, such as the right to health
Decreases in health care funding should be examined as potentially deliberate retrogressive measures, which would violate countries’ obligations on the right to health, unless fully justified. Human rights bodies, including the African Commission on Human and Peoples’ Rights in its General Comment no. 7 of 2021, have made it clear that the threshold to justify deliberate retrogressive measures is quite high; for example, the existence of an armed conflict is not sufficient by itself. to justify the regression.
African governments must commit to enacting policies, including through their budgets, that meet this commitment, human rights groups said. African governments should also seek to increase public revenues, including through policy measures to reduce tax abuses and illicit financial flows, as well as by considering progressive taxes.
For some countries, low levels of public health spending may also reflect a confluence of external factors, such as climate-related weather events and environmental changes, the cost of servicing external public debt, and established public spending limits by the loan programs of the International Monetary Fund.
To address these externalities, international and other financial institutions and higher-income governments, particularly those that have contributed most to climate change, should fulfill their human rights obligations to provide international assistance and cooperation ensuring that African governments have adequate fiscal space and political autonomy to meet spending benchmarks. vital to the realization of the right to the highest possible level of health.
African governments led by example with the Abuja Declaration, said Matt McConnell, economic justice and rights researcher at Human Rights Watch. They must do so again by meeting these commitments to finance more resilient, more sustainable and more rights-respecting health systems for all.
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