ABSTRACT Health is a valuable commodity that must be paid for and good finance systems are evident wherever good health systems are existent. The sustainable development initiative of the United Nations established in 2015 comprises goals common to all nations whether they have well-developed or less-developed health systems. Poorly developed health systems characterise health care
ABSTRACT
Health is a valuable commodity that must be paid for and good finance systems are evident wherever good health systems are existent. The sustainable development initiative of the United Nations established in 2015 comprises goals common to all nations whether they have well-developed or less-developed health systems. Poorly developed health systems characterise health care found in many countries in Africa and financing is crucial in making commendable landmarks. In this article, literature would be reviewed for evidence-based information regarding effective financing for optimal health care systems in Africa akin to achievement of the Sustainable Development Goals (SDGs).
Keywords: SDG, health, Finance, health care systems, Africa
BACKGROUND
The 2030 SDG agenda was adopted as a build-up on the achievements of the Millennium Development Goals (MDGs) and also an expansion to cover areas like climate change, economic inequality, innovation, sustainable consumption, peace and justice amongst other areas of priority1. Member states have had to turn to take practical steps to achieving these 17 goal-agenda launched on the 25th September, 2015 with 169 indicators1,2.
Most parts of Africa especially sub-Saharan Africa had to grapple with attaining most of the MDGs especially the health related; goals four to six3. Now that everyone has moved on to aim at achieving the SDG, it is important that we examine the odds against us point out ways to achieving these goals.
The third SDG, termed ‘good health and wellbeing’, now encompasses the health related MDG 4-6 and Africa cannot afford to fail again. Ensuring good health and well-being is important for her people as it influences her success in other aspects of the SDGs. It is hinged on three pillars- access, quality and cost containment4,5. These three are fundamental and greatly rely on one another. Affordability would continue to ensure access and good funding is important to ensure continued quality of care and much more access. Therefore, financing healthcare is at the root of ensuring access and quality services and the earlier we built a firm framework for this, the better.
Health in Africa is predominantly financed by domestic resources, with about 24% of the total health expenditure (THE) being external aid6. Since the adoption of the MDG in 2001, there has being an improvement in the total input of the African government to health, however, more grounds need to be covered6. For example, the estimated price tag for achieving the target of ending AIDS by 2030 is $36 billion a year, almost twice the current funding level of $19 billion. Similarly, global investments in malaria will need to triple by 2030 to reach the SDG elimination target7. There must be a paradigm shift to further minimise dependence on donors and create an active and robust system of financial mining in order to have consistency and autonomy in funding health in Africa.
PROBLEM STATEMENT
For every US$100 that goes into state coffers in Africa, on average US$16 is allocated to health, only US$10 is in effect spent, and less than US$4 goes to the right health services6.
There is deprioritization of health despite increasing revenues. African Heads of state at the Abuja declaration back in 2001 pledged to allocate 15 per cent of their governments’ budget to the health sector. However, attainment of this target has been varied, ranging from two countries reaching it in 2004 to nine in 2009, and then fewer in later years8. There has also been lesser commitment to health budgetary allocation despite an average 18% increase in GDP across African countries in the last decade6.
Out-of-pocket (OOP) payments for health have remained high in the African region. In 2013, only 10 of 47 countries had an OOP expenditure of less than 20 per cent of THE, while 19 had OOP payments of more than 40 per cent of THE, therefore exposing households to impoverishment8.
There is funding inconsistency which undermines capacity for effective planning and implementation irrespective of whether the source is from the government or donors. Budgetary allocation across the continent is underspent. Even when the government gives more to health, the execution is poor. There is as much as US$10-100 million as unrealized expenditure. This suggests weak links between health and public financial management6.
There is also misallocation of resources. Primary care receives less than 40% of public health funding in most African countries. Access to this first-contact, essential care is mainly funded through OOP expenditure. Evidence also shows that poor people tend to be affected more; through catastrophic expenditure, they feel the burden six (6) times more than the rich6.
Health coverage in Africa has indeed improved massively over the past decade but utilization by the poor remains constrained by financial barriers.
STRATEGIES FOR FINANCING HEALTH SDG
CONCLUSION
To achieve the ambitious health SDG, there has to be commitment to development of other critical sectors. It may not be primarily a financing challenge, governments need to set the right policy frameworks to mobilise private investments, domestic as well as international public resources for long-term investments in sustainable development. Regarding finance, if the world truly wants to live up to its promise that no country or person be left behind, all countries must work together and support each other. Although a push can be made to achieve the health SDG with less dependence on donors, it could be a steep hill climb for poor countries. For Africa to achieve the health SDG, in addition to good fiscal initiatives and domestic resource mobilisation, multi-sectoral development, support from the private sector, NGOs and other countries is needful.
REFERENCES
AUTHORS: Uyiose Iyoke and Joy Oluwaniyi (College of Medicine, University of Ibadan, Nigeria)
CONTACT: uyio92@gmail.com, joyoluwaniyi14@gmail.com
Published by the IMJC team — telling the medical stories that mainstream media miss, without bias, prejudice or favour.
