Africa recorded the world’s highest gain in healthy life expectancy over the past decade. But the lack of sustainable finance for health systems is a major threat to the gains recorded.

Africa recorded the world’s highest growth in healthy life expectancy—or the number of years an individual is in a good state of health—between 2000 and 2019. Healthy life expectancy increased on average 10 years per person, the World Health Organization (WHO) assessment reported.

The Tracking Universal Health Coverage in the WHO African Region 2022 report shows that healthy life expectancy—or the number of years an individual is in a good state of health—increased to 56 years in 2019, compared to 46 in 2000. While still well below the global average of 64, over the same period global healthy life expectancy increased by only five years.  

At a press briefing launching the report Thursday, WHO officials and other invited experts attributed the gains to increased universal health coverage (UHC) on the continent. But sustainable financing remains a major challenge for the 47 sub-Saharan countries that belong to WHO’s Africa Region – with all but seven of the 47 WHO African region countries depending on outside donors for more than 50% of the costs of health services delivery.  

At the same time, increased provision of essential health services, including for reproductive, maternal, newborn and child health were among the factors to which the gains of the past decade could be attributed. Other contributors are progress in the fight against infectious diseases notably rapid scale-up of HIV, tuberculosis, and malaria control measures from 2005. 

“The sharp rise in healthy life expectancy during the past two decades is a testament to the region’s drive for improved health and well-being of the population,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

“It means that more people are living healthier, longer lives, with fewer threats of infectious diseases and with better access to care and disease prevention services,” she said. “But the progress must not stall. Unless countries enhance measures against the threat of cancer and other noncommunicable diseases, the health gains could be jeopardized.”  

Most governments in Africa fund less than 50% of their national health budgets 

Progress in healthy life expectancy could also be undermined by the impact of the COVID-19 pandemic unless robust catch-up measures are instituted, WHO and other experts at the briefing warned. Insofar as the report’s data ends at 2019 – the COVID years were not captured by the data presented. 

On average, for instance, African countries reported greater disruptions across essential services compared with other regions, according to a 2021 WHO survey.  

Efforts have been made to restore essential services affected by the pandemic. However, to ensure long-term sustainability, it is crucial for governments to step up self-financing of services – weaning their countries away from heavy reliance on international donors.  

Most governments in Africa fund less than 50% of their national health budgets, the report notes.. Only Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa fund more than 50% of their national health budgets. 

“COVID-19 has shown how investing in health is critical to a country’s security. The better Africa can cope with pandemics and other health threats, the more our people and economies thrive. I urge governments to invest in health and be ready to tackle head on the next pathogen to come bearing down on us,” said Dr Moeti.      

According to the report, UHC coverage across the region increased by an average of 22 points on a scale of 0 to 100, rising to 46 in 2019 up from from 24 in 2000, along the lines of a Service Coverage Index (SCI). The scale measures some 14 UHC indicators including those for reproduction, material and child health, infectious diseases, and non-communicable diseases.  Even so, only four countries had a UHC index between 56 and 75, with the highest values in southern and northern African subregions respectively. 

“This progress, though significant, falls short of meeting the SDG 3.8.1 global target of a minimum of 80% coverage of essential health services by 2030,” the report notes.

Botswana provides good practice 

Botswana is one of the African countries making appreciable progress in public funding for healthcare, the report says, with almost 80% of its health spending in 2019 going towards the government’s domestic programs.

Speaking at the briefing, Moses Keetile, of Botswana’s Ministry of Health and Wellness Botswana, told Health Policy Watch the country’s ability to sustain its gains on UHC  largely hinges on ensuring that health ranks high on the priority list of politicians.

“Allocation of national resources is very important,” he said. “To what extent is health given a priority? What is it that we are spending our resources on? Is it on health, physical education, or is it in the military. So it’s very important that we speak to our politicians for that political will and ownership.” 

He also described reliance on external funds as unsustainable for Botswana and other African countries. Countries have to implement innovative ways of creating revenue and funding for health care delivery, he said, stressing that the private sector is also an important partner in advancing UHC. 

“The Botswana UHC experience is still predominantly government but that is not the most ideal situation. It is important to have all the necessary sectors, including the private sector, to be part of it,” he concluded.

The exception, rather than the norm

Botswana remains the exception, rather than the norm, however, the report says.  

Government coverage of catastrophic and out-of-pocket expenditures through health insurance or free health care systems is one of the measures key to improving health coverage. Health expenditure is considered “not catastrophic” when families spend less than 10% of their annual income on it, irrespective of their poverty level. 

Yet over the past 20 years out-of-pocket spending stagnated or increased in 15 countries out of the African Region’s 46 countries, the report finds. And out- of-pocket expenditure increased by more than 90% in at least three countries.

Conversely, a total of 15 countries are faring above the regional average, in terms of combined service coverage and financial risk protection. 

Good performance among that latter group of countries is not entirely income driven, the report says. Rwanda, Malawi and Mozambique are low-income countries among the 15 good performers on that scale of measurement.  Angola, Nigeria, Mauritania, Côte d’Ivoire, Cameroon and Comoros are middle-income countries with low performance in both service coverage and financial risk protection.

Lack of investment in health threatens economic and national security

Professor Muhammad Ali Pate,of the Harvard T. H. Chan School of Public Health agreed with Keetile. He noted that public and private investments in health in Africa can also be pitched to policymakers as contributing to economic growth.

“There is scope to harness private capital to invest in laboratories in hospitals. But with a public mission protected, every citizen should be guaranteed basic access to quality health care. The public health function should be publicly financed, and tax financing is a key part of that,” he told Health Policy Watch. 

According to Pate, enhancing the private sector’s role should not, however, absolve African governments from domestically investing in health services, including through robust tax collection.  

“What we have seen with the pandemic is a lack of investment in health that threatens economic and national security,” he said. “Finance ministers and economic planning ministers have a vested interest to ensure the public health outbreaks are contained, and that equipment and the test kits are available and produced locally so they also contribute to economic growth.”

Dr Lindiwe Makubalo, assistant director of WHO’s Regional Office for Africa, also highlighted the importance of multi-party partnerships. She noted that the new report provides guidance towards properly building health systems and ensuring health security in Africa.

“We elaborate the different components of what needs to be done. At the end of the day, I think it’s the value of understanding the value of health and health security, and appreciating all of the wider sector approach that is really what is going to be important,” she told Health Policy Watch.

Image Credits: World , WHO Afro.