Africa defies low spending on health to increase life expectancy
Thursday August 18 2022
A recent WHO report found that the number of years an individual is in a good state of health increased to 56 years in 2019, from 46 in 2000
Healthy life expectancy in Africa increased by 10 years between 2000 and 2019, a new World Health Organisation assessment report states. The rise was despite a drop in state spending on health.
“The number of people incurring financial hardship remains unacceptably high, as most countries continue to report high out-of-pocket spending for health,” said WHO. “Government spending on health as a proportion of total health expenditure is relatively low in African countries.”
The increase was greater than in any other region of the world in the same period. The report, Tracking Universal Health Coverage in the WHO African Region-2022, also notes that the disruptive impact of the Covid-19 pandemic could threaten the gains.
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It states that healthy life expectancy — the number of years an individual is in a good state of health — increased to 56.1 years in 2019, from 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 the heart of this leap has been the attainment of universal health coverage (UHC), particularly in service coverage. The service coverage index increased from 24 to 46 over the same period, contributing to a gain of nine years of life expectancy.
Besides the service coverage index (SCI) used to monitor progress the financial risk protection (FRP) is also measured.
Over the past two decades, seven countries mostly in southern and northern Africa subregions had an SCI of 60 and above, with Kenya being the only East African country in the group.
Some 29 countries had an SCI of between 40 and 59, and 12 others, including Ethiopia and South Sudan, were between 20 and 39. None of the countries had a value below 20.
The most significant progress between 2000 and 2019 was observed in East Africa at 24 index points, followed by West and Central Africa at 23 index points.
WHO said despite increases in overall service coverage at the national level, it had found inequities persisted at the subnational level, with disparities in coverage among vulnerable populations across various socioeconomic groups in the region, as well as gross national income per capita.
Overall, people in the poorest income quintile were most likely to experience barriers. The urban-rural divide, education and sex were also shown to be critical factors.
“In populations where seeking health care is impoverishing or near impoverishing, the opportunity cost is often too high, and this leads to the disparities observed in health care outcomes of the rich and the poor,” said the WHO report.
“In the African region, where the $1.90 poverty headcount ratio a day is 40.4 percent of the population, definitions of catastrophic expenditure at 10 percent of household consumption may leave out large pockets of the population for whom out-of-pocket (OOP) health spending represent spending on regrettable necessities,” the report added.
Financial risk protection is achieved when OOP health spending is not catastrophic, that is household expenditure on health greater than 10 percent of total household expenditure or income.
Also, as infectious diseases saw the most improvement between 2000 and 2019 — from six to 48 — with a pronounced acceleration in 2005 due to the rapid scale-up of HIV, tuberculosis and malaria services, the noncommunicable disease component of the SCI was the slowest to progress, pointing to a gap WHO fears will limit overall progress.
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The FRP however has largely stagnated over the past 20 years, placing financial hardship on those seeking healthcare services.
The proportion of the population spending more than 10 percent of their income on health was reducing by 0.1 percent annually in 25 countries. Out-of-pocket expenditure increased by more than 90 percent in at least three countries.
Only seven countries have their governments financing more than half of their health budgets.
When African Union member states met in Abuja, Nigeria, in April 2001, they committed to allocating 15 per cent of their government budgets to health.
“As far as domestic government health expenditure as a percentage of the current health expenditure in the countries in the WHO African Region in 2019, most governments are funding less than 50 percent of the health budget. Only the governments of Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa fund more than 50 percent of the total health expenditure,” said the report.
“Good performance is not income-driven — with examples of upper-, middle- and low-income countries among the 15 good performers. Rwanda, Malawi, and Mozambique are low-income countries having relatively high SCI and good FRP as compared to their peers, and so are doing well vis-à-vis UHC. We also note some middle-income countries with very low financial risk protection and service coverage, such as Angola, Cameroon, Comoros, Côte d’Ivoire Mauritania and Nigeria.”
“Over the past 20 years, out-of-pocket expenditure across most countries has increased. Some countries like Algeria, Equatorial Guinea, Guinea-Bissau, and Seychelles, have seen an increase in OOP per capita, greater than 90 percent, suggesting that efforts to improve financial risk protection in those countries have not seen much progress,” said WHO.
In 66 per cent of the countries where households are spending more than 10 per cent of their household income on health out-of-pocket, the proportion spent is more than 25 percent of the household budgets. Uganda, Tanzania, Ethiopia and South Sudan fall under this category.
“The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” noted WHO.
WHO also wants governments to focus on post-Covid-19 recovery and resilience by investing in common goods that are fundamental in attaining UHC and health security simultaneously.