Many governments in Africa have not yet recognised the importance of health in the overall national development; consequently, they have not allocated commensurate resources to the health sector. The levels of health budgets in many of these countries do not demonstrate that health is rated as a high priority among other national needs. Despite the fact that in 2001 African countries pledged at Abuja, to increase health sector budgetary allocation to 15% of government expenditure, and although they repeated this pledge in Kampala in July 2010, in most of these countries national budgetary allocations for health remain far below this target. For example, for the fiscal year 2010-11 Kenya allocated just about 5.5 percent of the total Government expenditure to the ministries of Medical Services and Public Health and Sanitation. As a result, out-of-pocket health expenditures in sub-Saharan African countries are generally high ranging from 6% in Namibia to 62% in Chad, and nearly 45% in Kenya. The implication of this is that ill health contributes significantly to, and perpetuates, poverty because health related costs result in the depletion of people’s meagre resources. Irrespective of where sick people seek treatment, be it in public or private health facilities, or private pharmacies and dukas, or even the herbalist, this is to a large extent dependent on their access to cash or household assets that can be sold in order to pay for the out-of-pocket health expenses.
Expenditure on health is not adequately perceived as a critical economic investment in the same way as is spending on education, agriculture or industries. In Africa, the biggest chunk of government expenditure is believed to go to security related expenses (military and civil defence), even in those countries that have not fought a serious war since independence. Despite the lack of absolute and valid correlation (whether positive or negative), between levels of defence spending and socio-economic indices, savings in defence expenditure can be one way of boosting the very low health budgets existing in sub-Saharan Africa. Even though generally, military spending is not recorded in the Public Expenditure Reviews, it has been estimated that in 2011 Kenya spent 2.8% of the GDP on military expenditure alone. Yet it should be common perception that health is a critical resource for development, without which investment in all the other sectors would go to waste. Poor health impacts negatively on economic productivity, through loss of labour, and under-performance due to illness.
Since the advent of the HIV epidemic there has been greater appreciation of the role of health on development. In the highly affected regions of the world the epidemic has negatively impacted on agricultural and industrial output, thereby perpetuating the cycle of poverty. Other diseases that have significantly influenced productivity are malaria and tuberculosis, as well as the so called neglected tropical diseases (NTDs), which even though they kill fewer people compared with HIV and AIDS, TB and malaria, they nevertheless are responsible for the crippling health and socioeconomic burden on the world’s poorest people in Africa, Asia, and the Americas.
The implications from the above are that African governments must recognise the pivotal role that the health sector should play in national social and economic development, and to urgently ensure commensurate allocations of resources. In addition, governments should recognise the critical barriers that poor health poses to any measures intended to uplift the social-economic status of poor and disadvantaged communities.
Africa Health Dialogue 