article · PLOS Global Public Health
Sub-Saharan Africa faces substantial health challenges alongside persistently low health financing. In 2021, health expenditure in the region stood at 92 dollars per person, roughly one fifth of that spent by the next lowest regional average. Although gross domestic product across sub-Saharan Africa is projected to increase through 2050, the proportion of economic output allocated to health is expected to rise only moderately. This slow growth is driven by persistently low domestic prioritisation, as regional governments dedicate approximately 7.2 percent of their budgets to health compared to an average of 12.4 percent in other parts of the world. Additionally, external development assistance is unlikely to match economic expansion and is projected to drop in several nations, meaning domestic public resources may be insufficient to bridge future healthcare funding deficits.
Regional life expectancy in sub-Saharan Africa lags behind the global average by eight years, while healthcare investment remains exceptionally constrained. If domestic governments do not increase budgetary prioritisation and reform health system governance, anticipated declines in foreign donor support could widen health inequities, leaving expanding populations without adequate healthcare coverage as regional economies grow.
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In 2021, global life expectancy at birth was 74 years whereas in sub-Saharan Africa it was 66 years. Yet in that same year, $92 per person was spent on health in sub- Saharan Africa, which is roughly one fifth of what the next lowest geographic region-North Africa and Middle East-spent ($379). The challenges to healthy lives in sub-Saharan Africa are many while health spending remains low. This study uses gross domestic product, government, and health spending data to give a more complete picture of the patterns of future health spending in sub-Saharan Africa. We analyzed trends in growth in gross domestic product, government health spending, development assistance for health and the prioritization of health in national spending to compare countries within sub-Saharan Africa and globally.We found that while gross domestic product was projected to increase through 2050 in sub-Saharan Africa, the share of gross domestic product that goes to health spending is only expected to increase moderately. Our exploration shows that this tepid growth is expected because the percent of overall government spending that is dedicated to health 7·2% (6·3-8·3) compared to average of 12·4% (11·7-13·2) in other regions) is expected to stay low. Even if the amount, of resources provided from donors climbs some, it is not expected to keep pace with growing economies in sub-Saharan Africa and may transition towards other global public health goods. Critically, development assistance for health provided to sub-Saharan Africa is expected to decrease in some countries, and the expected growth in government health spending might not be enough to cover this expected decline. Increases in spending with a concordant prioritization of health and the appropriate health system governance and structural reforms are critical to ensure that people who live in sub-Saharan Africa are not left behind.
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DOI: 10.1371/journal.pgph.0003433
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