Health spending in Africa remains largely adequate to meet the growing healthcare financing needs and the rising healthcare demands, creating a huge financial gap of 66 billion per annual. The slow down in economic growth and high public indebtedness across the continent have restricted the fiscal space for the public financing of health. With the average debt to GDP ratio increasing by 15 percentage points between 2010 and 2017. The achievement of the health goals of the 2030 agenda for sustainable development and africa agenda 2063 demands countries to take a fresh look at healthcare financing as an important channel for improving health outcomes, enhancing labor productivity, creating employment and accelerating progress towards the continental and global health goals , while leaving no one behind.

Introduction

Health is increasingly recognized as a key aspect of human and economic development in Africa and countriesareincreasinginvestmentinactionsandreformstoimprovehealthoutcomesandaccelerate progress towards meeting the health Millennium Development Goals (MDGs). The political will of the national leaders to put health in forefront of development has been reiterated at the continental level through actions such as the Abuja Declaration of 2001 on increasing government funding for health, the Addis-Ababa Declaration of 2006 on community health in the African Region and the 2008 Ouagadougou Declaration on primary health care and health systems in Africa. Health system financing is one of the key areas that offer important opportunities to translate these commitments and political will into results.

Challenges

The need to develop strong health financing systems is a common objective of all countries. Even the richest countries are finding it increasingly difficult to keep up with rising health care costs, and the current economic downturn is adding more pressure on health spending. In low and middle income countries, which are where the vast majority of African countries are ranked, scarcity of funds for health is an even more acute problem. The average total health expenditure in African countries stood at US$ 135 per capita in 2010, which is only a small fraction of the US$ 3150 spent on health in an average high-income country.

Insufficient investment in the health sector or in actions to tackle the environmental and social determinants of health is a serious obstacle to improving health outcomes in Africa, particularly considering that the continent bears the bulk of the global morbidity and mortality burden for maternal and infant mortality and HIV/AIDS. In addition, the rise in noncommunicable diseases and injuries has put many countries under the pressure of a double burden of disease.The major constraint arising from funds shortage in most African countries is that the strategies and mechanisms that underpin health financing systems pose problems. In about half of African countries, 40K or more of the total health expenditure is constituted of household out-of-pocket payments, which is the most regressive way of funding health care. The reliance on this payment mechanism creates financial barriers to access to health services and puts people at the risk of impoverishment.

Furthermore, the current financial flows within the health systems are creating and exacerbating inefficiencies and inequities, for example through skewed allocation of funds to urban areas and specialized care. These weaknesses in the health financing systems have been identified as the main underlying reasons for the limited progress towards achieving the health MDGs in Africa.

Opportunities

The health sector will increasingly be viewed as a productive and job-creating sector. The health sector will become a labor-intensive industry that can provide an estimated 2–3 million skilled jobs for young Africans and contribute to economic growth on the continent. As the pharmaceutical, medical technologies, and ICT segments develop, there will be more opportunities in research and development, manufacturing, sales and distribution. Within this industry, other opportunities will be driven by the hospital, health insurance, and medical education segments. Leveraging e-Health to Improve Access and Achieve Cost Efficiencies. Over the next half century, technology will also play an important role in the future of the African healthcare system. Harnessing technology and creating effective eHealth and m-Health108 services will be one way to increase access to healthcare across the continent. Harnessing e-Health will help overcome the triple challenges of inadequate access, finance, and human resources by delivering high-quality healthcare services to all citizens.Scaling up Human Resources in Health Addressing the challenge of inadequate human resources in health will require strategic initiatives. This will involve scaling up investment in medical education and training, and promoting community oriented education programs. International recruitment of health professionals will be required. In addition, performance incentives should be introduced to improve the 108 m-Health (or mobile health) refers to the use of mobile communication devices, such as mobile phones, tablet computers and PDAs, for health services and information. Quality of healthcare and the adequate supply of health staff to rural and remote areas. The future of healthcare in Africa will see increased task-shifting to non-professional healthcare workers. Through basic training to members of local communities in areas such as supporting treatment for HIV or delivering prescribed medicines, local communities can take ownership of health, freeing up some of the burden placed upon professional medical staff. Regional development organizations and international donors will be critical in establishing training academies for healthcare workers and paying their wages. African countries will also look for other ways to relieve staff shortages: for example, by advertising the prospect of inexpensive medical training to nationals of developed countries.

Conclusion

Several African countries have recently implemented successful health financing reforms. For example Ghana has moved from out-of-pocket payments to the use of prepaid and pooled funds; Botswana is looking at policy options for creating efficiencies that will help sustain its achievements and prepare for future challenges, and Rwanda has implemented a national health financing mechanism that covers the vast majority of the population and has been a key element in increasing access to health services. Many other African countries are looking for innovative ways to improve funding for health. For countries in which health systems financing has been improving and for countries with more acute need for reforms and action, there is need to constantly track health financing progress in order to adapt to changing situations and implement reforms and actions that keep them on the right track to achieve the health financing goals that will support the objective of UHC. In light of these cross-country observations, there is a great need to increase investment in health and to focus on the way health systems are financed. Countries will need to translate this general message into an in-depth, in-country situation analysis that is relevant to their context and policy aims.This analysis will serve to provide a solid evidence basis for developing a health financing system.

References

United nations economic commission for Africa (2009-2022)) Healthcare and economic growth in Africa. Addis Ababa UN.ECA

Palmer N., Mueller, D.H, Mills A., & Haines, A. Health fnancing to promote access in low income settings—how much do we know? 2004; Lancet 364: 1365 - 70.

WHO Regional Ofce for Africa. Word health Organization: The Abuja Declaration: ten years on. Brazzaville: WHO; 2011.