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Health Financing in Development
Recent Trends in the Africa
Alexander S. Preker
World Bank
Senegal
Novembre 2007
15
10
Percentage
Abuja Target
Fifteen Percent of Gen Gov Revenues
Government Expenditure on Health as Percentage of Total Government Expenditure 2002
25
20
5
0
Mozambique
Dem. Rep. Congo
Tanzania
Rwanda
Namibia
Zimbabwe
Chad
Gambia
Zambia
Senegal
Equatorial Guinea
Malawi
Uganda
Algeria
Mali
Guinea Bissau
Kenya
Ghana
Mauritius
Madagascar
Egypt
Congo
Eritrea
Liberia
Libya Arab Jamahiriya
Morocco
Guinea
Angola
Nigeria
Burundi
Abuja Target
Regional Average
1
Pecentage
Progress Towards the Abuja Target
Has been Slow & Sometimes Negative
3.5
Dem. Rep. Congo
Mozambique
Gambia
Cameroon
Mauritania
Senegal
Angola
Burkina Faso
Lesotho
Mali
Uganda
Central Africa Republic
Tanzania
Kenya
Djibouti
Zimbabwe
Benin
Zambia
Namibia
Rwanda
South Africa
Malawi
Togo
Ethiopia
Sudan
Swaziland
Sierra Leone
-1.5
Nigeria
-1
Somaria
Liberia
-0.5
Percentage Point Change in Health Expenditure as
percentage of National Budget 1998-2002
3
2.5
2
1.5
0.5
0
But the Abuja Target is Not Enough
To Reach the MDGs
Fig. 3.1.2: Expenditure on Health Compared to CMH Target
Private Spending
Abuja Shortall in Public Spending
Would Meeting the Abuja Targets Make Much Difference?
excludes all countries with total spend > $100 per capita
Current Public Spend
100
90
80
70
Macromedia Contribute 3.lnk
60
50
40
US$34
CMH Target
30
20
10
E Africa
W Africa
Central Africa
S
Africa
Sudan
Morocco
Egypt
Swaziland
S Tome
Lesotho
DR Congo
Chad
Congo
CAR
Cameroon
Togo
Angola
Sierra Leone
Nigeria
Senegal
Niger
Mauritania
Mali
Liberia
Guinea-
Ghana
Guinea
Gambia
Côte d'Ivoire
Burkina
Cape Verde
Benin
Uganda
Tanzania
Rwanda
Mozambique
Malawi
Madagascar
Kenya
Eritrea
Ethiopia
Djibouti
Comoros
Burundi
0
N Africa
Share of Public Spending to
Reach Targets
Figure 3.1.3 Share of Public Spending Required
to achieve per capita public health expenditure of $34
Source: WHO 2002 excludes DRC, Niger and Ethiopia where share would need to exceed 100%
100
80
40
20
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M
Ke
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0
Bu
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nd
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D
jib
ou
ti
% of budget
60
External Spending for Health
Has Increase Dramatically Recently
Changes in HIV over time
External Aid to SSA
Growth in Social Sector Spending
Composition of bilateral sectorspecific ODA from OECD members to all Sub-Saharan Africa
100%
80%
60%
40%
20%
PRODUCTION SECTORS
ECONOMIC INFRASTRUCTURE AND SERVICES
SOCIAL INFRASTRUCTURE & SERVICES
0%
1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Share of sectorspecific ODA to all Sub-Saharan Africa
100%
80%
60%
40%
20%
Ot h e r b i l a t e r a l ODA e x c l u d i n g d e b t r e l i e f
Se c t o r s p e c i f i c b i l a t e r a l O D A
0%
1973
1974
1975
1976
1977
1978
Source: OECD DAC
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
There are Problems with
Donor Funding
Predictability and Longevity of ODA Must Be Improved
Donor Commitment for Health as % of Total Health
Expenditure
Donor Commitments for Health as % of Total Health
Expenditure
100
60.00
80
50.00
Mauritania
60
Tanzania
40
20
0
Guinea
40.00
Benin
30.00
Mali
20.00
Eritrea
10.00
Burundi
Liberia
0.00
1997 1998 1999 2000 2001
1997 1998 1999 2000 2001
Somalia
0.0
Equatorial Guinea
Madagascar
Liberia
Congo
Sierra Leone
Comoros
Mauritius
Burundi
Libyan Arab Jamahiriya
Mauritania
Central African Republic
Niger
Democratic Republic of Congo
Gabon
Burkina Faso
Algeria
Mali
Morocco
Public spending on health as % of GDP
Cameroon
Benin
Nigeria
United Republic of Tanzania
Sudan
Kenya
Egypt
Cape Verde
Angola
Senegal
Eritrea
Seychelles
Rwanda
Ghana
Ethiopia
Tunisia
Guinea
Zambia
Mozambique
Swaziland
Botswana
Lesotho
Côte d'Ivoire
Guinea-Bissau
Djibouti
Chad
Namibia
Gambia
Uganda
Zimbabwe
South Africa
Malawi
Togo
Sao Tome and Principe
% of GDP
Much More Effort Needed To
Harness Private Sector Resources
Figure A2.1.3.1Health spending by Source as % of GDP
Private spending on health as % of GDP
12.0
10.0
8.0
6.0
4.0
2.0
The End