WHO raises alarm over growing health inequality, financial barriers in Africa

 Universal Health Coverage Day 2025

WHO raises alarm over growing health inequality, financial barriers in Africa

The World Health Organization (WHO) has raised concerns over growing health inequality and financial barriers in Africa, highlighting the need for increased investment in healthcare. Key issues include¹ ²:

- Inadequate Funding: Africa's health sector faces a financing crisis, with a 70% decline in Official Development Assistance (ODA) from 2021 to 2025, impacting critical health programs.

- Healthcare Disparities: Many African countries allocate less than 10% of their national budgets to health, far below the 15% target set by the African Union in 2001. Only three countries - Rwanda, Botswana, and Cabo Verde - have consistently met or exceeded this target.

- Debt Burden: African countries are expected to service $81 billion in debt by 2025, surpassing anticipated external financing inflows and further eroding fiscal space for health investments.

- Public Health Emergencies: The continent is experiencing a surge in public health emergencies, with a 41% increase in 2024, exposing severe under-resourcing of health infrastructure and workforce.

- Inequality and Poverty: The pandemic has widened social and economic inequality, with the poorest people and countries suffering the most. Debt repayments are crowding out spending on health and education.

To address these issues, experts recommend³:

- Debt Relief: Providing debt relief to developing countries to alleviate long-term economic harm and stop the cycle of disease outbreaks deepening inequality.

- Increased Investment: Increasing national healthcare budgets to build better infrastructure and ensure the availability of essential healthcare to all.

- Targeted Interventions: Implementing targeted health policies that address the root causes of inequality, such as expanding access to healthcare, implementing social protection programs, and promoting gender equality in health.

- Improved Governance: Establishing transparent governance structures to prevent corruption and fraud, ensuring equitable distribution of healthcare resources.

Most countries make progress towards universal health coverage, but major challenges remain, WHO–World Bank report finds

Cost of Healthcare in Africa Soaring High, with 384m Pushed into Poverty, Says WHO

The World Health Organization (WHO) has reported that the high cost of healthcare in Africa is pushing hundreds of millions of people into poverty. Specifically, over 384 million people were pushed into poverty in 2022 due to out-of-pocket healthcare payments. This alarming trend affects many African countries, where people are forced to make impossible choices between healthcare and basic necessities like food and shelter.

Key Statistics:

- 423 million Africans faced financial hardship due to healthcare costs in 2022

- 384 million people were pushed into poverty due to out-of-pocket payments

- 31 countries in Africa have out-of-pocket payments accounting for over 25% of total health expenditure

- 11 countries have out-of-pocket payments exceeding 50% of total health expenditure¹ ²

Causes of High Healthcare Costs:

- Out-of-pocket payments: Many Africans rely on out-of-pocket payments for healthcare, which can be catastrophic for those who are already poor

- Limited access to healthcare: Inadequate healthcare infrastructure and lack of health insurance coverage exacerbate the problem

- Debt burden: African countries are expected to service $81 billion in debt by 2025, further reducing fiscal space for health investments

Consequences:

- Poverty: High healthcare costs push people into poverty, perpetuating cycles of illness and destitution

- Limited access to healthcare: High costs deter people from seeking medical care, worsening health outcomes

- Inequality: The poor and vulnerable are disproportionately affected, exacerbating existing health disparities

Solutions:

- Increase domestic health investment: Governments should allocate more funds to healthcare to reduce reliance on out-of-pocket payments

- Expand health insurance coverage: Implementing universal health coverage and risk-pooling mechanisms can protect people from financial hardship

- Strengthen primary healthcare: Investing in primary care can reduce healthcare costs and improve health outcomes in the long run³ ⁴

One‑Sided Compacts: Why the World Bank’s National Health Compacts Need to be a Two-Way Deal

The World Bank's National Health Compacts are designed to support countries in achieving Universal Health Coverage (UHC) by providing a framework for governments and development partners to work together. However, critics argue that these compacts are one-sided, focusing primarily on government commitments while neglecting the responsibilities of donors.

Key Issues with Current Compacts:

- Lack of Mutual Accountability: The compacts do not clearly outline the roles and responsibilities of donors, making it challenging to ensure that they adhere to their commitments.

- Insufficient Funding: The compacts rely heavily on domestic funding, with donors providing limited and unpredictable support.

- Fragmented Financing: The current system leads to duplicated efforts, inefficiencies, and waste.¹

Proposed Solutions:

- New Compact Approach: A new framework that promotes mutual accountability, shared priorities, and coordinated financing.

- Three Pillars:

    - Locally-Led Priority Setting: Governments define core benefits packages and prioritize services based on evidence and equity impact.

    - Domestic-First Resource Allocation: Governments commit to funding high-priority services before aid is allocated.

    - Consolidated Supplementary Aid: Donors provide support on-budget or in closely coordinated pools, with explicit mapping of roles and responsibilities.

Benefits of Two-Way Compacts:

- Improved Coordination: Enhanced collaboration among governments, donors, and other stakeholders.

- Increased Funding: More predictable and sustainable funding for health programs.

- Better Health Outcomes: More effective use of resources leads to improved health outcomes and increased financial protection for citizens.

By transforming the National Health Compacts into two-way agreements, the World Bank can help ensure that development assistance for health is more effective, efficient, and equitable.