POLICY BRIEF FOR ACHIEVING THE 15% BUDGETARY ALLOCATION TO HEALTH IN AFRICA: FULFILLING THE 2001 ABUJA DECLARATION current concerns 2-011

 

16 September 2025  current concerns 2-011

POLICY BRIEF FOR ACHIEVING THE 15% BUDGETARY ALLOCATION TO HEALTH IN AFRICA: FULFILLING THE 2001 ABUJA DECLARATION

-by Dr. Uzodinma Adirieje / +2348034725905 (WhatsApp) / EMAIL: druzoadirieje2015@gmail.com

 CEO/Programmes Director, Afrihealth Optonet Association (AHOA) – CSOs Network and Think-tank

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I. BACKGROUND

In April 2001, African Union (AU) member states met in Abuja, Nigeria, and collectively committed to allocating at least 15% of their annual national budgets to the health sector. This landmark agreement, known as the Abuja Declaration, was designed to strengthen health systems, improve healthcare delivery, and address Africa’s heavy disease burden, particularly HIV/AIDS, malaria, tuberculosis, and other communicable and non-communicable diseases. Two decades later, progress has been uneven, with only a handful of countries achieving or sustaining the 15% allocation. Many African states still spend less than 8% of their budgets on health, leaving millions without access to quality and affordable healthcare. The persistent underfunding of health has contributed to weak infrastructure, inadequate human resources, shortages of essential medicines, and dependence on external aid. These gaps were further exposed during the COVID-19 pandemic, which highlighted the urgency of investing in resilient health systems. Achieving the 15% target is therefore central to advancing Universal Health Coverage (UHC), improving maternal and child health, reducing preventable deaths, and meeting the Sustainable Development Goals (SDGs). A renewed policy focus is required to translate the Abuja Declaration into actionable national strategies, ensuring sustainable domestic financing for health in Africa.

 

II. IMPLEMENTATION ACROSS COUNTRIES

Although several African countries including Nigeria that hosted this meeting, have failed to progress in proportionate budgetary allocation to health, some African countries have shown evidence of good and progressive governance, in implementing the agreement. Rwanda has proven that this goal is achievable, as she has consistently invested over 15% in health, enabling near-universal health insurance. Ethiopia’s Health Extension Program has expanded cost-effective primary health care (PHC) nationwide. Botswana has prioritized HIV/AIDS spending, achieving one of Africa’s strongest HIV responses. Unfortunately, many of the countries including Ghana and South Africa have resorted to introducing new taxes and or increasing existing ones. While Ghana introduced a health insurance levy (2.5% VAT) to sustainably finance its NHIS, South Africa used sugar tax raised over R2 billion (2018–2020), showing potential of earmarked taxes. But these taxes further impoverish the citizens.

 

III. POLICY RECOMMENDATIONS

a. Political Will and Legal Backing: Enshrine the Abuja target into national laws, health financing strategies, and strengthen parliamentary and citizen oversight of budget allocations.

b. Expand Domestic Revenue: Broaden tax bases and improve collection efficiency, introduce earmarked health taxes (e.g., on alcohol, tobacco, sugary drinks), and tackle illicit financial flows, corruption, and tax evasion.

c. Improve Spending Efficiency: Strengthen public financial management and transparent procurement, and prioritize Primary Health Care (PHC) for equitable, cost-effective outcomes.

d. Strengthen Partnerships: Align donor support with national health plans, and explore innovative financing tools (diaspora bonds, solidarity levies).

e. Invest in Systems and Workforce: Expand health workforce training and retention, and upgrade infrastructure and integrate digital health innovations.

f. Regional Accountability and Peer Learning: Use AU’s Africa Scorecard on Domestic Financing for Health to track and compare progress, and share best practices among countries making progress.

g. Citizen and Civil Society Engagement: Foster community-led advocacy to demand Abuja commitment fulfillment, and promote open budget platforms for transparency and accountability.

 

However, using taxes on daily needs and consumer goods (like VAT on food, basic utilities, or other essential items) can disproportionately hurt low-income households. However, the Abuja 15% health financing target can still be achieved without such regressive and impoverishing measures.

 

IV. ELIMINATING POVERTY AND ACHIEVING ‘SDGs’ THROUGH NON-TAXING OF DAILY NEEDS AND CONSUMER GOODS TO FINANCE HEALTH SERVICES

Alternatively, it is hereby proposed to enthrone a Policy that embraces the following practical alternatives:

 

a. Improve Efficiency in Current Government Spending

1. Reduce waste and corruption: According to WHO, 20–40% of health resources globally are lost to inefficiencies. Eliminating leakages in procurement, payroll, and infrastructure projects can free significant resources.

2. Reallocate from non-priority sectors: Some African countries spend large shares of their budgets on subsidies, oversized government structures, or defense. Even a 2–3% reallocation could substantially boost health budgets.

b. Leverage Natural Resource and Extractive Revenues

1. Resource rents and royalties: Countries rich in oil, gas, and minerals (e.g., Nigeria, Angola, DRC) can dedicate part of these revenues to health through sovereign wealth or stabilization funds.

2. Transparent resource-for-health agreements: For example, Botswana used diamond revenues to finance a strong HIV/AIDS response.

c. Curb Illicit Financial Flows (IFFs)

1. Africa loses about $88.6 billion annually through tax evasion, trade mis-invoicing, and corruption (UNECA, 2020). Even recovering 10% of IFFs could finance major increases in health budgets without new taxes.

d. Optimize Debt Management and Reallocation

1. Debt swaps for health: Countries can negotiate with creditors to channel debt repayments into health programs (similar to “debt-for-nature swaps”).

2. Reprioritization in borrowing: When borrowing is necessary, governments can earmark a defined share for health infrastructure and workforce expansion.

e. Innovative Non-Tax Financing

1. Diaspora bonds: Mobilize African diaspora communities to invest in bonds whose proceeds are dedicated to health infrastructure. Nigeria and Ethiopia have experimented with diaspora bonds for development projects.

2. Health solidarity levies (non-essential sectors): Instead of taxing food or daily needs, levies could target luxury goods, air tickets, or high-pollution industries. For example, UNITAID’s airline ticket levy has raised over $2 billion globally for health.

3. Public–private partnerships (PPPs): Private sector contributions in infrastructure, technology, and workforce training can reduce the burden on government health budgets.

f. Strengthen Insurance and Risk-Pooling Mechanisms

1. National Health Insurance Schemes (NHIS): Contributions from employers, employees, and government subsidies can mobilize additional funds without taxing essentials. Ghana’s NHIS, funded partly through a small VAT levy plus other streams, shows mixed lessons, but other models can be designed without relying on consumer goods.

2. Community-based health insurance (CBHI): In Rwanda, CBHI has provided near-universal coverage by pooling contributions across households, supplemented by government support.

g. Regional and Multilateral Financing Mechanisms

1. African Union pooled funds: Member states can contribute to a continental health solidarity fund to support weaker systems.

2. Leveraging climate and development financing: With the health impacts of climate change rising, African countries can tap Green Climate Fund (GCF) and other multilateral mechanisms to co-finance health resilience.

h. Digitalization and Efficiency Gains

1. Digitizing tax collection, customs, and procurement systems reduces leakage and boosts government revenue without new taxes.

2. e-Health solutions can reduce costs in service delivery, ensuring existing allocations go further.

 

V. CONCLUSION

Achieving the Abuja 15% health budget target does not have to mean burdening ordinary citizens with higher taxes on daily essentials. In the interest of the welfare of the citizens and to truly work towards eliminating poverty, Policies should Reallocate from wasteful expenditures; Harness natural resource wealth; Recover illicit flows; Engage the diaspora and private sector; and Innovate with financing instruments. This approach ensures that health financing is equitable and sustainable, while protecting the poorest households from additional financial strain towards the achievement of the SDGs. The Abuja Declaration remains an urgent call to action. Achieving the 15% target requires political leadership, sustainable financing, efficiency, partnerships, and citizen accountability. Health is an investment in Africa’s future. It is vital for economic growth, resilience, and human development.

 

 

Dr. Uzodinma Adirieje is a seasoned consultant with extensive expertise in global health, climate change, health/community systems strengthening, development planning, project management, Sustainable Development Goals (SDGs), governance, policy advocacy, and monitoring and evaluation (M&E), based in Nigeria. He provides high-level consultancy services to governments, UN agencies, international organizations, NGOs, and development partners across Africa, leveraging over 25 years of multidisciplinary experience across Africa and the Global South. He was the Chair of Nigeria’s national World Malaria Day Committee in 2019; National President and fellow of the Nigerian Association of Evaluators (NAE) during 2019 – 2022; President of the Civil Society Organizations Strategy Group on SDGs in Nigeria (CSOSG); and Chair of the Resource Mobilization sub-committee of Nigeria’s national World Tuberculosis Day Committee in 2025, etc. He’s currently President of the African Network of Civil Society Organizations (ANCSO), and Chair of the Global Consortium of Civil Society on Climate Change and Conference of Parties (GCSCCC).