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).
