Following the 2001 Abuja Declaration of committing 15 percent government expenditure on health, is Africa making progress towards universal health coverage?

Abstract

Background: In 2001, 46 African Union nations signed the Abuja Declaration, committing 15 percent of their public expenditures to health. Objectives: In this paper, I was motivated to determine if government spending on health could significantly predict the African countries’ progress towards universal health coverage service coverage (UHC-sc). Methods: The nature of the term paper was primarily of qualitative descriptive research with limited inferential analysis. I explored the research question around the relations between domestic resources and progress towards UHC in Africa in two phases: literature review and secondary data analysis and interpretation. Results: In 2018, only three countries have reached or exceeded the Abuja Declaration target, and no country has achieved the universal health coverage service coverage index threshold value of 80. The findings show that government health spending, particularly absolute per capita expenditure, does explain improvements in UHC-sc. Therefore, I rejected the primary and secondary null hypotheses indicating that linear coefficient is not equal to zero at the 5 percent p-value. Moreover, I determined that absolute expenditure per person has a stronger correlation and explanation for progress towards UHC-sc compared with government health spending as a proportion of government expenditures in African countries. Discussion and conclusions: In moving forward, African leaders should institutionalize their commitments to attaining universal health coverage (UHC) through legislations and prioritize health by striving towards the Abuja Declaration target while ensuring a minimum per capita spending required for provision of basic health services. Given the wide variations in performance despite same level spending, African countries should concurrently address allocative and technical efficiencies and strengthen financial management systems. Finally, at least in the short to medium terms, international and donor communities should support the African countries’ path towards UHC with sufficient development assistance for health to bridge the expected domestic shortfalls.