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Is Universal Health Coverage Possible for Africa?

The UN's Third Sustainable Development Goal aims to provide universal health coverage in all countries — an aspiration that everyone who needs health services will receive it without incurring financial hardship.


Sub-Saharan Africa has by far the lowest healthcare coverage rates in the world, even though their neighbors in North Africa are at the global average, so there is much room for improvement.


Total health expenditure has grown rapidly in the region over the past two decades, particularly in middle income countries, but this increase has been driven by out-of-pocket spending by households and by contributions from development assistance groups — half of which was for HIV/AIDS.


On average, 50% of health expenditure in sub-Saharan Africa is financed by out-of-pocket payments from individuals. Such payments have increased in nearly all countries from about $15 per capita in 1995 to about $38 per capita in 2014. However, only four countries in Africa have met the 2001 Abuja Declaration, where countries committed to spend 15% of general government spending on healthcare. Most countries today still spend only 5-10% of their government budget on health needs.


Most of the healthcare also remains informal, whether it is advice from local pharmacists or village doctors, neither of whom are formally trained in many cases. Self-medication is also widespread.


In Nigeria, informal providers account for about 30-40% of visits, whereas in Kenya, 33% of visits are informal.


Rates of out-of-pocket spending vary widely across countries with Nigeria and South Africa at opposite ends of the spectrum, reflecting starkly different health systems. 72% of spending is out-of-pocket in Nigeria, compared with just 8% in South Africa.

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