Notable achievements in health outcomes in Africa since the early 2000s can lead to a more productive healthy workforce and progress towards the 2030 Agenda and the Africa Agenda 2063. This has been driven partly by improved health nancing by member States and by the private sector which has played an important role in health delivery and health nancing on the African continent. Providing access to quality healthcare for all at aordable rates remains an important challenge facing Africa and the nancing of healthcare is a key policy issue in most countries. Scarce public funds and unpredictable donor aid often result in high out-of-pocket expenditure that pushes many people into poverty and exacerbates inequality. Countries need to mobilize more domestic resources and identify innovative sources of nance for healthcare. The private sector can contribute by leveraging the African Continental Free Trade Area to invest in sectors such as pharmaceuticals, digital technologies and health education to expand access to quality and aordable healthcare for all. Printed in Addis Ababa, Ethiopia by the ECA Printing and Publishing Unit. ISO 14001:2015 certied. Printed on chlorine free paper. Ordering information: To order copies of this report, please contact: Publications Section Economic Commission for Africa P.O. Box 3001 Addis Ababa, Ethiopia Tel: +251 11 544-9900 Fax: +251 11 551-4416 E-mail: [email protected] Web: www.uneca.org © 2019 United Nations Economic Commission for Africa Addis Ababa, Ethiopia All rights reserved First printing February 2019 Material in this publication may be freely quoted or reprinted. Acknowledgement is requested, together with a copy of the publication. The designations used and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the United Nations Economic Commission for Africa (ECA) concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries, or its economic system or degree of development. Designations such as “developed”, “industrialized” and “developing” are intended for statistical convenience and do not necessarily express a judgment about the stage reached by a particular country or area in the development process. Cover design, layout and printing: ECA Printing and Publishing Unit. ISO 14001-2015 certified. Healthcare and Economic Growth in Africa TABLE OF CONTENTS Foreword .................................................................................................................................... vi Acknowledgements .................................................................................................................viii Abbreviations ............................................................................................................................. x Factsheet ................................................................................................................................... xii Executive Summary .................................................................................................................xiii 1. Overview ............................................................................................................................1 Key Messages .......................................................................................................................................................................................................2 1.1 Overview of healthcare financing in Africa ...........................................................................................................................2 1.2 Progress on health in Africa .............................................................................................................................................................3 1.3 Health and economic growth – what is the link? ..............................................................................................................6 Appendix ............................................................................................................................................................................................................10 2. Challenges in improving healthcare in africa ...............................................................11 Key Messages ....................................................................................................................................................................................................12 2.1 Demographic, urban and epidemiological transitions ...............................................................................................13 2.2 Supply-side constraints ...................................................................................................................................................................23 3. The cost of healthcare in Africa ......................................................................................29 Key Messages ....................................................................................................................................................................................................30 3.1 Introduction ...........................................................................................................................................................................................31 3.2 Healthcare expenditure and outcomes in Africa ............................................................................................................32 3.3 How much should countries spend on healthcare? ....................................................................................................37 3.4 Financing gap in Africa....................................................................................................................................................................38 3.5 Mobilising domestic resources to finance healthcare .................................................................................................40 3.6 Health-stressed countries ..............................................................................................................................................................50 4. Private sector role in financing healthcare in Africa ....................................................54 Key Messages ....................................................................................................................................................................................................55 4.1 The private health sector in Africa ...........................................................................................................................................56 4.2 Public–Private Partnerships (PPPs) in health in Africa ..................................................................................................58 4.3 Key features of the PPPs in the health space in Africa .................................................................................................60 4.4 Opportunities for the private sector in healthcare in Africa ....................................................................................64 Conclusion ..........................................................................................................................................................................................................72 Appendix ............................................................................................................................................................................................................73 iii Healthcare and Economic Growth in Africa 5. Conclusions and recommendations ...............................................................................75 5.1 The nexus between health and economic growth .......................................................................................................76 5.2 The most severely health-stressed countries ....................................................................................................................76 5.3 Africa’s major challenges ................................................................................................................................................................76 5.4 The biggest challenge: bridging the financing gap .....................................................................................................77 5.5 Mobilising funding: constraints and ways forward ......................................................................................................77 5.6 Recommendations ............................................................................................................................................................................79 BIBLIOGRAPHY .........................................................................................................................80 Annex .........................................................................................................................................87 Country Classification and Codes.........................................................................................................................................................87 List of tables, figures and boxes Tables Table 1.1: Africa’s health and mortality indicators, 1990–2016 .....................................................................................................5