public health

African investment in public health must be astute as well as ample: Image: Adobe stock

African investment in public health must be astute as well as ample

To save the lives of countless citizens, African governments must do more to foster economic growth and optimize their fiscal infrastructure.

public health

African investment in public health must be astute as well as ample: Image: Adobe stock

Delegates recently gathered in Durban, South Africa, for the seventh edition of the country’s conference on tuberculosis– and the extent of the issue was laid bare to all attendees. More than 110 000 South Africans have died from the disease between 2021 and 2022, outstripping the number who succumbed to Covid-19 throughout the entire pandemic.

As tuberculosis cases rise, Covid remains a threat in areas with low vaccination rates, and other illnesses such as HIV wreak havoc, in the health system in South Africa—and, indeed, health systems across the continent—are stretched to their limit. Health bodies are desperately underfunded, and bridging the shortfall in funds will require improved domestic performance as well as greater international aid. To save the lives of countless citizens, African governments must do more to foster economic growth and optimize their fiscal infrastructure, while simultaneously ensuring that money is spent more intelligently and efficiently in the health sector.

Progress has a price

According to the World Health Organization (WHO), over one million children were diagnosed with TB worldwide in 2020. Of that number, a quarter have since died from the disease and less than half (400 000) are officially being treated. Africa is home to 17 of the 30 highest burden countries in the world for TB, with around 25% of all 2020 cases diagnosed on the continent. South Africa is just one of those high-burden nations, with 3.5% of TB patients and 17% of HIV sufferers.

These two diseases, along with malaria, represent the three deadliest infectious maladies on the planet. Significant progress has been made towards curtailing their impact, with the work done by the Global Fund to Fight Aids, Tuberculosis and Malaria playing an important role. Since its establishment in 2002, the Fund has helped save more than 44 million lives, resulting in attractive economic benefits as well as public health ones.

Nonetheless, this progress cannot be achieved without adequate investment and empty state coffers post-pandemic risk derailing the global aim of ending TB once and for all by 2030. In 2020, deaths caused by the disease rose for the first time in a decade, while malaria fatalities also sprang up 13% to reach their highest level since 2012. In both cases, the problem is largely a financial one.

Achieving targets contingent on investment

For TB, for example, Africa requires some $1.3 billion a year for routine testing and treatment, but receives just over half (56%) of that figure. As a result, as many as 44% of TB patients are believed to be undiagnosed, while 49% face “catastrophic” costs of treatment. To surmount the problem, greater investment is required.

The Global Fund has earmarked a target of $18 billion in external investment by 2025 in order to tackle all three diseases, yet there is still a sizeable shortfall that must be met by both foreign and domestic sources. The UK and Italy have yet to announce their revised contributions, precipitating hope that the gap can be narrowed, while at least nine African nations have all increased their pledges by 30%, despite the economic crises facing them. Even so, there is room for improvement.

The upcoming formation of the African Continental Free Trade Area (AfCTFA) should help in this regard, but African governments can also do more to maximize their budgets by closing tax loopholes and tackling corruption. According to the Tax Justice Network (TJN), the continent loses $88.6 billion to Illicit Financial Flows (IFF) a year, much of it from strategic tax evasion practiced by foreign multinationals operating on African soil.

Tobacco clampdown

The tobacco industry, in particular, is crying out for tighter oversight. Although smoking rates are falling in most parts of the world, they’re on the rise in Africa. Raising tax excise would be the most effective method of curbing use, especially given that Africa is home to some of the world’s weakest tobacco tax excise policies. Indeed, the higher prices that come from greater taxation are shown to  deter young smokers from taking up the habit and persuade long-time stalwarts to kick it.

In order to reap the greatest fiscal and public health benefits, policymakers must not only levy taxes but must efficiently collect them—a challenging task given the scale of the illicit tobacco trade. Some African governments have successfully deployed high-tech solutions to tackle parallel tobacco sales—Kenya and Togo, for example, have implemented a system called SICPATRACE, which uses a combination of secure physical and digital stamps to allow authorities to track cigarettes throughout the supply chain and ensure that all appropriate taxes have been paid, and have seen significant increases in revenue.

The benefits of rigorously collecting taxes on the tobacco sector are manifold. Not only does it grant governments access to more capital with which they could bolster their ailing healthcare infrastructure, but it also bolsters public health by discouraging people from a habit which kills up to half of users.

Spending smart

Of course, generating more income is all well and good, but African governments must also ensure that the funds are diverted to the areas and initiatives which need them the most. Public health investment is sorely lacking; while governments currently spend a cumulative $4.5 billion on the issue, it’s estimated that over five times that amount is required. What’s more, up to 40% of resources spent on healthcare across the globe are wasted.

As a result, it’s incumbent on African politicians and policymakers to heed the guidance offered by the WHO and the African Development Bank, who have monitored multiple case studies and identified lessons to be learned in the future. Providing primary healthcare for the most vulnerable citizens, developing secondary, tertiary and specialist services and building out the capacity and capability to effectively diagnose patients in a timely manner are just three of the ways in which Africa can evolve its healthcare going forwards. Achieving those objectives will require sufficient investment from overseas, optimization of domestic sources of revenue and the wherewithal and acumen to ensure that the resulting capital is expended to maximum effect.

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