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Member State
A. How much does government spend on health?
(Current expenditure, 2016)		 B. Sources of health spending, by percentage
(Current expenditure, 2016)		 C. UHC
(2017)		 D. Fiscal space
(Latest available data)
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15
Per Capita as a % of GDP as a % of Govt budget Government Voluntary pre-paid insurance Households Out-of-pocketX Other private health spending Development partners UHC Service Coverage Index Annual GDP growth rate Government debt (Total) Tax collected as a % of GDP
Benchmark: > $86.3 per capita U
USD
vs. 2015
 > 5 % GDP %V % GDP trend 2001-2016 >15%W
vs. 2015
 Add up to 100% of total (current) health expenditure 100% Y GDP growth rate 2011 - 2018 As a % of GDP 2019 >15% in LIC + LMIC >18% in UMIC Z

With the support of:


The Africa Scorecard on Domestic Financing for Health is a tool for AU Member States to use in financial planning and expenditure tracking. This Scorecard is based on 2016 health financing data - the latest data currently available. As per an AU Assembly Declaration (27th AU Summit, 2016) the Scorecard will be updated annually and released each year.
This Digital version of the Scorecard is updated daily via automated feeds from various data services.

No Data
Target met
Target not met



What story are the indicators trying to tell?
A. How much does government spend on health (current expenditure only)
#1. Per Capita Total US$ amount that government invests in health
per person.
The WHO HLTF recommends investing a minimum of $86.30pp (inflated to 2015 US$).
The interventions included in this package are detailed in the box below (What health benefits package does $86.30 per capita buy?).
#2. Per Capita ,= , or Whether per capita government spending on health has , or remained = between 2015 and 2016.
#3. as a % of GDP The % of the total economy (% GDP) that government invests in health.
It makes little sense for small and larger economies to have the same US$ per capita target.
Governments should therefore also spend >5% of GDP on health (often more than $86.30).
#4. As a % of GDP 2019 #3, tracked over time (from 2001 to 2016). This graph should track upwards as governments progressively increase domestic investment in health.
#5. as a % of Govt budget The % of the govt budget dedicated to health. (An approximation of the Abuja 15% target).

Getting to 15% will take time, but it will only be achieved through substantial increases in domestic investment in health made incrementally every year, year-after-year.
#6. As a % of govt budget ,= , or Whether the % of the government budget spent on health has , or remained = between 2015 and 2016.
B. Who provides the resources (The contribution to total spending on health by each of the five sources (totalling 100%)
#7. Government The % of health spending provided by government (domestic resources only).
#8. Voluntary pre-paid insurance The % of health spending provided through pre- paid voluntary insurance.
#9. Households Out-of-pocket The % of health spending provided through household out-of-pocket (OOP) spending.
#10. Other private health spending The % of health spending provided by households through all other means, excluding OOP.
#11. Development partners The % of health spending provided by development partners (on and off budget support).
C. Is the country making progress towards providing Universal Health Coverage (UHC)
#12. UHC Service Coverage Index Measures country progress towards SDG 3.8.1: Coverage of essential health services.
D. How much ‘fiscal space’ does the government budget have for increasing domestic spending (on any priority)?
#13. Annual GDP growth rate (%) Has the economy been growing over time?
A growing (larger) economy means more resources even at the same % of investment.
#14. Government debt as % GDP General government gross debt as a % of GDP.

(Includes all liabilities that require payment or payments of interest and/or principal).
#15. Tax collected as a % of GDP Is government generating enough revenue by collecting a sufficient % of the economy through taxation? If not, increasing tax collection provides room to expand the fiscal space.

Benchmarks are the recommendations of the IMF (by country income classification level)
[Note that this indicator (‘Tax revenue’) fails to capture resources from mining, oil and gas and therefore under-estimates tax revenue in resource dependent countries].
Member State record of conducting National Health Accounts (NHAs)
Member State SHA11 National Health Accounts completed
2012 2013 2014 2015 2016 2017 #
1 Algeria
No
No
No
No
No
No
 0
2 Angola
No
No
No
No
No
No
 0
3 Benin
Yes
Yes
Yes
Yes
No
No
 4
4 Botswana
No
Yes
Yes
Yes
Yes
Yes
 5
5 Burkina Faso
Yes
Yes
Yes
Yes
Yes
Yes
 6
6 Burundi
Yes
Yes
Yes
Yes
Yes
No
 5
7 Cameroon
Yes
No
No
No
No
No
 1
8 Cabo Verde (formerly Cape Verde)
Yes
Yes
Yes
Yes
Yes
No
 5
9 Central African Republic
No
No
No
No
No
No
 0
10 Chad
No
No
No
No
No
No
 0
11 Comoros
No
No
No
No
No
No
 0
12 Congo Republic
Yes
Yes
Yes
Yes
No
No
 4
13 Côte d'Ivoire
Yes
Yes
Yes
Yes
Yes
Yes
 6
14 Democratic Republic of the Congo
Yes
Yes
Yes
Yes
Yes
Yes
 6
15 Djibouti
Yes
No
No
No
No
No
 1
16 Egypt
Yes
No
No
Yes
No
No
 2
17 Equatorial Guinea
No
No
No
No
No
No
 0
18 Eritrea
No
No
No
No
No
No
 0
19 Eswatini (formerly Swaziland)
No
No
No
No
No
No
 0
20 Ethiopia
No
No
Yes
No
No
Yes
 2
21 Gabon
Yes
Yes
Yes
Yes
Yes
Yes
 6
22 Gambia
No
Yes
No
Yes
No
No
 2
23 Ghana
Yes
Yes
Yes
Yes
Yes
No
 5
24 Guinea
Yes
Yes
Yes
Yes
Yes
No
 5
25 Guinea-Bissau
No
No
No
No
No
No
 0
26 Kenya
No
Yes
No
No
Yes
No
 2
27 Lesotho
No
No
No
No
No
No
 0
28 Liberia
Yes
No
Yes
No
Yes
No
 3
29 Libya
No
No
No
No
No
No
 0
30 Madagascar
No
No
No
No
No
No
 0
31 Malawi
Yes
Yes
Yes
Yes
No
No
 4
32 Mali
No
Yes
Yes
Yes
Yes
No
 4
33 Mauritania
Yes
Yes
Yes
Yes
Yes
Yes
 6
34 Mauritius
No
No
Yes
No
Yes
No
 2
35 Morocco
No
Yes
No
Yes
No
No
 2
36 Mozambique
No
No
No
No
No
No
 0
37 Namibia
Yes
No
Yes
Yes
Yes
Yes
 5
38 Niger
Yes
Yes
Yes
Yes
Yes
Yes
 6
39 Nigeria
Yes
Yes
Yes
Yes
Yes
Yes
 6
40 Rwanda
Uses Own Tool
41 Sahrawi Republic (Western Sahara) No Data
42 São Tomé and Príncipe
Yes
Yes
Yes
Yes
No
No
 4
43 Senegal
No
Yes
Yes
Yes
Yes
No
 4
44 Seychelles
No
Yes
Yes
Yes
Yes
Yes
 5
45 Sierra Leone
No
Yes
Yes
No
No
No
 2
46 Somalia
No
No
No
No
No
No
 0
47 South Africa
No
Yes
No
No
No
No
 1
48 South Sudan
No
No
No
No
No
Yes
 1
49 Sudan
No
Yes
No
Yes
Yes
No
 3
50 Tanzania
Yes
Yes
Yes
Yes
No
No
 4
51 Togo
No
Yes
Yes
Yes
Yes
No
 4
52 Tunisia
Yes
Yes
Yes
No
No
No
 3
53 Uganda
Yes
Yes
Yes
Yes
No
No
 4
54 Zambia
No
Yes
Yes
Yes
Yes
No
 4
55 Zimbabwe
No
No
No
Yes
No
No
 1
Target met
Target not met
No Data
What health benefits package does $86.30 per capita buy?
The amount of $86.30pp is derived from the cost estimates of the High Level Taskforce on Innovative International Financing for Health Systems (HLTF), inflated to 2016 US$. The HLTF was convened by the WHO in 2005 and 2009 and was an effort to cost a set of primary health care interventions and services guaranteed by various UN conventions (i.e. health interventions committed to by all UN Member States).

The HLTF cost estimates were based on the health burden of 49 low- income countries (including 33 in Sub-Saharan Africa). The focus was on the cost of scaling up interventions and health system support required to accelerate achievement of the health-related Millennium Development Goals (MDGs). The benefit package therefore focussed on malnutrition (MDG1), maternal health (MDG4), child health (immunisation and newborn health - MDG5) and AIDS, TB & malaria (MDG6) interventions as well as the on providing the necessary health system support – the inputs required to scale-up the systems and the services. Finally, the estimate includes the cost of health promotion for MDGs 4-6 as well as two interventions that address chronic diseases (tobacco control and salt reduction in processed foods) and essential drugs for chronic diseases, some cancers, neglected tropical diseases, mental health and general care as well as the medicines needed for these areas (MDG8e).
Technical indicator name and source of data:
0 AU Member States AU.init The 55 members of the African Union, as per the African Union (as per https://au.int/en/memberstates)
1
2		 Per Capita “Domestic General Government Health Expenditure (GGHE-D) per Capita in US$”, 2016
“Domestic General Government Health Expenditure (GGHE-D) per Capita in US$”, 2016
3
4		 as a % of GDP “Domestic General Government Health Expenditure (GGHE-D) as % Gross Domestic Product (GDP)”, 2016
“Domestic General Government Health Expenditure (GGHE-D) as % Gross Domestic Product (GDP)”, 2016
5
6		 as a % of Govt budget “Domestic General Government Health Expenditure (GGHE-D) as % General Government Expenditure (GGE)”, 2016
“Domestic General Government Health Expenditure (GGHE-D) as % General Government Expenditure (GGE)”, 2016
7
8
9
10
11		 Source: Government
Source: Voluntary pre-paid insurance
Source: Out-of-pocket spending
Source: Other private health spending
Source: Development partners		 “Transfers from Government domestic revenue (allocated to health purposes)” [FS.1], 2016
"Voluntary Health Insurance" [FS.5], 2016
"Other revenues from households n.e.c." [FS.6.1], 2016
“Social insurance contributions” + “Compulsory prepayment (other than FS.3)” + (“Other domestic revenues n.e.c.” minus “Other revenues from households n.e.c.”) [FS.3 + FS.4 + (FS.6 – FS.6.1)] , 2016
“Transfers distributed by government from foreign origin” + “Direct foreign transfers” [FS.2+FS.7] , 2016
12 UHC Service Coverage WHO GHO WHO Universal Health Coverage (UHC) service coverage index, 2017
13 Annual GDP growth rate (%) World Bank GDP growth (annual %) ["NY.GDP.MKTP.KD.ZG"], 2011-2018
14 Government debt (as a % GDP) IMF "General government gross debt as a % of GDP", 2019
15 Tax collected (as a % of GDP) World Bank Tax revenue (% of GDP) [GC.TAX.TOTL.GD.ZS], various (range 2012-2018)
Sources for each benchmark:
U > $86.30 per capita (in 2015)
WHO High Level Task Force (HLTF) target (2005) of $56 per capita minimum required to meet a basic level of health. Inflated to 2015 US$ ($86.30)
Di McIntyre & Filip Meheus (2017) updated the 2005 HLTF estimate to 2015 U$ dollars, accounting for variable inflation rates and exchange rate changes across the countries included in the HLTF. [Pg. 11, Footnote 3 in Mcintyre, D. & Meheus, F. (2017)]
As a % of GDP
V > 5% GDP As a % of GDP
W > 15% Abuja declaration target (2001) (The Abuja Declaration on HIV/AIDS, Tuberculosis and other related infectious diseases)
X < 20% WHO (World Health Report 2010, Table 5.2, page.98) advises that "Where out-of-pocket health payments... is lower than 15–20%, there is little financial catastrophe or impoverishment." (Note: McIntyre & Meheus calculate that reducing OOP expenditure to <20% equates to Govt spending 6% of GDP on health)
Y 100% access to UHC
SDG indicator 3.8.1 is part of the indicator for SDG Goal 3.8 of "Achieving universal health coverage".
Z
>15% and >18%
The International Monetary Fund (IMF) recommended targets. >15% for low-income countries (LICs) and low-middle income countries (LMICs); >18% for upper-middle-income countries (UMICs). [Note that this indicator is SDG target 17.1].