Africa Scorecard on Domestic Financing for Health - Information
The Africa Scorecard on Domestic Financing for Health is a tool for AU Member States to use in financial planning and expenditure tracking. The below information tables detail the indicators used, source of each benchmark as well as links to the source data websites.
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).
A. Is the country making progress towards providing Universal Health Coverage (UHC)
#1. UHC Service Coverage index
Measures country progress towards SDG 3.8.1: Coverage of essential health services
B. How much does government spend on health (current expenditure only)
#2. 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 $86.30 per capita buy?)
#3. Per Capita ▲, =, or ▼
Whether per capita government spending on health has ▲, ▼ or remained = since the previous scorecard.
#4. As a % of GDP
The % of the total economy (% GDP) that government invests in health. It makes little sense for small and larger economies to have the same US$ per capita target. Governments should therefore also spend >5% of GDP on health (often more than $86.30).
#5. As a % of GDP ▲, =, or ▼
Whether the % of the total economy (% GDP) that government invests in health #4, has ▲, ▼ or remained = since the previous scorecard.
#6. 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.
#7. As % of Govt budget ▲, =, or ▼
Whether the % of the government budget spent on health has ▲, ▼ or remained = since the previous scorecard.
C. Who provides the resources (The contribution to total spending on health by each of the five sources (totalling 100%)
The % of health spending provided by government (domestic resources only).
#9. Voluntary pre-paid insurance
The % of health spending provided through pre-paid voluntary insurance.
#10. Households Out-of-pocket
The % of health spending provided through household out-of-pocket (OOP) spending.
#11. Other private health spending
The % of health spending provided by households through all other means, excluding OOP.
#12. Development partners
The % of health spending provided by development partners (on and off budget support).
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].
AU Member States
The 55 members of the African Union, as per the African Unionas per (https://au.int/en/memberstates)
UHC service coverage
WHO Universal Health Coverage (UHC) service coverage index, 2017
|WHO Global Health Expenditure database|
"Domestic General Government Health Expenditure (GGHE-D) per Capita in US$", 2018
"Domestic General Government Health Expenditure (GGHE-D) per Capita in US$", 2018 vs 2017
As a % of GDP
"Domestic General Government Health Expenditure (GGHE-D) as % Gross Domestic Product (GDP)", 2018
"Domestic General Government Health Expenditure (GGHE-D) as % Gross Domestic Product (GDP)", 2017-2018
As a % of Govt budget
"Domestic General Government Health Expenditure (GGHE-D) as % General Government Expenditure (GGE)", 2018
"Domestic General Government Health Expenditure (GGHE-D) as % General Government Expenditure (GGE)", 2018 vs 2017
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], 2018
"Voluntary Health Insurance" [FS.5], 2018
"Other revenues from households n.e.c." [FS.6.1], 2018
"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)] , 2018
"Transfers distributed by government from foreign origin" + "Direct foreign transfers" [FS.2+FS.7] , 2018
Annual GDP growth rate (%)
GDP growth (annual %) ["NY.GDP.MKTP.KD.ZG"], 2011-2020
Government debt (as a % GDP)
"General government gross debt as a % of GDP", 2021
Tax collected (as a % of GDP)
Tax revenue (% of GDP) [GC.TAX.TOTL.GD.ZS], various (range 2012-2021)
> $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)]
Mcintyre, D., Meheus, F., & Røttingen, J. (2017). What level of domestic government health expenditure should we aspire to for universal health coverage? Health Economics, Policy and Law, 12(2), 125-137.
> 5% GDP
Mcintyre, D. & Meheus, F. (2017). Fiscal Space for Domestic Funding of Health and Other Social Services. Chatham House Centre on Global Health Security Working Group Papers
Abuja declaration target (2001) (The Abuja Declaration on HIV/AIDS, Tuberculosis and other related infectious diseases)
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)
100% access to UHC
SDG indicator 3.8.1 is part of the indicator for SDG Goal 3.8 of "Achieving universal health coverage".
>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: This indicator is related to SDG target 17.1.1].