Academic journal article Bulletin of the World Health Organization

Benchmarks for Health Expenditures, Services and Outcomes in Africa during the 1990s

Academic journal article Bulletin of the World Health Organization

Benchmarks for Health Expenditures, Services and Outcomes in Africa during the 1990s

Article excerpt

Voir page 767 le resume en francais. En la pagina 768 figura un resumen en espanol.


During the last four decades, a period when most African countries have obtained independence, they have also achieved remarkable improvements in health conditions. Yet Africans still suffer from some of the worst health problems in the world. The highest mortality and fertility rates are found in African countries. In 1990, the median age of death was estimated to be five years (1).

African countries face enormous difficulties in mobilizing and managing resources to improve public health. Two-thirds of the African countries are classified as low income and have limited potential to mobilize resources. Nearly all have weak health management systems. The challenge of a massive burden of disease from largely preventable or treatable conditions that precede the epidemiological transition, the emergence of new diseases and health problems (such as acquired immunodeficiency syndrome and drug-resistant tuberculosis), and changes in the political climate combine to make information increasingly important for management and accountability of the health sector in African countries.

Good information is vital to making intelligent choices about strategies and investments in health. Yet in much of Africa, information that would be critical to policy-makers, health systems managers and public consumers of health services is often not available, despite increasing emphasis on data collection in many countries. Unfortunately, even the little information available is rarely used. Overly simplistic prescriptions are made about how countries should be performing, without analysis of historical trends or comparison with peers. For example, public sector health expenditures are often unrealistically targeted at 5% of the gross domestic product (GDP), whereas immunization coverage is expected to be sustained at 80%.

This paper highlights the findings of a study that set out to make available information on health expenditures, health service outputs and health outcomes at the national level, in a way that could assist health planning and policy development in Africa (2).


The study included all 48 countries located south of the Sahara Desert as of 1997 (excluding the French dependencies of Reunion and Mayotte). The variables under study included 15 indicators of health status (concentrating on infant mortality rate, prevalence of child malnutrition, and total fertility rate); eight health service indicators; seven types of health expenditure variable; socioeconomic factors known to affect health (e.g., GNP per capita, amount of development assistance, secondary school enrolment, adult female illiteracy, and access to safe sanitation and water), and indicators of the national policy environment (e.g., assessments of bureaucratic quality; the legal and regulatory framework, and government, military, and public education expenditure). The data were derived mainly from a database maintained by the International Monetary Fund (IMF), the United Nations Children's Fund (UNICEF), the United Nations Population Division, the World Health Organization (WHO), and the World Bank, along with household surveys sponsored by the World Bank and the United States Agency for International Development, notably the Demographic and Health Surveys. The health financing data came largely from government accounts, World Bank expenditure reviews, household surveys, IMF and other studies. These data were compared with the World Development Report 1993 estimates for 1990 (1). Missing or incomplete information was updated from the World Bank African Regional Database. Where possible, annual estimates of variables were used for 1990-95. Period averages for 1990-96 were calculated using as many years of information as were available. Population-weighted averages were used for data aggregated across countries. …

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