African leaders pledged at the Abuja conference in 2001, to mobilize more
financial resources to allocate at least 15% of their national budgets to the health
sector to achieve the Millennium Development Goals (MDGs), seem to have difficulty
meeting this commitment because of weakness and fragmentation of health systems.
These commitments were renewed in Gaborone, Botswana in 2005 and in Ouagadougou,
Burkina Faso in 2006. Indeed, donor funding is still a large part of public health
spending on the continent. In some countries, 50% or more of their budgets come from
foreign or private assistance. In about half the countries, the private health financing is
equal to or exceeds largely public funding, up to 70% in some states like Sudan, Coˆte
d’Ivoire, Cameroon, Chad, Liberia and Uganda. Only five countries (Rwanda, Malawi,
Zambia, Burkina Faso, and Togo) have so far respected the promise made to the Abuja
conference. In Cameroon, where 51% of the population lives on less than two dollars
per day, the average propensity of the total medical consumption is very high. Indeed,
32% of households spend less than half of income on health, while 16% of households
spend more than half of the income and 52% spend more than the total income. This
corresponds to a weight of 68% in health care spending.