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This article was first published in the July/August 2020 Africa edition of Accounting and Business magazine.

The Covid-19 pandemic has once again exposed the poor healthcare systems in Africa. Reports from several countries in sub-Saharan Africa reveal acute shortages of both facilities and equipment. Tests, isolation centres, ventilators and personal protective equipment, even medical personnel, are all in short supply. This is hardly surprising, given that for decades government spending on health in sub-Saharan Africa has been among the lowest in the world.

Efforts have been made to change this narrative. With the Abuja Declaration of April 2001, African leaders pledged to raise their countries’ health spending to at least 15% of their total public sector budgets. But when the World Health Organization (WHO) assessed performance a decade later, it found that only Tanzania had managed to do so. A few others were on track back then, but the majority were either making no progress or had slipped back. The latest available WHO data shows that in 2014 only Ethiopia, at 15.8%, was still on target.

There is a parallel lack of private expenditure. A 2019 Brookings report paints a grim picture – sub-Saharan Africa, with 16% of the world’s population and 23% of the world’s disease burden, accounted for just 1% of global health spending in 2015. Yet it is widely said in Africa that health is wealth.

Low health expenditure is the product not just of poor economies, but also of poorly designed systems, poor planning and misplaced priorities. Out-of-pocket health expenditure, where people pay directly for treatment, is a problem. According to Brookings, in 2016 out-of-pocket expenditure made up 37% of total African health spend, with 11% of Africans reporting catastrophic health expenditure in that year. Health insurance schemes are on the rise, but they do not cover most people. Lack of funds often forces people to self-medicate or pursue ineffective alternative remedies, and they present at hospitals only when their condition has deteriorated, driving higher mortality rates.

Misplaced government priorities are a problem. It is not unusual to see government officials in communities with inadequate health facilities spend large sums on SUVs for their convoys – an accusation recently levelled at the Nigerian legislature as the country struggled to provide for its citizens during the pandemic.

Planning is another issue. Too little attention is paid to what needs to be in place and how to finance it. Given the presence of diseases like malaria, Lassa fever and Ebola, Africa ought to have been better prepared for Covid-19.

Governments must reduce reliance on donors and foreign bailouts and develop responses from inside the continent. They must increase capacity and begin to produce medicines, vaccines and equipment in domestic markets. They should design pooled healthcare financing systems that work, and which cover as many people as possible. A healthy population is a more productive one.

Okey Umeano FCCA is head of risk management at Nigeria’s Securities and Exchange Commission.