A recent report by the World Health Organization (WHO) sheds light on the escalating financial burden that out-of-pocket health care payments place on millions of people across Africa. With a growing number of individuals being pushed into poverty due to healthcare expenses, the report highlights the urgent need for structural reforms in health financing systems.
The report reveals that between 2000 and 2019, the number of people experiencing what is termed “catastrophic” health care costs those who spend over 10% of their household budget on health care grew by 2.5 million annually. This increase, from 52 million to 95 million people over two decades, reflects a worrying trend. Despite some progress, the overall number of people pushed into poverty by out-of-pocket payments only halved, a much slower pace than seen in the rest of the world. Globally, this figure dropped by more than three-quarters, yet Africa still accounts for half of the world’s population impoverished by health care costs.
In the WHO Africa Region, out-of-pocket payments accounted for a significant portion of health spending, with 31 countries reporting these payments making up more than a quarter of total health expenditure. In 11 of these nations, out-of-pocket payments surpassed 50%, and in three countries, they exceeded 70%. This reality is exacerbated by the fact that, on average, people in Africa spent less on health care than anywhere else in the world—only $35 per person in 2019. This low spending underscores the barriers faced by many when it comes to accessing necessary health care, which leads to further financial hardship.
Out-of-pocket expenses are most heavily felt by the poorest and most vulnerable populations, particularly those living in rural areas, multigenerational households, or in homes headed by elderly individuals. For many, paying for medicines and outpatient care means cutting back on other essential needs, such as food and housing. The financial burden not only worsens health outcomes but also deepens the cycle of poverty.
Despite these challenges, the report also highlights areas where progress has been made. Some countries have introduced measures such as health insurance schemes, abolished patient fees at the point of care, and increased reliance on government-funded health services. These measures have been successful in reducing the financial burden on citizens, but much more needs to be done.
One crucial aspect emphasized in the report is the importance of governments investing in sustainable health systems that prioritize financial protection for their populations. Countries that invested more in their health systems tended to have lower levels of catastrophic health payments and less impoverishment due to health costs. This investment is critical for achieving universal health coverage, which remains an elusive goal for many African nations.
The WHO report serves as an important tool for guiding countries in tracking their progress toward financial protection in health. It encourages governments to strengthen their health financing systems, improve data generation, and make evidence-based decisions to better protect their citizens from the crippling costs of health care. As Dr. Matshidiso Moeti, WHO’s Regional Director for Africa, pointed out, the report should serve as a call to action for African nations to do more in ensuring that no one is forced into poverty due to the cost of seeking essential health care.
For African countries, tackling the issue of out-of-pocket health care payments is not just about improving access to treatment; it is about breaking the cycle of poverty and ensuring that the most vulnerable have the financial protection they need to lead healthier, more stable lives.
