What is it about?
In 2001, African Union member states pledged to spend at least 15% of their government budgets on health, under the Abuja Declaration. We looked at what governments actually spent on health between 2002 and 2023 in 54 African countries, using WHO and World Bank data. We asked three questions: how many countries reached 15%, how many stayed there, and how likely others are to get there by 2063 if past trends continue. In 2023, one country, South Africa, was at or above the benchmark. Five countries reached it at least once over two decades, and three held it for three years or more. Of the 51 countries with complete data, 42 were not on track to reach it by 2063. We also found that health’s share of government spending changes slowly from year to year, and that countries giving health a higher priority tend to spend more domestic funds per person on primary health care.
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Why is it important?
Most assessments of the Abuja target look at budget pledges. We looked instead at what governments actually spent, and asked a forward-looking question that few studies have explored: if countries continue on their current path, where will Africa be by 2063, the horizon of the AU’s Agenda 2063? The answer is sobering. For countries that have never reached the benchmark, the typical chance of doing so by 2063 is around 8%. Health’s share of public spending also changes very slowly, which means small, gradual increases will not change this outlook. Reaching the Abuja ambition will require deliberate and sustained action that shifts the trajectory itself: expanding fiscal space, protecting health budgets, improving budget execution and investing in primary health care. As external aid declines, these findings give governments and partners an evidence base to act with urgency, at the 25th anniversary of the Declaration.
Perspectives
This work was a collaboration between UNICEF, the University of Ghana, Management Sciences for Health and Africa CDC, and I am grateful to every co-author. After 25 years, my reading of the evidence is that the answer is not a new target or a new measure. Changing the target will not change what reaches the budget line. What we need now is a frank look at what has held countries back, where the system breaks down between commitment and spending, and which parameters must change for the next decades to look different. That means practical, sustained action: building health economics capacity inside governments so that health has a stronger voice in budget negotiations, strengthening dialogue between ministries of health and finance, improving how budgets are executed, and linking spending more clearly to results for people, especially children. The Abuja ambition remains right although insufficient. Our task is to make it work.
alex adjagba
UNICEF HQ
Read the Original
This page is a summary of: Beyond aspiration: An expenditure-based evaluation of progress towards the Abuja Declaration target and implications for domestic health financing in Africa, PLOS Global Public Health, October 2026, PLOS,
DOI: 10.1371/journal.pgph.0007423.
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