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What does the end of Africa's boom mean for Universal Health Coverage?

Future Health Systems

Achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.


The following actions will be needed by governments and donors to counterbalance the negative impact of the projected economic downturn on health and health systems in affected countries:

  • Priority to be given to the establishment and protection of primary health-care services;
  • Provision of social protection to low-income, vulnerable groups, who are more likely to experience economic hardship and increased risk of disease in times of economic downturn;
  • Strengthen basic public health and prevention, as a cost-effective way to protect people from illness;
  • Ensure that salaries are paid for key public health service employees;
  • Ensure funding for drugs and necessary goods, which are among the first items to disappear when dwindling funds disrupt complex supply chains;
  • The introduction of health insurance to be piloted in phases to ensure the scheme is resilient to economic downturn;
  • Unsustainable health investments to be avoided during expansionary periods, to reduce the risk that commitments to recurrent expenditure cannot be met during downturns;
  • International health partners to focus on stabilising volatile situations through countercyclical measures, to attenuate the impact for health and health services of financial and other crises and to moderate excessive expectations and commitments to recurrent expenditure during expansionary periods.