{
  "abstract": "In 2001, African Union (AU) member states committed to allocating 15% of their annual budget to health under the Abuja Declaration (AD). However, after more than two decades, health allocations across many countries still fall short of the target. This study uses an expenditure-based proxy for the AD to examine the likelihood and timing of attainment of the benchmark under historical fiscal trajectories.We compiled a 2002–2023 panel for 54 African countries using WHO and World Bank data. We distinguished observed, first and sustained attainment. Kaplan-Meier and Weibull models characterised time to first attainment, country-specific linear trends projected benchmark-crossing years through 2063, system GMM assessed expenditure-share persistence, and country and year fixed-effects models examined associations with primary health care (PHC) and immunisation expenditure per capita.In 2023, South Africa was the only one of 54 countries at or above the expenditure-based 15% benchmark. Five countries had attained it at least once during 2002–2023, and three sustained it for at least three consecutive years. Under the primary trend specification, which included the 51 countries with complete series, 42 (82.4%) were off track to attain the benchmark by 2063. Among the 48 countries without previous attainment, the median adjusted conditional probability of first attainment during 2023–2063 was 7.9% (IQR 4.6%–13.3%). The primary system-GMM lag coefficient was 0.821 (95% CI 0.635 to 1.006), indicating strong expenditure-share persistence. Higher government health prioritisation was associated with higher domestic government PHC expenditure per capita, while the association with total immunisation expenditure per capita was not statistically significant.Attainment of the expenditure-based Abuja benchmark remains uncommon and is unlikely to become widespread by 2063 if historical trends continue. While the 15% target remains politically useful as an accountability signal, efforts should target improving public health expenditure per capita, fiscal capacity, budget execution, financial protection and service coverage.",
  "abstract_shown": true,
  "affiliations": [
    "Global Health Practice, Centre of Excellence for Child Survival and Development, UNICEF, Nairobi, Kenya",
    "Centre for Social Policy Studies, University of Ghana, Accra, Ghana",
    "School of Public Health, University of Ghana, Accra, Ghana",
    "Management Sciences for Health, Arlington, Virginia, United States of America",
    "Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia",
    "Program Division-UNICEF Headquarters, New York, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Alex Olateju Adjagba"
    },
    {
      "affs": [
        1
      ],
      "name": "Jacob Novignon"
    },
    {
      "affs": [
        2
      ],
      "name": "Justice Nonvignon"
    },
    {
      "affs": [
        3
      ],
      "name": "Richmond Owusu"
    },
    {
      "affs": [
        4
      ],
      "name": "Ephrem Lemango"
    },
    {
      "affs": [
        5
      ],
      "name": "Helga Fogstad"
    },
    {
      "name": "Ngashi Ngongo"
    },
    {
      "name": "Jean Kaseya"
    },
    {
      "name": "George Laryea-Adjei"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/837y64x8ejh9x.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0007423",
  "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007423",
  "id": "837y64x8ejh9x",
  "issns": [
    "2767-3375"
  ],
  "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007423",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3600|Global Health Care Issues"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Vaccination and immunization"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health care policy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health economics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Vaccination and immunization"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health/Global health"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization"
    ],
    [
      "plos",
      "/People and places/Geographical locations/Africa"
    ],
    [
      "plos",
      "/Social sciences/Economics/Finance"
    ],
    [
      "plos",
      "/Social sciences/Economics/Finance/Financial management/Budgets"
    ],
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      "plos",
      "/Social sciences/Economics/Health economics"
    ]
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  "openalex": "W7221159986",
  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007423&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-09",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/837y64x8ejh9x.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:30Z",
      "native_id": "10.1371/journal.pgph.0007423",
      "source": "plos",
      "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007423"
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  "subjects": [
    {
      "field": "biology",
      "origin": "plos:immunology",
      "subfield": "immunology"
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    {
      "field": "medicine",
      "origin": "plos:public and occupational health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Beyond aspiration: An expenditure-based evaluation of progress towards the Abuja Declaration target and implications for domestic health financing in Africa",
  "title_text": "Beyond aspiration: An expenditure-based evaluation of progress towards the Abuja Declaration target and implications for domestic health financing in Africa",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:30Z",
  "url": "https://research.draconitic.com/paper/837y64x8ejh9x",
  "venue": "PLOS Global Public Health",
  "versions": []
}