Persistent shortfalls in government health expenditure: a decade-long analysis of Abuja 15% target attainment across 52 African countries, 2014-2023.
16 affiliations
- 1Faculty of Economics and Management Sciences, University of Ibadan, Ibadan, Nigeria.
- 2Department of Economics, Lead City University, Ibadan, Nigeria.
- 3Bristol Medical School, University of Bristol, Bristol, UK.
- 4Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
- 5Department of Health Informatics, College of Public Health and Health Informatics, University of Hail, Hail, Saudi Arabia.
- 6Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria.
- 7Women in Global Health, Abuja, Nigeria.
- 8Department of Health Policy, London School of Economics and Political Science, London, UK.
- 9London School of Hygiene and Tropical Medicine, London, UK.
- 10African Young Leaders for Global Health, Abuja, Nigeria.
- 11University of Ilorin, Ilorin, Nigeria.
- 12Clinton Health Access Initiative, Abuja, Nigeria.
- 13Equicare Strategies, Zaria, Nigeria.
- 14College of Social Sciences, University of Glasgow, Glasgow, UK. [email protected].
- 15Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria. [email protected].
- 16Global Health Focus, Kigali, Rwanda. [email protected].
Abstract
Background
In 2001, African governments committed through the Abuja Declaration to allocating at least 15% of annual government budgets to health. More than 2 decades later, the extent to which this commitment has been achieved consistently, rather than in isolated years, remains unclear. We assessed recent trends, persistence of attainment, country trajectories and convergence in government prioritisation of health among the original Abuja Declaration endorsers.Methods
We conducted a longitudinal country-level (ecological) panel analysis of 52 original Abuja Declaration endorsers with complete comparable data from 2014 to 2023, supplemented by an analysis of all available data for 2001-2023. Annual data on domestic general government health expenditure as a percentage of general government expenditure were obtained from the World Bank World Development Indicators, drawing on the World Health Organisation Global Health Expenditure Database. Attainment was defined as an expenditure share of at least 15%. We summarised annual and subregional distributions, persistence of attainment and country-specific linear trends. Overall temporal change was examined using country fixed-effects regression with standard errors clustered by country. Exploratory beta- and sigma-convergence analyses, including specifications robust to regression to the mean, assessed whether lower-spending countries improved faster and whether between-country dispersion narrowed. Sensitivity analyses addressed classification thresholds and trend heterogeneity.Results
The unweighted mean government health-expenditure share increased from 6.73% in 2014 to 7.09% in 2023, while the median increased from 5.91 to 6.05%. Only South Africa met the 15% benchmark in 2023. Across the 10-year period, 48 countries (92.3%) never attained the benchmark, 3 (5.8%) attained it occasionally, and only South Africa demonstrated sustained attainment. Southern Africa had the highest mean share in 2023 at 13.79%, whereas Western Africa had the lowest at 5.87%. The average within-country linear trend was small and statistically uncertain at 0.053 percentage points per year (95%CI -0.052 to 0.157; p = 0.316). Country-specific trends varied substantially (standard deviation of slopes 0.32 percentage points per year; p < 0.001). Apparent catch-up by lower-baseline countries (β = -0.382; 95%CI -0.667 to -0.097) was not robust to regression to the mean, and dispersion did not consistently narrow. Over 2001-2023, 47 countries never attained the benchmark and the average within-country trend was 0.012 percentage points per year (95%CI -0.032 to 0.057).Conclusions
Government prioritisation of health among original Abuja Declaration endorsers remained substantially below the 15% benchmark during 2014-2023. More than nine in ten countries never attained the target, and only one demonstrated sustained attainment. This stagnation is long-standing, and since 2001, the continental distribution has barely moved. The Abuja benchmark should be accompanied by stronger accountability mechanisms and complementary measures of absolute spending adequacy, fiscal capacity and financial protection.
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BibTeX
@article{adebisi2026persistent,
title = {{Persistent shortfalls in government health expenditure: a decade-long analysis of Abuja 15% target attainment across 52 African countries, 2014-2023.}},
author = {Muhammed Adeniyi Adebisi and Isaac Olushola Ogunkola and Don Eliseo Lucero-Prisno and Anas Ali Alhur and Quadri Aishat Adeola and Azeezat Fajembola and Goodness Ogeyi Odey and Nafisat Dasola Jimoh and Atunde Ahmed Olarewaju and Luke Alade and Joshua Aluga Gideon and Yusuff Adebayo Adebisi},
journal = {Tropical medicine and health},
year = {2026},
month = oct,
doi = {10.1186/s41182-026-01102-6},
url = {https://europepmc.org/article/MED/42897695},
note = {CC BY},
}
RIS
TY - JOUR
TI - Persistent shortfalls in government health expenditure: a decade-long analysis of Abuja 15% target attainment across 52 African countries, 2014-2023.
AU - Muhammed Adeniyi Adebisi
AU - Isaac Olushola Ogunkola
AU - Don Eliseo Lucero-Prisno
AU - Anas Ali Alhur
AU - Quadri Aishat Adeola
AU - Azeezat Fajembola
AU - Goodness Ogeyi Odey
AU - Nafisat Dasola Jimoh
AU - Atunde Ahmed Olarewaju
AU - Luke Alade
AU - Joshua Aluga Gideon
AU - Yusuff Adebayo Adebisi
PY - 2026
DA - 2026/10/19
JO - Tropical medicine and health
DO - 10.1186/s41182-026-01102-6
UR - https://europepmc.org/article/MED/42897695
AB - Background In 2001, African governments committed through the Abuja Declaration to allocating at least 15% of annual government budgets to health. More than 2 decades later, the extent to which this commitment has been achieved consistently, rather than in isolated years, remains unclear. We assessed recent trends, persistence of attainment, country trajectories and convergence in government prioritisation of health among the original Abuja Declaration endorsers.Methods We conducted a longitudinal country-level (ecological) panel analysis of 52 original Abuja Declaration endorsers with complete comparable data from 2014 to 2023, supplemented by an analysis of all available data for 2001-2023. Annual data on domestic general government health expenditure as a percentage of general government expenditure were obtained from the World Bank World Development Indicators, drawing on the World Health Organisation Global Health Expenditure Database. Attainment was defined as an expenditure share of at least 15%. We summarised annual and subregional distributions, persistence of attainment and country-specific linear trends. Overall temporal change was examined using country fixed-effects regression with standard errors clustered by country. Exploratory beta- and sigma-convergence analyses, including specifications robust to regression to the mean, assessed whether lower-spending countries improved faster and whether between-country dispersion narrowed. Sensitivity analyses addressed classification thresholds and trend heterogeneity.Results The unweighted mean government health-expenditure share increased from 6.73% in 2014 to 7.09% in 2023, while the median increased from 5.91 to 6.05%. Only South Africa met the 15% benchmark in 2023. Across the 10-year period, 48 countries (92.3%) never attained the benchmark, 3 (5.8%) attained it occasionally, and only South Africa demonstrated sustained attainment. Southern Africa had the highest mean share in 2023 at 13.79%, whereas Western Africa had the lowest at 5.87%. The average within-country linear trend was small and statistically uncertain at 0.053 percentage points per year (95%CI -0.052 to 0.157; p = 0.316). Country-specific trends varied substantially (standard deviation of slopes 0.32 percentage points per year; p < 0.001). Apparent catch-up by lower-baseline countries (β = -0.382; 95%CI -0.667 to -0.097) was not robust to regression to the mean, and dispersion did not consistently narrow. Over 2001-2023, 47 countries never attained the benchmark and the average within-country trend was 0.012 percentage points per year (95%CI -0.032 to 0.057).Conclusions Government prioritisation of health among original Abuja Declaration endorsers remained substantially below the 15% benchmark during 2014-2023. More than nine in ten countries never attained the target, and only one demonstrated sustained attainment. This stagnation is long-standing, and since 2001, the continental distribution has barely moved. The Abuja benchmark should be accompanied by stronger accountability mechanisms and complementary measures of absolute spending adequacy, fiscal capacity and financial protection.
SN - 1348-8945
SN - 1349-4147
ER -