Africa’s Abuja Declaration: The urgent call for healthcare reform and why it matters now

In 2001, leaders from 53 African countries met in Abuja, Nigeria, and made a big promise: they would spend at least 15% of their national budgets on healthcare. This promise, called the Abuja Declaration, was meant to transform healthcare across the continent. But 23 years later, most countries, including Nigeria, haven’t kept their promise, leaving millions of people without proper healthcare.

For example, in 2023, Nigeria spent only 5.75% of its budget on healthcare, far from the 15% goal. This means that many people, especially in rural areas, struggle to get the care they need. In places like Damagaza, a village in Abuja, mothers wait for hours with sick children, but the clinic has hardly any medicine or supplies. There is no electricity sometimes, so the nurse has to work by the light of lanterns. The only nurse working that day, Godiya Ishaku, says she often has to make do with what little they have. She uses pieces of cloth for bandages and cleans wounds with salt and water. She says, “Every day, I am forced to make difficult choices. Do we help this mother or that child? Our resources are never enough.”

This is just one example of how healthcare workers across Africa are fighting to make a difference, but often feel betrayed by their governments. While some countries are doing better, like Rwanda, which uses community health workers to prevent disease and improve care, many others are still struggling.

The Abuja Declaration’s promise is falling short, and experts say that simply aiming for 15% of national budgets is no longer enough. Instead, African countries need to focus on targeted, smart investments that meet their specific needs. Michael Okoh, a health economist, suggests that African countries should use zero-based budgeting, meaning they should spend based on actual needs rather than past budgets.

One of the biggest issues is corruption. Too often, health funds are mismanaged or taken for personal gain. Maimuna Abdullahi, a health economist, says, “Countries like Rwanda have succeeded because they have transparent systems that ensure funds are used as they should be.” Without accountability, even large budgets won’t make a difference.

To fix this, experts like Oyewale Tomori, a virology professor, are calling for a “New Abuja Vision”. This could include things like national health insurance and better tax policies to generate money for healthcare. He believes these changes would reduce the reliance on foreign aid, which has been a big problem during COVID-19.

Countries like Rwanda, Malawi, and Ethiopia have shown that even with smaller budgets, focusing on primary healthcare and community health programs can make a huge difference. These programs help prevent diseases before they become big problems and reduce pressure on hospitals.

As African leaders met again in February 2023 to revisit the Abuja Declaration, they renewed their commitment to improving healthcare. But the road ahead is still tough. More than 20 countries still depend on donors for over 20% of their healthcare budgets.

Ayodele Adetunji, a public health expert, says, “We cannot keep leaving the health of Africans to chance. It is a moral failure, a governance failure, and an economic mistake.” The question now is not whether to meet the 15% target, but how to make sure that money is spent wisely and gets to the people who need it most.

To truly make a change, African governments need to be transparent, track spending, and focus on investing smartly. Only then will the Abuja Declaration become more than just a promise, but a real force for change in African healthcare.