Africa is home to 1.5 billion people, about 18.3 percent of the world’s population, but accounts for 69 percent of all global maternal deaths and nearly 60 percent of deaths of children under the age of five. The majority of these deaths are preventable.
The continent is also home to nine of the 10 countries with the highest maternal mortality rate globally. Children in Africa have the lowest chance of survival globally, accounting for about 2.9 million deaths yearly and the average maternal mortality rate for the continent is as high as 1,000 for every 100,000 live births.
These challenges are compounded by a multiplicity of factors, including low coverage and quality of essential health interventions caused by dysfunctional health systems and under-resourced health workforce, conflated with conservative gender norms and financial constraints.
Low funding for the health sector remains a great challenge. In fact, domestic public spending on health has declined as a priority in low-income countries over the past decade, leaving individual households paying out of pocket. Direct payments at point of care accounted for a third (32.9 percent) of total health expenditure in Africa in 2021.
In the same year, African countries spent only 7.3 percent of their national budgets on health care.
Despite country commitments towards the Abuja Declaration, requiring 15 percent of Gross Domestic Product allocated towards the health sector, only two out of 55 African countries were able to meet this target in 2021.
This is a result of limited fiscal space, further reduced by rampant inflation and heavy external debt management. In 2024 alone, African countries will pay out $163 billion just to service debts, an increase of over $100 billion since 2010.
Despite this confronting reality, there is hope. There is possibility of scaling up low-cost and life-saving maternal and newborn interventions on the African continent. An investment of just $1.15 per person per year can reduce 71 percent of neonatal deaths, 33 percent of stillbirths, and 54 percent of maternal deaths.
While $1 spent on interventions for reproductive and maternal, newborn and child health would return $9 to $20 in economic and social benefits as a result of lower morbidity and mortality by 2035.
At this turning point in Africa's future, there exists a great potential to realise a demographic dividend by 2050, expanding the workforce, increasing human capital, and driving significant growth. Nowhere in the world are children and adolescents more central to a continent’s future than in Africa, where the child population is due to reach 1 billion by 2050, the highest of all regions.
West and Central Africa face some of the highest challenges in adolescent well-being, with six of the 10 countries with the highest prevalence of child marriage located in this region. Evidence shows that investing in interventions to reduce child marriage can yield a return of $25.90 for every dollar spent.
Likewise,18 of the 27 African countries practising Female Genital Mutilation (FGM) are in the West and Central African region, and interventions to reduce FGM offer returns of $10.10 for every dollar invested.
The cost of inaction, morally and economically, is too large to ignore.
Looking to the source
The need for investment is clear. But how do African leaders get there? There is a need to rethink the long-favoured financing models that silo funds and fragment resources. Traditional development aid mechanisms used to fund health programmes have proven they are no longer fit-for-purpose and unable to confront the complex global health challenges of today.
The 77th World Health Assembly Resolution on Maternal, Newborn and Child Mortality, led by Somalia and co-sponsored by 11 African States, made the historic call to accelerate equitable access to integrated primary health care services and necessary domestic budgetary support and oversight.
Highlighting that 50percent of maternal and newborn deaths occur in fragile contexts, with a heavy toll in the African region, the resolution further stresses the need for urgent international cooperation towards investments where they are most needed.
Finally, the global health and development community, shepherded by African leaders, must push for multilateral organisations to support and negotiate debt relief for low- and middle-income countries, especially from private lenders. Debt relief remains essential for vulnerable countries to protect their people and avoid further economic hardship, as global challenges build.
There is no time to waste. Failure to invest in the health of our women, children and adolescents now is failing their future. Each moment missed without action is another life at risk.
The writer is Executive Director, Partnership for Maternal, Newborn & Child Health (PMNCH) [email protected]