So, we all agree: the international response to the Ebola outbreak in West Africa has been lacking, to put it mildly (and some are not putting it so mildly). But this consensus might obscure an even more important conclusion: if the global community had kept their past commitments to Africa we wouldn’t be in the mess we’re in now.
In 2001 the heads of state of most African countries signed the Abuja Declaration, committing themselves to spending 15% of their budget on health. In 2012, WHO figures show that of the three most heavily impacted countries by the current Ebola outbreak only Liberia kept good on its promise (19% – including overseas development assistance channelled through the government). In Sierra Leone health spending was at 12% and in Guinea only 7% of the government budget went to health.
But even countries meeting the Abuja Declaration targets are struggling. Liberia’s admirable level of government spending still only translates into an average total health care expenditure of $35 per capita, well below $60 – the minimum amount the WHO considers necessary to meet essential health needs. Total government revenue is simply too small to finance the country’s health needs. In Liberia, like most low-income countries, the majority of the gap is filled by people paying out of pocket at the point of service delivery. On average the families of patients in low income countries pay 30% of total health costs. For the poorest this poses a devil’s dilemma of having to choose between medical attention and financial ruin. Late treatment is not only generally more expensive, it is also disastrous for preventing the spread of diseases like Ebola or HIV, not to mention for the health of the patient.
In short, the least developed countries are not going to get there on their own, at least not in the short-term. They need “global solidarity” as the WHO puts it in their 2010 World Health Report, in the form of overseas development assistance (ODA). In the 1970s, the wealthy member states of the OECD committed to spending 0.7% (0.1% on health) of Gross National Income on ODA. Today the WHO estimates the gap between that promise and the reality at $200 billion annually. In 2013, only three countries hit that target. In fact, as the WHO puts it, “If countries were to immediately keep their current international pledges, external funding for health in low-income countries would more than double overnight and the estimated shortfall in funds to reach the MDFs would be virtually eliminated.”
Would we need a massive international response in West Africa today if the international community had lived up to their global health commitments? There is strong reason to believe that we would be facing a much more manageable and less costly (both in terms of lives and dollars saved) situation than we are today. But one fact is clear: all but three rich countries have broken their (repeated) promise to the poorer countries of the world. A promise that committed them to giving just one penny of every $1000 to helping their less-fortunate brethren stay healthy.