Health expenditures, services, and outcomes in Africa: basic data and cross-national comparisons, 1990-1996

This paper presents a broad set of data on health expenditures, services, and outcomes in African countries, as well as examples of how this information can be used. Critical gaps in health information are also discussed with regard to both public and non-governmental provision and financing. The paper identifies a growing differentiation in African country health sector experiences. While the median annual per capita government expenditure on health in Africa was nearly US$6 from 1990 to 1996, it averaged US$3 per capita in the lowest-income countries and US$72 per capita in the middle-income countries. Declines in total fertility rates (TFRs) were much greater in middle-income, lower-fertility countries (25 percent) than in the low- and lowest-income countries (13 and 5 percent, respectively). The paper also reports a reversal in adult mortality trends from 1990 to 1995, with small increases for both males and females. In the course of this study, the relationship between public expenditures on health and key health services was examined, as well as that between health services and health outcomes. Higher public sector health expenditure was associated with higher measles immunization coverage, even after adjusting for levels of gross domestic product (GDP) and female literacy. Three associations were also found between health services and improved health outcomes: measles immunization with childhood malnutrition; contraceptive prevalence with lower infant mortality; and supervised deliveries with lower infant mortality.