The Effectiveness of Official Development Assistance in the Health Sector in Africa

On an average, life expectancy at birth in several sub-Saharan African countries is below 50 years, whereas it is at least 70 years in developed nations. The maternal mortality ratio per 100,000 live births is more than 500 in several African countries compared to a ratio of less than 10 mortalities per 100,000 live births in developed countries. African health systems are underfunded, understaffed, overstretched and poorly equipped, making it seriously challenging to address the triple disease burden of communicable and non-communicable diseases and pandemics such as Ebola and COVID-19. According to the recent statistics of the WHO Africa has recorded approximately 25% of the world’s disease burden while – alarmingly – its share of global health expenditure is less than 1% and the continent houses only 3% of global health workers. It manufactures less than 2% of the medicines consumed in Africa. Most Africans, including those in the middle-income category, depend on underfunded public health facilities and only a very small elite minority can afford access to well-funded private health care.

In April 2001, heads of the state of African Union countries met in Abuja and committed to set a target of apportioning at least 15% of their annual budget to improving the health sector. Simultaneously, the African Union appealed to donor countries to their commitment to meeting the target of 0.7% of their GNP as official Development Assistance for developing countries. The Abuja declaration drew the attention of the entire world to the shortage of resources for improving health care in Africa. However, 20 years later, very few African countries have met this commitment.

With the commencement of the millennium development goal in 2000 until its end in 2015, despite substantial progress, several assessments and evaluation reports have consistently shown that performance on many health indicators is still lagging. Several challenges were enumerated, including weak institutional capacity; inadequate internal and external resources allocated to achieving the millennium development goals (MDGs); poor human resources; weak institutional capacity; inadequate statistical health data; and inadequate monitoring and evaluation capacity.

To streamline international development efforts, the international community launched in New York on 25 September 2015 the Sustainable Development Goals (SDGs) of the United Nations 2030 Agenda for Sustainable Development. This major development framework is built on an approach different than the preceding MDGs and is more universal in scope, with an emphasis on local adaptation and an accent on sustainability, while looking to expand integration across actors and domains for attaining results.

The results of this case study on Uganda have emphasized on the governance and accountability system of the recipient country that includes establishing an accountable health management system framework, an appropriate role delineation policy for various levels of health facilities, a transparent process of procuring health commodities and clear anti-corruption policies with an effective law enforcement mechanism as the main prerequisite for ODA effectiveness and sustainable development at large.

This book also includes an expansion on providing in Chaps. 2 and 3, a detailed critical analysis on the theoretical frameworks on development and International Consensual Development Frameworks, commonly called the Global Agenda or Platform for Action, respectively. The aid management has been at the heart of various economic development theories since academics believe that recipient countries and donor countries can strengthen their co-operation with an appropriate model. Modernization, world systems, international dependency, neoclassical growth, basic needs model, the concept of gross national happiness and human development are some of the theories that have been reviewed in this study, because they provide insight into the aid management and its associated challenges in Africa.

I encourage all of you to read and disseminate this research work that represents another step in our collective efforts in promoting the achievement of sustainable development goals in Africa.

Dr Cyriaque Rene Sobtafo Nguefack