Medical costs push 150 million people into poverty in Africa every year

Out-of-pocket medical costs push 150 million people into poverty every year in Africa, the United Nations Economic Commission for Africa (ECA) has warned.

The warning came at the opening of the 76th Session of the World Health Organization (WHO) Regional Committee for Africa, held at the Adwa Museum under the theme, “Roots and Wings – Heritage Meets Digital Health.”

The ECA said rising debt payments are crowding out health spending in Africa’s poorest countries, noting that the continent’s health sector faces not only a financing gap but also a confidence gap.

“Confidence, unlike capital, cannot be borrowed but must be built,” the commission said.

Speaking on behalf of ECA Executive Secretary Claver Gatete, his Chief of Staff, Aboubakri Diaw, told health ministers at the opening of the conference in Addis Ababa that the situation was deeply concerning across the continent.

The session was opened by Ethiopia’s President Taye Atske Selassie, alongside African Union Commission Chairperson Mahmoud Ali Youssouf, WHO Director-General Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa, Mohamed Yakub Janabi.

To illustrate the human cost, Diaw described “Amina”, a composite small-business owner who delays seeking medical care because of the cost, only to later face bills that force her to sell equipment and cut jobs.

“What began as one person’s illness has become a household financial crisis… and, when repeated across millions of families, a macroeconomic problem,” he said.

Diaw identified three converging pressures: external health assistance has fallen by almost 30 per cent, while debt servicing now exceeds health spending in the median low-income country; out-of-pocket payments account for an average of 35 per cent of health expenditure across the region, above the WHO benchmark of 20 per cent; and national health strategies often remain uncosted and unsequenced, making financing harder to attract.

To close the gap, he said the ECA was asking governments to make three shifts.

“First, health ministries should bring finance ministries a quantified investment case, not just a request, tied to productivity and growth.

“Second, countries should replace fragmented plans with one politically endorsed national health-financing compact spanning health, finance, planning, revenue, debt, insurance and private-sector actors.”

He warned that putting more money into a fragmented system could simply finance greater fragmentation.

Diaw said governments should also match financing instruments to their fiscal circumstances, adding that credible national compacts could help turn financing into transformation.

Early data from ECA’s adopter countries shows that health receives only 5 to 9 per cent of national budgets, while out-of-pocket payments can account for as much as 64 per cent of health spending.

The work is being carried out under ECA’s African Initiative on Transforming Health Financing, launched in Tangier in April 2026.

Diaw also urged governments to treat digital health as financing infrastructure, noting that fewer than a third of health systems in low-income settings can track spending digitally in real time.

He described this as one of the fastest opportunities to improve efficiency and transparency in public health financing.

Diaw cited Ethiopia’s digital health drive under Prime Minister Abiy Ahmed, the AU’s AI and Digital Health Champion, as a model for tracing every birr or franc from budget to patient.

He said this could transform digital health from “a project” into “a financing revolution.”

Diaw said the ultimate measure of success would not be government declarations but whether people like Amina could seek medical care early without losing their livelihoods.

“Health is not what we spend when Africa grows. Health is how Africa grows. ECA stands ready to help turn this ambition into financed, measurable action,” he said.