Africa Health and WaSH Futures: Thematic Futures

The report details a strategic scenario for Africa to improve health and demographic outcomes by 2050. Key interventions include increasing modern contraceptive use to 75% in sub-Saharan Africa and 85% in North Africa, reducing mortality for the top five disease types by 20 percentage points, and expanding safely managed water and sanitation access. The scenario also targets a 20% reduction in under-five stunting in 39 countries. These improvements require an additional US$18.9 billion in health spending continentwide, with infrastructure spending peaking at US$4.7 billion per annum in 2037. The model is based on empirical benchmarks from countries like Ethiopia, Malawi, Ghana, and Kenya, and mirrors historical progress in South America and South Asia.

• The scenario aims to significantly increase the use of modern contraceptives by 2050, targeting an average usage rate of 75% in sub-Saharan Africa (a 24 percentage point increase over the Current Path) and 85% in North Africa.
• To reduce the disease burden, the scenario implements a 20 percentage point reduction in mortality rates for the top five disease types in every African country compared to the Current Path, and a 20% reduction in HIV infection rates in nine countries where the rate exceeds 1% of the population.
• The scenario projects a substantial increase in access to safely managed water and sanitation in sub-Saharan Africa by 2050, with average urban access rising from 45% in 2025 to 74%, and rural access rising from 17% in 2050 to 45%.
• The scenario targets a 20% reduction in under-five stunting rates below the 2050 Current Path in 39 African countries that had rates above 20% in 2021, aiming to reduce the number of stunted children from 30 million in 2025 to 12.8 million in 2050.
• Implementing these health improvements requires a 5% increase in health spending, totaling an additional US$18.9 billion continentwide, with annual infrastructure spending peaking at US$4.7 billion in 2037.

APA

Cilliers, J. (2026). Africa Health and WaSH Futures: Thematic Futures. Institute for Security Studies. https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario

Chicago

Cilliers, Jakkie. Africa Health and WaSH Futures: Thematic Futures. Institute for Security Studies, 2026. https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario.

Wikipedia

{{cite report |last1=Cilliers |first1=Jakkie |title=Africa Health and WaSH Futures: Thematic Futures |publisher=Institute for Security Studies |date=29 March 2026 |url=https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario |access-date=17 August 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{cilliers2026africa, author = {Cilliers, Jakkie}, title = {{Africa Health and WaSH Futures: Thematic Futures}}, institution = {Institute for Security Studies}, year = {2026}, month = mar, url = {https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario}, urldate = {2026-08-17}, note = {Indexed by Climate Insights Directory} }