SADC and the Abuja Declaration: Honouring the Pledge

The document examines the failure of most SADC member states to adhere to the Abuja Declaration's pledge to allocate 15% of annual budgets to health, noting that by the end of 2018, all member states were struggling to meet this target. It identifies aid dependency and economic decline as primary barriers, while arguing that the COVID-19 pandemic serves as a critical catalyst for overhauling underfunded systems. To bridge funding gaps, the author recommends establishing a SADC regional healthcare fund backed by the African Union, forming public-private partnerships, improving domestic tax compliance, and involving civil society organisations to ensure transparency.

• SADC member states have consistently struggled to meet the Abuja Declaration's 2001 pledge to allocate at least 15% of their annual national budgets to healthcare. While some countries like Botswana, Malawi, Mozambique, Eswatini, and Zambia reached this level for specific periods between 2001 and 2014, and Tanzania met it in 2011, data from the WHO Global Health Expenditure Database indicates that by the end of 2018, all SADC member states were failing to meet the target.
• A primary reason for the failure to meet the 15% target is a heavy reliance on external aid to cover expenditure in various sectors, including health. In some countries, such as Zambia, this dependency is compounded by austerity measures implemented to reduce national debt burdens, which further hinders the ability to allocate public funds sustainably.
• The COVID-19 pandemic highlighted severe historical gaps in SADC healthcare, including high morbidity and mortality rates, insufficient drug supplies, underinvestment in infrastructure, poor retention of medical professionals, and the prevalence of HIV/AIDS. Despite these weaknesses, the pandemic is viewed as a 'wake-up call' and an opportunity to inform strategic investments to build more resilient systems.
• Economic conditions in the SADC region are deteriorating, with the region facing an external debt burden exceeding 99% of GDP. The World Bank projected that sub-Saharan Africa would enter an economic recession in 2020, with growth rates declining from 2.4% in 2019 to between -2.1% and -5.1% in 2020, further limiting the capacity of governments to fund healthcare.
• To address funding shortfalls, the document proposes several innovative mechanisms: the creation of a SADC regional healthcare fund backed by the African Union to allow member states to borrow against budget shortfalls; the use of health public-private partnerships (PPPs) to leverage private sector expertise and resources; and the strengthening of domestic resource-generation, such as improving tax compliance.
• The author recommends involving civil society organisations (CSOs), such as Amref Health Africa and EQUINET-Africa, in health-financing policy and priority-setting. This involvement is intended to increase operational transparency, build trust in government decision-making, and improve adherence to health-financing measures.

APA

Bwalya, J. (2021). SADC and the Abuja Declaration: Honouring the Pledge. South African Institute of International Affairs. https://saiia.org.za/wp-content/uploads/2021/03/Policy-Briefing-230-bwalya.pdf

Chicago

Bwalya, Jack. SADC and the Abuja Declaration: Honouring the Pledge. South African Institute of International Affairs, 2021. https://saiia.org.za/wp-content/uploads/2021/03/Policy-Briefing-230-bwalya.pdf.

Wikipedia

{{cite report |last1=Bwalya |first1=Jack |title=SADC and the Abuja Declaration: Honouring the Pledge |publisher=South African Institute of International Affairs |date=February 2021 |url=https://saiia.org.za/wp-content/uploads/2021/03/Policy-Briefing-230-bwalya.pdf |access-date=23 October 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{bwalya2021sadc, author = {Bwalya, Jack}, title = {{SADC and the Abuja Declaration: Honouring the Pledge}}, institution = {South African Institute of International Affairs}, year = {2021}, month = feb, url = {https://saiia.org.za/wp-content/uploads/2021/03/Policy-Briefing-230-bwalya.pdf}, urldate = {2026-10-23}, note = {Indexed by Climate Insights Directory} }