Article Text

Download PDFPDF

Trends and drivers of government health spending in sub-Saharan Africa, 1995–2015
  1. Angela E Micah,
  2. Catherine S Chen,
  3. Bianca S Zlavog,
  4. Golsum Hashimi,
  5. Abigail Chapin,
  6. Joseph L Dieleman
  1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Angela E Micah; amicah{at}


Introduction Government health spending is a primary source of funding in the health sector across the world. However, in sub-Saharan Africa, only about a third of all health spending is sourced from the government. The objectives of this study are to describe the growth in government health spending, examine its determinants and explain the variation in government health spending across sub-Saharan African countries.

Methods We used panel data on domestic government health spending in 46 countries in sub-Saharan Africa from 1995 to 2015 from the Institute for Health Metrics and Evaluation. A regression model was used to examine the factors associated with government health spending, and Shapley decomposition was used to attribute the contributions of factors to the explained variance in government health spending.

Results While the growth rate in government health spending in sub-Saharan Africa has been positive overall, there are variations across subgroups. Between 1995 and 2015, government health spending in West Africa grew by 6.7% (95% uncertainty intervals [UI]: 6.2% to 7.0%) each year, whereas in Southern Africa it grew by only 4.5% (UI: 4.5% to 4.5%) each year. Furthermore, per-person government health spending ranged from $651 (Namibia) in 2017 purchasing power parity dollars to $4 (Central African Republic) in 2015. Good governance, national income and the share of it that is government spending were positively associated with government health spending. The results from the decomposition, however, showed that individual country characteristics made up the highest percentage of the explained variation in government health spending across sub-Saharan African countries.

Conclusion These findings highlight that a country’s policy choices are important for how much the health sector receives. As the attention of the global health community focuses on ways to stimulate domestic government health spending, an understanding that individual country sociopolitical context is an important driver for success will be key.

  • government health spending
  • sub-Saharan Africa
  • domestic health spending
  • government health expenditure

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Handling editor Seye Abimbola

  • Contributors AEM conceived of the study and wrote the first draft of the article. JD and AEM managed the implementation of the analytical strategy. JD reviewed and provided critical feedback on several drafts of the manuscript. CSC and BSZ conducted the analysis. JD, AC and GH managed the research project. All authors read and approved the final manuscript.

  • Funding This research was supported by the Bill & Melinda Gates Foundation.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets generated and/or analysed in the current study are available in the Institute for Health Metrics and Evaluation Global Health Data Exchange repository,

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.