Implementing programmes and measures that promote social integration requires hu
man and financial resources. Such programmes may include strategies that address intra
regional disparities; inequalities due to gender, income, ethnic, disability and age differ
ences; among many. Data on resources spent specifically on social integration activities is not readily available; it is included in the data on resources spent for the whole sector.
For example for the education sector, analysis of resources spent promoting social integra
tion would focus on the disaggregated expenditure data on activities to promote access of vulnerable groups (for example persons with disability, girls, OVC, and ethnic minorities) to education. This section reviews government expenditure on health and education as a proxy of government's commitment to promoting social integration.
Public expenditure on health as a percentage of total expenditure on health has been low and varies across the countries (See table 3.5). Although most African governments have increased their expenditure on health since 1991, the proportion of government expenditure on health to total expenditure is still low in most countries. As of 2006, only five countries: Niger, Botswana, Burkina Faso, Rwanda, and Malawi had achieved the expenditure level of 15 per cent agreed upon by African Heads of States in Abuja, in 2001.
Seventeen African countries were allocating between 10 and 15 per cent of government expenditure to health. On the other hand, 8 African countries allocated less than 5 per cent of Government expenditure to health.
Table 3.5
Government Health Expenditure as a percentage of total government expenditure 2006
Level of public health expenditure
(% total expenditure)
Countries
15 per cent or more Niger, Botswana, Burkina Faso, Rwanda, Malawi
10-15 per cent Algeria, Benin, Central African Rep., Cape Verde, Chad, Djibouti, Ethiopia, Gabon, Gambia, Mali, Mozambique, Namibia, Sao Tome Principe, Senegal, Swaziland, Tanzania, Zambia
5-10 per cent Angola, Cameroon, Comoros, Congo, DRC, Equatorial Guinea, Kenya, Lesotho, Liberia, Libya, Madagascar, Mauritania, Mauritius, Seychelles, Sierra Leone, Togo, Tunisia, Uganda, Zimbabwe, Sudan, Egypt, S.
Africa,
<5 per cent Burundi, Cote dlvoire, Eritrea, Nigeria, Guinea, Ghana, Guinea Bissau, Morocco
Source: WHO, 2009
The African Social Deveiopment Report 2009
Public expenditure on health as a per cent of GDP is low in Africa ranging from 2.1 per cent to 12.9 per cent. Every high-income country spends at least 5 per cent of its GDP on public health care (WHO, 2006a). In 2006 twenty nine African countries allocated more than 5 per cent of their GDP on public health as shown in table 3.6. This is a major improvement from 2003 where only two African countries (Sao Tome and Principe, and Namibia) allocated more than 5 per cent of their GDP on public health (WHO, 2006a).
Table 3.6
Government Health Expenditure as a percentage of GDP 2006
Level of public health expenditure
(% GDP)
Countries
>10 per cent Malawi, Rwanda,
>5-10 per cent Botswana, Burkina Faso, Burundi, DRC, Djibouti, Egypt, Gambia, Ghana, Guinea, Guinea-Bissau, Lesotho, Mali, Morocco, Mozambique, Namibia, Niger, Sao Tome and Principe, Senegal, Seychelles, South Africa, Swaziland, Togo, Tunisia, Uganda, Tanzania, Zambia, Zimbabwe
>2.5-5 per cent Angola, Benin, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Eritrea, Ethiopia, Gabon, Kenya, Liberia, Madagascar, Mauritius, Nigeria, Sierra Leone, Sudan
2.5 per cent or less Congo, Cote divoire, Equitorial Guinea, Libya, Mauritania Source: WHO, 2009
However addressing health inequities requires more resources since some of the actions that promote social integration demand human and financial resources. These strategies include (a) measures that improve geographical access such as expansion of basic or essen
tial health packages; expansion of health services to rural and remote areas; expansion and integration of community level health services; and (b) measures that improve financial access such as expansion of national health insurance; promotion of community based health insurance schemes; targeted fee exemptions at public facilities; free primary health care and reproductive health services to improve utilization of health services by the poor (EGA, 2009d). Overall it is important that countries improve their public spending on health in order to promote social inclusion especially for primary health care. It is also important that further research is undertaken to identify all the actions needed to social integration in health and the costs that are required.
Government expenditure on education as a percentage of total government expenditure is higher than government expenditure on health and varies widely across countries from a high of 29.8 per cent in Lesotho to 4 per cent in Equitorial Guinea as shown in figure 3.1. Government spending on education has increased since 1990 in most of the countries with data and these increases in spending have been associated with substantial progress towards achieving Education For Ail goals. For example Ethiopia, Kenya, Mozambique and Senegal have sharply increased the government spending on education and each has seen a significant decline in the number of out-of-school children (UNESCO, 2009).
Placing Social Integration at the Centre of Africa's Development Agenda
Nevertheless despite the higher level of funding on education when compared to health, UNESCO 2009 argue that developing countries are mot spending enough on basic edu
cation to address the deep and persistent disparities to education that include wealth, gender, location, ethnicity, disability and other sources of inequities.
Figure 3.1
Public expenditure on education as a percentage of total government expenditure in 2007
Source: UNDP, 2009 Note: Missing countries had no data.
Data on government expenditure on education as a percentage of GDP shows that most of the countries with data allocate 5 per cent or less of the share of income to education.
This is not sufficient to promote strategies that ensure the achievement of equity for all in education that can benefit the most vulnerable and disadvantaged groups. It is crucial that governments allocate adequate resources that can help break the cycle of disadvantage, improve access, raise quality and enhance participation; actions that contribute to the achievement of social integration.
The African Social Deveiopment Report 2009
Table 3.7
Government Expenditure on Education as a percentage of GDP 2006
>10 per cent Lesotho
>5-10 per cent Botswana, Burundi, Cape Verde, Djibouti, Ethiopia, Ghana, Guinea-Bissau, Kenya, Morocco, Mozambique, Namibia, Sao Tome and Principe, South Africa, Tunisia
>2.5-5 per cent Angola, Benin, Burkina Faso, Cameroon, Comoros, Egypt, Gabon, Libya, Madagascar, Malawi, Mali, Mauritania, Mauritius, Rwanda, Senegal, Seychelles, Sudan, Togo, Uganda, Zambia, Zimbabwe 2.5 per cent or less Central African Republic, Chad, Congo, Cote d'lvoire, Equitorial
Guinea, Guinea, Eritrea, Gambia, Sierra Leone, Swaziland, Tanzania, Source: UNDP, 2009