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Why commitment to the Abuja Declaration is necessary during COVID-19


The COVID-19 pandemic has proven just how important strong health systems and both patient and healthcare worker safety is. With World Patient Safety Day falling on 17 September during a global health crisis, the gaps in our health systems are more apparent now than ever before.

At its core, World Patient Safety Day “calls for global solidarity and concentrated action by all countries and international partners to improve patient safety.” The current pandemic, unfortunately, has “unveiled the huge challenges health workers are facing globally” — but it has also led to a focused prioritization of healthcare worker safety to ultimately ensure patient safety.

Prioritizing the safety of those in the system, however, is just one part of the solution. To successfully fight COVID-19, countries must commit their governments and funding to strengthening their health systems. The Abuja Declaration does just that for African Union nations. But now in the midst of a global pandemic, countries and leaders in the African Union must step up to ensure that they are fully committed to upholding the demands of the declaration.

Here’s a look at why.

Why the Abuja Declaration exists

The Abuja Declaration was formed in 2001 following a pledge made by AU countries to allocate “at least 15% of [the] annual budget to improve the health sector.” The declaration also “urged donor countries to scale up support.”

The most recent year for which data is available on the Abuja Declaration is 2011, which found that by August, only Tanzania “achieved the Abuja Declaration target of  ‘at least 15%,’” while 11 countries “reduced their relative contributions of government expenditures to health during the period.” And in 2020, Nigeria allocated only 4.1% of its total expenditure to health. Unfortunately, even with the addition of a COVID-19 related budget, the total ratio of expenditure to health rose only to 7%, less than half of the original commitment. With 55 member states in the African Union, that is not enough.

In 2016, a WHO report found that a number of African governments spent “less than 40% of health service expenditure on primary care.” Funding from external and private parties covers the rest. Another WHO report found that in 2017, 20 sub-Saharan African countries relied on donor funding to account for “more than one-fifth of their health spending.” The necessary investments from governments into their own health systems is not happening.

Now, with a global pandemic in full effect, these shortcomings are exacerbated even more.

COVID-19 has brought to light just how unprepared so many countries around the world were to respond to a health crisis of this size. Specifically in Africa, the pandemic “revealed the acute shortage of critical and lifesaving equipment such as ventilators and intensive care beds.” Coupled with a lack of government funding going towards primary care, the effects of the pandemic could be even worse.

Despite overall lower confirmed cases of COVID-19 in Africa compared to Europe and North America, the pandemic is still having devastating effects on the continent, increasing poverty and hunger levels.

But with proper funding and investment in long-term preparedness, these effects can be mitigated.

The need to re-commit

Although COVID-19 has presented a number of challenges, it also provides a unique opportunity for countries and governments to invest in long-term preparedness and re-commit to policies and declarations designed to do so, like the Abuja Declaration.

Right now, many countries are responding to this pandemic in a very cyclical way. Like we saw with previous health crises like SARS, Zika, MERS, and Ebola, funding is made available during the crisis, but as soon as it ends, both funding and attention shift. The result is an under prepared response system to any future health crises.

To mitigate these impacts, all countries in the world must step up their compliance with International Health Regulations to have a strong response to COVID-19, and must provide financial support to low-income countries that have the greatest need to fund their health systems now and in the future. The ultimate goal is to invest in long-term preparedness so when another health crisis of this scale happens again, every country will be ready to effectively respond. That’s why for African Union nations, recommitting to the Abuja Declaration is necessary.

The commitment asked of the Abuja Declaration is an investment in the future. Although a number of countries within the African Union stand out for their proactive response to COVID-19, that is not enough. Every country within the union must fully commit to allocating at least 15% of its annual budget via the Abuja Declaration to invest in health systems. Doing so ultimately ensures patient safety and healthcare worker safety worldwide in the midst of the pandemic, and ensures that countries are adequately prepared to respond when a crisis like this happens again.

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