New UNAIDS Report Says Debt Crisis Choking Healthcare Funding in Africa

Michael Olugbode in Abuja

Growing public debt is choking sub-Saharan African countries, leaving them with little fiscal room to finance health and critical HIV services, a new report by the Joint United Nations Programme on HIV and AIDS (UNAIDS) has said.

The report noted that that the debt crisis was putting in jeopardy progress made towards ending AIDS on the continent.

It added that sub-Saharan Africa accounts for the largest number of people living with HIV, with more than 25.9 million people of the 39.9 million living with HIV globally.

 The region’s success in having reduced new HIV infections by 56 per cent since 2010 , it stressed, will not be sustained if the fiscal space is constrained.

The report, released ahead of the 79th session of the United Nations General Assembly in New York, showed that the combination of growing public debt payments and spending cuts set out in International Monetary Fund (IMF) agreements in the next three to five years will, if unaddressed, will leave countries dangerously under-resourced to fund their HIV responses.

The UNAIDS Executive Director Winnie Byanyima said: “When countries cannot effectively look after the healthcare needs of their people because of debt payments, global health security is put at risk.

 “Public debt needs to be urgently reduced and domestic resource mobilisation strengthened to enable the fiscal space to fully fund the global HIV response and end AIDS.”

The report said debt servicing now exceeds 50 per cent of government revenues in Angola, Kenya, Malawi, Rwanda, Uganda, and Zambia, adding that even after debt relief measures, Zambia will still be paying two-thirds of its budget on debt servicing between 2024 and 2026.

It said there had been a noted decline in HIV response spending since 2017 in Western and Central Africa, from 0.3 per cent of Gross Domestic Product (GDP) in 2017 to just 0.12 per cent in 2022.

It said Western and Central Africa will need to mobilise $ 4.18 billion to fully fund the HIV response in 2024. This it said will climb to $ 7.9 billion by 2030 unless efforts are scaled up today to stop new HIV infections.

While $20.8 billion was available for the HIV response in 2022 in low and middle-income countries through both domestic and international sources, this funding was not enough to sufficiently finance the HIV response. Western and Central Africa for example had a funding shortfall of 32 per cent in 2022.

In 2024 alone, Eastern and Southern Africa will need to mobilise almost $12 billion to fully fund the HIV response. This amount will climb to around $17 billion by 2030 unless new HIV infections are reduced.

It said to enable increased domestic resource mobilisation for countries to respond effectively to their pandemics, sub-Saharan African countries will need to strengthen their tax systems.

It added that this will include closing tax exemptions which currently cost countries an average of 2.6 per cent of GDP in lost revenue across the region.

According to the organisation, donors need also to scale up financial assistance for health and the HIV response between now and 2030, while creditors should offer debt relief to heavily indebted countries to ease the burden.

Byanyima said: “World leaders cannot let a resource crunch derail global progress to end AIDS as a public health threat by 2030.”