Diverted Dollars: The Health Impact of Africa’s Debt Crisis

By guest contributors Riya Sawhney, Gabriella Y. Hyman, Nikathan Kumar, Nakul P. Raykar, and Kee B. Park

Africa has a debt problem. At the 79th United Nations General Assembly (UNGA 79), world leaders addressed how Africa’s burgeoning debt challenges prevent the continent from reaching Sustainable Development Goals (SDGs) and the newly-adopted Actions laid out in The Pact of the Future. The continent is teeming with human resources, capital, and profound opportunities for economic growth. Many nations are actively building infrastructure and expanding their workforce. Yet, these strides are overshadowed by a $1.1 trillion debt burden brought on by decades of political and capital strong-arming by “superpower” interests. In addition to financial and political implications, Africa stands to lose $2.4 trillion every yearif health-related SDGs are not met. Diverting scarce resources to repay debt, rather than investing in health, leads to countless avoidable deaths.

Health underpins nearly all crises on the continent. Beyond pandemics, debt-induced underfunding exacerbates food insecurity, housing and education deficits, and forced migration – all of which are intrinsically linked to poorer health outcomes. This compounds losses incurred by inadequate direct health expenditure. Only two African countries’ health spending meets the 15% of government spending target outlined in the Abuja Declaration. The rest of the world spends ten times more on health, and with continued diversion of funds towards debt, Africa’s per capita health expenditure will continue to dwindle. 

While achieving financial independence for these countries is paramount, debt swaps offer an immediate way to provide debt relief and simultaneously increase government investment in health. Programs like the Global Fund’s Debt2Health (D2H) initiative use debt swaps to address development priorities. D2H enables countries to invest in domestic health programs in exchange for debt cancellation by creditor nations. To date, D2H has successfully invested $226 million in health programs, including $79 million in Africa. For example, Spain cancelled €24.1 million in debt owed by Cameroon, under the condition that €9.3 million would be reinvested into Cameroon’s health sector, particularly to support HIV programs. Such financing approaches may alleviate the debt crisis and help channel resources towards health.

World leaders must place economic development of these countries as a top priority and avoid exploiting financial disparities. As signatories of the UNGA 79 Pact for the Future, leaders should also encourage innovative solutions like debt swaps for health. By reimagining financial flows, Africa can use innovative financial instruments to redirect debt repayments towards health systems.

About the authors:

Dr. Sawhney, Dr. Hyman, and Dr. Kumar are Paul Farmer Global Surgery Research Fellows at the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School. Dr. Raykar serves as Fellowship Director, and Dr. Park as the Director of Policy and Advocacy at the PGSSC. The authors have no conflicts of interest to disclose.

Twitter handles:

@RiyaSawhney_

@GabHyman

@NikathanSKumar

@NakulRaykar

@KeePark

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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