Editor’s Note: Paul Kagame is the President of Rwanda. Bill Gates is co-chair of the Bill & Melinda Gates Foundation. The views expressed in this commentary are their own. View more opinion on CNN.
According to United Nations projections, by the end of this century, Africa will be home to one of every three people on the planet and to five of the world’s 10 largest cities, including the largest – Lagos, Nigeria
What will those cities look like? Will people live in health and prosperity? Will they have access to quality education and good jobs? These are the unknowns, but it is within our power to shape the future we want – and that Africans deserve.
The African Union has a plan to transform the continent and its economy by the year 2063. Success depends on laying the groundwork today with smart investments, especially in health care.
The link between health and economic growth is clear. When people aren’t sick in bed or the hospital, they can go to work. But the wider impact of these investments is not always obvious. For example, over the past two decades, every dollar spent on essential medicines in Africa has generated $20 more in social and economic benefits. Every shot of a vaccine into a child’s arm, it turns out, acts like a shot of adrenaline into the heart of the economy.
To explain, let’s start with an example. At the turn of the millennium, Rwanda, still recovering from a genocide that wiped out nearly 1 million people, was one of the poorest nations in the world. More than one in every 10 babies died before their first birthday, and, according to the World Health Organization, the country ranked 185th out of 191 in terms of life expectancy.
Then the demographics took a sharp turn.
Between 2000 and 2016 (the latest year for which we have data), life expectancy in Rwanda increased almost 20 years. The progress was so rapid that it created a demographic anomaly: Today, the average Rwandan is both older and farther away from the end of his life than in 2000.
This didn’t happen by chance. In the early 2000s, Rwanda established a goal of universal health care for its citizens and, over the next decade, began to train 60,000 community health workers to administer it. To achieve universal coverage, Rwanda increased health expenditure per capita from $10 in 2000 to $53 in 2015.
The result? Today, 90% of the population has access to primary health care, and more than 97% are immunized with basic vaccines. Meanwhile, the country’s GDP has grown at an average annual rate of 8%.
Rwanda isn’t the only country to witness remarkable progress. Over the past 20 years, the number of people dying from HIV in Africa has been cut in half, and malaria-related deaths have fallen by about one-third around the world. Senegal is on track to eliminate malaria from parts of the country, and Ethiopia has managed to cut its child and maternal mortality in half by training tens of thousands of health extension workers.
The continent’s future depends on making even bigger and smarter investments in health. Despite the progress, Africa as a whole still lags behind the rest of the world. Africa accounts for 16% of the world’s population – but 24% of the global disease burden and roughly 50% of child mortality. These numbers are out of proportion, in part, because spending on health is still too low: Africa accounts for just 1% of world health spending.
This is particularly alarming because the health care math also works in reverse: One dollar spent on health care may generate many more in economic growth, but it’s also true that the cost of skimping on health spending is much greater than the savings. Illness is expensive. Malaria, for example, drags down Africa’s GDP growth by up to 1.3% a year. In Nigeria, studies have shown that a 1% increase in the death rate is equal to a 2.5% decrease in economic growth.
There is a role for everyone to play in solving this problem, in partnership with African institutions. After all, one reason Rwanda witnessed such progress is that other nations and organizations substantially increased the amount of health-related foreign aid given to the country after the genocide, while Rwanda created a policy environment focused on results and accountability. The work of organizations like Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria played an important role in helping Rwanda. The same is true for many other nations in Africa and beyond.
Still, the case for foreign aid is much easier to make if the rest of the world knows Africa is investing in its own health, too.
Going forward, the international community will call upon Africa to contribute an increasing share of the funding for the health programs that make such a difference in the lives of citizens. This is as it should be.
In 2001, African Union member states pledged to dedicate at least 15% of their annual budgets to public health. Today, while only three AU member states have met this target, the situation is changing. Between 2000-15, 29 member states increased total health spending. Earlier this month, the African Union resolved to establish a domestic health financing tracker to monitor progress. Better data will help us see what is working, what isn’t – and how we can all work together to achieve more.
All of us have a role to play in making good on our promises to improve health on the continent. Africa’s future depends on it.