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Document Abstract
Published: 2016

Are Africans willing to pay higher taxes or user fees for better health care?

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In many parts of Africa, access to and quality of medical services remain poor. While economic growth in recent decades has fostered improved health care on the continent, weak funding, brain drain of trained professionals, and ongoing battles with diseases such as TB, HIV, diarrheal diseases, and malaria as well as recurring epidemics such as Ebola continue to put immense pressure on medical systems in many countries. Struggling medical systems confront governments and citizens with difficult choices: Needed investment in the medical sector must compete with other priorities, and increasing health spending by cutting other programs may not be a popular or even feasible solution. One alternative may be to raise taxes or user fees in order to increase available funding.
 
In its Round 6 surveys, Afrobarometer asked citizens in 36 African countries whether they would support or oppose paying higher taxes or user fees in order to increase government spending on public health care. This paper describes citizens’ responses and analyzes whether they are correlated with demographic factors, access to health services, and perceptions of health care, government performance, and official corruption.
 
Key findings:
  • on average across 36 surveyed countries, half (49%) of Africans went without medical care at least once in the year preceding the survey. Countries vary widely on this indicator, ranging from 3% in Mauritius to 78% in Liberia and 77% in Togo
  • among Africans who obtained medical care, four in 10 (42%) found it “difficult” or “very difficult” to do so
  • Africans are almost evenly divided on the question of whether to pay higher taxes or user fees in exchange for increased government spending on health care, with 42% in favour and 45% opposed. Only eight of 36 surveyed countries register majority support for such a policy (Madagascar, Mozambique, Senegal, Burkina Faso, Liberia, Mali, Namibia, and Gabon).
  • support for higher taxes/fees in exchange for increased health-care funding is correlated with public trust in the tax department and the president, positive performance evaluations for the president and members of Parliament, and the perception that leaders want to serve the people rather than themselves.
  • perceptions of official corruption and difficulties experienced in obtaining health care, on the other hand, tend to reduce support for higher taxes
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Authors

T. Isbell

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A scientific diagram of the circulatory system, painted on a wall in Dubangat Momicha government-run secondary school, in Ethiopia. The mural indicates the main arteries and veins of the heart.

© 2004 Crispin Hughes, Panos Pictures