A Human-Capital-Driven Strategy to Health Investment in African Small and Island States
Download DocumentDeep Dive Overview
African Small and Island States (S&IS) are defined by their unique vulnerabilities — a narrow economic base, high production costs, and heavy reliance on trade and foreign aid. Despite these challenges, these states often perform comparatively well in health financing, maintaining significantly higher Total Health Expenditure per capita and lower donor dependency than their larger African counterparts. The study focused on 14 S&IS that represent approximately 26% of all African nations but only 1.53% of the continent's total population.
Because S&IS frequently have limited natural resources, they rely heavily on high-quality human capital, making domestic investment in health a critical priority. However, their small population sizes and isolated geographies lead to specific 'small-country problems,' such as high costs for medical products due to a lack of economies of scale, the need for specialised tertiary care unavailable locally, and a disproportionately high burden of non-communicable diseases. Among the S&IS, Mauritius stands out with 26.6 doctors per 10,000 people and publicly funded overseas treatment schemes.
Policy Recommendations
Larger states should prioritise the integration of health services into national insurance schemes to prevent medical costs from pushing households into poverty
Collaborate to overcome small market size. Smaller or mid-sized regions within larger countries can achieve better prices and more stable supplies by joining regional procurement blocks rather than negotiating with manufacturers individually
Larger states can learn to shift health policy from a "social welfare" perspective to a "human capital" framework, recognising that healthier working-age populations significantly boost national economic performance
As an alternative to building expensive tertiary hospitals that may end up undertilised, countries can consider high-quality referral networks and financial assistance for overseas care as a more cost-effective way to achieve Universal Health Coverage
Key Numbers
more government expenditure allocated to health by S&IS
African Small and Island States studied
"doctors per 10
average health expenditure per capita in S&IS
Deep Dive Summary
Investigating how African Small and Island States (S&IS) view health investment as a strategic economic priority, utilising pooled procurement, overseas referral programs, and sin taxes to achieve superior health metrics compared to larger African nations.
Content Type
Case Study
Region
Pan-African
Author
Research Team
Read Time
10 min
Key Findings
Small and Island States allocate approximately 21% more of their general government expenditure to health than larger African states.
S&IS have twice as many doctors per 10,000 people and more than double the hospital beds (21 vs 9 per 10,000) compared to larger states.
Mauritius achieved the highest doctor-to-population ratio (26.6 per 10,000) and hospital bed density (34 per 10,000) among the states studied.
Four of the six African countries that recently increased health coverage while reducing catastrophic spending are S&IS.