HIVAIDS in subSaharan Africa July 2002 01 July
HIV/AIDS in sub-Saharan Africa July 2002 01 July 2002 slide number SSA-1
• • • Trends in the HIV/AIDS Epidemic Different Sectors of the Population HIV/AIDS and Youth Impact of HIV/AIDS Knowledge and Behavior Success Stories 01 July 2002 slide number SSA-2
Trends in the HIV/AIDS Epidemic 01 July 2002 slide number SSA-3
HIV prevalence in adults in sub-Saharan Africa, end 2001 20 – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region 01 July 2002 slide number SSA-4
HIV prevalence in adults in sub-Saharan Africa, 1986 -2001 1986 20 – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region 01 July 2002 slide number SSA-5 1996 1991 2001
Millions Number of people living with HIV/AIDS in sub-Saharan Africa, 1980 -2001 30 25 20 15 10 5 0 1983 Source: UNAIDS, 2002 01 July 2002 slide number SSA-6 1989 1992 1995 1998 2001
Thousands Number of people who died from HIV/AIDS in sub-Saharan Africa, 1980 -2001 2, 500 2, 000 1, 500 1, 000 500 0 1983 Source: UNAIDS, 2002 01 July 2002 slide number SSA-7 1986 1989 1992 1995 1998 2001
HIV prevalence among pregnant women in South Africa, 1990 to 2001 HIV prevalence (%) 30 25 20 15 10 5 0 1990 ‘ 91 ‘ 92 ‘ 93 ‘ 94 ‘ 95 ‘ 96 ‘ 97 ‘ 98 ‘ 99 2000 ‘ 01 Source: Department of Health, Republic of South Africa 01 July 2002 slide number SSA-8
Estimated adult HIV prevalence in Kenya, 1990 -1999 16 HIV prevalence (%) 14 12 10 8 6 4 2 0 1990 91 92 93 94 95 Source: National AIDS and STD Control Programme, 1999 and UNAIDS 01 July 2002 slide number SSA-9 96 97 98 1999
Kenya: HIV prevalence for adults and pregnant women HIV prevalence (%) Major urban and outside major urban areas 50. 0 Urban 40. 0 Outside Urban 30. 0 Median (Urban) 20. 0 Median (Outside Urban) 10. 0 UNAIDS Adult Prevalence 0. 0 1985 1990 1995 2000 Year Source: 1 UNAIDS/WHO Epi Country Fact Sheets 2001. 2 U. S. Census Bureau Database 01 July 2002 slide number SSA-10
Senegal: HIV prevalence for pregnant women Major urban and outside major urban areas 3. 2 Urban HIV Prevalence, (%) 2. 8 Outside Urban 2. 4 Median (Urban) 2. 0 Median (Outside Urban) 1. 6 UNAIDS adult prevalence 1. 2 0. 8 0. 4 0. 0 1985 1990 1995 Year Source: 1 UNAIDS/WHO Epi Country Fact Sheets 2001. 2 U. S. Census Bureau Database. 3 Conseil National de Lutte Contre le SIDA, Republique du Senegal 01 July 2002 slide number SSA-11 2000
HIV prevalence rates among pregnant women attending antenatal clinics in urban sites in Cameroon: 1989 -2000 20. 0 18. 0 % HIV-positive 16. 0 14. 0 Bamenda 12. 0 Limbe 10. 0 Yaounde 8. 0 6. 0 Garoua 4. 0 2. 0 0. 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Source: National AIDS Programme, Cameroon (1989 -2000). Data compiled by the US Census Bureau 01 July 2002 slide number SSA-12
Jun Jul Aug 1998 Source: WHO/UNAIDS, 2002 01 July 2002 slide number SSA-13 Apr 2000 re Me r a an d Ci pl Fu rth er d isc ice pr er rth nw ith us sio ct io ns b du er ro ffe y. B MS Ug an da n ed uc tio Ph ar to aw ith in 0 Fu 2, 000 pl ao Ne go 4, 000 Ci tia tio 6, 000 fp ric R& n 8, 000 wi th La Price US$ 10, 000 D un ch 12, 000 m of AA I 14, 000 ck th e. A AI Prices (US$/year) of a first-line antiretroviral regimen in Uganda: 1998 -2001 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 2000 2001 2001
Different Sectors of the Population 01 July 2002 slide number SSA-14
HIV prevalence among people consuming alcohol and among non-drinkers, Carletonville, South Africa, 1998 70 HIV prevalence (%) 60 drinkers non-drinkers 50 40 30 20 10 0 men Source: Campbell et al. (unpublished data) 01 July 2002 slide number SSA-15 women in commercial sex areas
HIV prevalence rate and frequency of sexually transmitted infection (STI) episodes, Carletonville miners, South Africa, 1991 -1998 HIV prevalence (%) 90 70 50 30 10 1 2 -4 5 -9 Number of STI episodes Source: Ballard R, 2000 (unpublished data). 01 July 2002 slide number SSA-16 10+
Percentage of workforce lost to AIDS by 2005 and 2020 in selected African countries 50 2005 2020 40 20 10 Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs, Population Division (1998) World Population Prospects: the 1998 Revision 01 July 2002 slide number SSA-17 Zimbabwe United Rep. of Tanzania Togo South Africa Nigeria Mozambique Guinea-Bissau Ethiopia Cote d’Ivoire Central African Republic Cameroon 0 Botswana % 30
HIV prevalence in military personnel in Africa l Nigeria: 11% among peacekeepers returning from Sierra Leone and Liberia vs 5% in adult population l South Africa: 60 -70% in military vs 20% in adult population Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail & Guardian, Pretoria, March 31, 2000; UNAIDS/WHO 1999 estimate 01 July 2002 slide number SSA-18
HIV prevalence by self-reported urban/rural residence among ANC attendees aged 15 -24, Zimbabwe 2000 50 Percent 40 30 20 10 0 Rural (n=1753) p = 0. 8 Place of Usual Residence Source: Ministry of Health and Child Welfare, Zimbabwe 01 July 2002 slide number SSA-19 Urban (n=1544)
120 25 new AIDS cases medical spending 100 20 80 15 60 10 40 5 20 0 1989 90 91 92 93 94 95 96 1997 Source: Rugalema et al. HIV/AIDS and the commercial agricultural sector of Ken UNDP/FAO, 1999 01 July 2002 slide number SSA-20 0 Medical expenditure (KSh millions) Number of newly diagnosed AIDS cases Newly diagnosed AIDS cases and medical expenditure on an agricultural estate in Kenya, 1989 to 1997
Condom use among men with non-regular partners over time in selected sub-Saharan African countries: 1994 -2000 60 Malawi Tanzania 50 % Uganda Zambia 40 30 20 1994 1995 1996 1997 1998 1999 Source: Macro International (1994 -2000) Demographic Health Surveys; Measure Evaluation 01 July 2002 slide number SSA-21 2000
HIV prevalence by educational level among ANC attendees aged 15 -44, Zimbabwe, 2000 50 Percent 40 30 20 10 0 None (n=154) p<0. 01 Primary (n=1769) (n=3718) Education Level Source: Ministry of Health and Child Welfare, Zimbabwe 01 July 2002 slide number SSA-22 Secondary Tertiary (n=9)
HIV/AIDS and Youth 01 July 2002 slide number SSA-23
Prevalence among pregnant women in major urban areas, Uganda 35 Prevalence 30 25 20 15 10 5 0 1985 86 87 88 89 90 Source: Uganda National AIDS Programme 01 July 2002 slide number SSA-24 91 92 93 94 95 96 97 98 99 2000
HIV prevalence by age among ANC attendees, Zimbabwe 2000 50 Percent 40 30 20 10 0 15 -19 20 -24 25 -29 30 -34 n=1286 n=2045 n=1334 n=648 Age Group Source: Ministry of Health and Child Welfare, Zimbabwe 01 July 2002 slide number SSA-25 35 -39 n=284 40 -44 n=96
HIV prevalence (%) HIV prevalence rate among teenagers by age in Kisumu, Kenya 35 30 25 20 15 10 5 0 boys girls 15 16 17 18 Age in years Source: National AIDS Programme, Kenya, and Population Council, 1999 01 July 2002 slide number SSA-26 19
Percentage of women who are mothers or pregnant by the end of their teens, 1990 -1998 60 40 0 en am in er oo n C A C R om C ôt oro e s d' Iv oi G re ha na K en M ad ya ag as ca r M M a oz li am b N iqu am e ib i N a ig e N r ig e R ria w an Se da ne ga To l g U o ga n Za da m Zi bi m a ba bw e 20 C B Percentage of women 80 Source: Demographic and Health Surveys, various countries 01 July 2002 slide number SSA-27
The Impact of HIV/AIDS 01 July 2002 slide number SSA-28
Age in years Projected population structure with and without the AIDS epidemic, Botswana, 2020 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 Males Females Projected population structure in 2020 Deficits due to AIDS 140 120 100 80 60 40 20 40 60 Population (thousands) Source: US Census Bureau, World Population Profile 2000 01 July 2002 slide number SSA-29 80 100 120 140
Increase in mortality among men between 15 and 60, selected African countries, 1986 -1997 80 Probability of dying from all causes 70 60 estimated for 6 years before survey estimated for year of survey 50 40 30 20 10 0 Tanzania 1996 Malawi 1992 Source: Timaeus I, AIDS 1998, 12 (suppl): S 15 -S 27 01 July 2002 slide number SSA-30 Zimbabwe 1994 Uganda 1995 Zambia 1996 -97
Adult mortality attributable to HIV, community-based studies in Africa, 1990 -1996 Mortality among HIV-negatives Mwanza, Tanzania Excess mortality due to HIV (4% HIV) Kisesa, Tanzania (7% HIV) Masaka, Uganda (8% HIV) Rakai, Uganda (21% HIV) 0 5 10 15 20 25 30 Mortality per 1, 000 person - years Source: Boerma JT et al, AIDS 1998, 12 (suppl 1): S 3 -S 14 01 July 2002 slide number SSA-31 35 40
Trends in mortality among children under five years old and end-1999 adult HIV prevalence rate, selected African countries, 1981 -1996 Relative under-5 mortality (1981 = 100%) 110 % 105 % Zambia HIV prevalence 19. 9% 100 % 95 % Kenya HIV prevalence 14. 1% 90 % Cameroon HIV prevalence 7. 7% 85 % 80 % 1980 82 84 86 88 90 Source: Demographic and Health Surveys, Macro International, USA 01 July 2002 slide number SSA-32 92 94 96 1998
Probability of a Zimbabwean boy aged 15 dying before age 50, trends over time, various national surveys 60 Probability of dying before age 50 (%) 50 40 reports from surviving siblings death registration household reports of death 30 20 10 1985 Source: Feeney G, 1999 (unpublished data). 01 July 2002 slide number SSA-33 1990 1995 2000
Estimated impact of AIDS on under-5 child mortality rates, selected African countries, 2010 250 Deaths per 1, 000 live births 200 Without AIDS With AIDS 150 100 50 0 Botswana Kenya Malawi Tanzania Zambia Zimbabwe Source: US Census Bureau 01 July 2002 slide number SSA-34
Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950 - 2005 65 Life expectancy (years) 60 with high HIV prevalence: Zimbabwe South Africa Botswana 55 50 45 with low HIV prevalence: Madagascar Senegal Mali 40 35 30 1950– 1955 - 1960 - 1965 - 1970 - 1975 - 1980 - 1985 - 1990 - 1995 - 20001955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision. 01 July 2002 slide number SSA-35
Predicted loss in life expectancy due to HIV/AIDS in children born in 2000 Predicted life expectancy Loss in life expectancy due to HIV/AIDS Botswana Zimbabwe South Africa Kenya Zambia Côte d'Ivoire Rwanda Mozambique Haiti Cambodia 0 10 20 30 40 50 Life expectancy at birth (years) Source: U. S. Census Bureau, 2000 01 July 2002 slide number SSA-36 60 70
Lifetime risk of AIDS death for 15 -year-old boys, assuming unchanged or halved risk of becoming infected with HIV, selected countries risk halved over next 15 years current level of risk maintained Risk of dying of AIDS 100% Botswana 80% Zimbabwe South Africa Zambia 60% Zimbabwe Kenya 40% 20% 0% Botswana South Africa Zambia Côte d’Ivoire Cambodia Burkina Faso 0% Kenya Côte d’Ivoire Cambodia Burkina Faso 5% 10% 15% 20% 25% 30% Current adult HIV prevalence rate Source: Zaba B, 2000 (unpublished data) 01 July 2002 slide number SSA-37 35% 40%
Leading causes of death in Africa, 2000 25. 0 22. 6 20. 0 % of Total 15. 0 10. 1 10. 0 9. 1 6. 7 5. 5 4. 3 5. 0 3. 6 3. 1 2. 9 2. 3 0. 0 HIV/AIDS Malaria Lower respiratory infections Diarrhoeal disease Source: The World Health Report 2001, WHO 01 July 2002 slide number SSA-38 Perinatal conditions Tuber culosis Measles Ischaemic Heart disease Cerebro vascular disease Maternal conditions
Leading causes of disease burden in Africa, 2000 25. 0 20. 6 20. 0 % of Total 15. 0 10. 1 10. 0 8. 6 6. 3 6. 1 4. 5 5. 0 3. 6 2. 8 1. 9 0. 0 HIV/AIDS Lower respiratory infections Malaria Diarrhoeal diseases Perinatal conditions Maternal conditions Measles Other unintentional injuries* Tuberculosis * Unintentional injuries aside from traffic accidents, poisoning, falls, fires and drowning Source: The World Health Report 2001, WHO 01 July 2002 slide number SSA-39 Pertussis
Impact of HIV/AIDS on urban households, Côte d’Ivoire General population. Families living with AIDS 30 000 Francs CFA 25 000 Monthly income per capita 20 000 15 000 Monthly consumption per capita 10 000 5 000 0 Savings/Disavi ngs – 5 000 Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997 01 July 2002 slide number SSA-40
Reduction in production in a household with an AIDS death, Zimbabwe Crops • • • Reduction in output Maize 61% Cotton 47% Vegetables 49% Groundnuts 37% Cattle owned 29% Source: Stover & Bollinger, 1999 01 July 2002 slide number SSA-41
Estimated and projected deaths at ages 15 -34, with and without AIDS in South Africa: 1980 -2025 Deaths (Thousands) 2, 000 1, 600 Without AIDS With AIDS 1, 200 800 400 0 1980 -1985 -1990 -1995 -2000 -2005 -2010 -2015 -2020 -2025 Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision. 01 July 2002 slide number SSA-42
Reduction in size of primary- school-age population by 2010, in selected African countries 30. 0 % reduction 25. 0 20. 0 15. 0 10. 0 5. 0 0. 0 Zimbabwe Source: World Bank, 2000 01 July 2002 slide number SSA-43 Zambia Kenya Uganda
Reduction in life expectancy compared to the ‘no AIDS’ scenario in selected countries: 2000 -2005 Botswana Zimbabwe Swaziland South Africa Kenya Mozambique Côte d'Ivoire Cameroon Burkina Faso Haiti Guyana Bahamas Cambodia Dominican Rep. Angola Myanmar Thailand 0 5 10 15 20 25 30 35 Number of years Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision. 01 July 2002 slide number SSA-44 40
Knowledge and Behavior 01 July 2002 slide number SSA-45
0 N ha d ig e N r ep M Le al ad s a o B ga tho an s g ca C lad r M am esh oz bo am d i bi a qu e M a Pa l pu G Be i n u a a in N te ew m G ala M ui So on nea ut go C h lia en A Vi fri tr al e c A Cap t N a fr ic e V am an e R rd C ep e am u er blic o C E on ôt rit e re d' a Ta Ivo nz ire R an om ia a Tu nia rk e To y C g om o or K os en ya Zi Pe m ru ba b M we al aw H i Za aiti m D U bia om ga nd in ic an Br a R azi ep l ub lic C Percentage who do not know Percentage of 15 -19 girls who do not know that a HIV-infected person may look healthy, 1994 -1999 100 90 80 70 60 50 40 30 20 10 Sources: UNICEF, DHS surveys and other nationwide surveys, 1994 -99. 01 July 2002 slide number SSA-46
Knowledge of condoms among adolescent boys 100% 75% 50% 25% 0% Do m in ic Br an az Re il pu b Ha lic it Pe i Bo ru liv M ia Ni ala ca wi ra g Za ua Zi mb m ba ia Ta bw nz e an Ke ia n Ug ya an da M al M oz Nig i am e bi r qu Ch e ad Percentage of 15 -19 year old boys Do not know condoms Sources: UNICEF, DHS surveys, 1994 -1999 01 July 2002 slide number SSA-47 Know condoms but not where to get them Know condoms and where to get them
Percentage of 15 -49 year old women who are aware that HIV can be transmitted from a mother to her child, 1994 -1999 Dominican Rep. Zimbabwe Zambia Uganda Kenya South Africa Peru Haiti Sources: UNICEF, DHS and other nationwide surveys, 1994 -1999 01 July 2002 slide number SSA-48 0% 10 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 0% Tanzania CAR Cote d'Ivoire Cameroon Benin Madagascar Mali Chad Niger
Risk perception percentage of sexually active women (15 -19) that perceive not to be at risk at all of getting AIDS Nicaragua Nepal Colombia Bolivia Guatemala Brazil Dominican Rep. Niger Benin Chad Mali Cameroon Togo Haiti CAR Kenya Uganda Zambia Zimbabwe HIV Prevalence (at time of survey *) % 10 0 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0% Percentage of 15 -19 year old girls who think they are not at risk of AIDS *HIV prevalence in women attending antenatal care clinics in major urban areas Sources: UNICEF, DHS surveys, 1994 -1999 01 July 2002 slide number SSA-49
Number of reported rapes and convictions in Botswana, 1984 to 1997 1400 reported rapes 1200 convictions Number 1000 800 600 400 200 0 1984 85 86 87 88 89 90 91 Source: Emang Basadi Women’s Association, Botswana, 1998 01 July 2002 slide number SSA-50 92 93 94 95 96 1997
Percentage of sexually experienced girls in South Africa who say … “I have been forced to have sex. ” Yes 39% “I am afraid of saying no to sex. ” Agree 33% No 61% 7% Agree 55% Disagree 39% 6% “There are times I don't want to have sex but I do because my boyfriend Insists on having sex. ” Source: Kaiser Family Foundation/KLA (2000) South African National Youth Survey 01 July 2002 slide number SSA-51 Disagree 60%
Condoms per man per year Condom gap in sub-Saharan African countries in 1999 Six countries with highest condom procurement rate 30 25 20 Average condom procurement of top 6 countries = 16. 9 15 10 Additional condoms needed to get all countries to the level of 16. 9 = 1. 9 billion per year 5 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Countries in sub-Saharan Africa, ordered by condom procurement rate Source: Shelton JD, Johnston B (2001) Condom gap in Africa: evidence from donor agencies and key infromants, British Medical Journal 01 July 2002 slide number SSA-52
Orphans holding the belief (%) Knowledge and beliefs concerning AIDS among AIDS orphans, Rusinga Island, Kenya 100 80 60 40 20 0 0 Know about AIDS Believe many people in their community have died of AIDS Believe people in extended family died of AIDS Source: Johnston T et al. Population Communication Africa, Kenya, 1999 01 July 2002 slide number SSA-53 Believe parents died of AIDS
Casual sex and condom use by educational status, Mozambique Respondents reporting the behaviour (%) 60 casual sex in the past year condom use at last casual sex 50 40 30 20 10 0 0 -2 3 -6 7 -9 10+ Number of years respondent spent in school Source: Agha S, et al. The promotion of safer sex among high-risk individuals in Mozambique, Population Services International, USA, 1999 01 July 2002 slide number SSA-54
Success Stories 01 July 2002 slide number SSA-55
HIV prevalence rate among 13 to 19 -year-olds Masaka, Uganda, 1989 to 1997 HIV prevalence (%) 5 Girls 4 Boys 3 2 1 0 1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 Source: Kamali et al. AIDS 2000, 14: 427 -434 01 July 2002 slide number SSA-56
HIV prevalence rate among pregnant 15 to 19 -year-olds, Lusaka, Zambia, 1993 to 1998 1993 1994 1998 HIV prevalence (%) 35 30 25 20 15 10 5 0 Chelstone Chilenje Kalinga Clinic Source: Ministry of Health, Zambia, 1999 01 July 2002 slide number SSA-57 Matero
Prevalence among pregnant women, outside major urban areas, Uganda 14 HIV Prevalence (%) 12 10 8 6 4 2 0 1989 90 91 92 Source: Uganda National AIDS Programme 01 July 2002 slide number SSA-58 93 94 95 96 97 98 99 2000
Prevalence in 15 -24 years old first time testers Kampala, Uganda HIV Prevalence (%) 30 Males 25 Females 20 15 10 5 0 1992 1993 1994 Source: Uganda National AIDS Programme 01 July 2002 slide number SSA-59 1995 1996 1997 1998 1999 2000
Behavioural Indicators Uganda, 1996 -2000 Percentage 60 1996 -1997 1999 -2000 50 40 30 20 10 0 Reported non-regular sexual partners Reported condom use with nonregular partners Source: Uganda National AIDS Programme 01 July 2002 slide number SSA-60 Reported incidence of Urethritis (men) Condom use at last sex with regular partner Age at first sex
Percentage Knowledge about HIV/AIDS Uganda, 1996 -2000 90 80 70 60 50 40 30 20 10 1996 - 1997 1999 - 2000 0 Knowledge of preventive practices Source: Uganda National AIDS Programme 01 July 2002 slide number SSA-61 Knowledge of condom source Knows a friend, colleague with AIDS
HIV prevalence and reported consistent condom use among female sex workers, Abidjan, Côte d'Ivoire, 1992 -1998 HIV prevalence Reported consistent condom use % HIV seropositive 80 80 60 60 40 40 20 20 0 0 1992 1993 1994 Source: Ghys PD et al. (2002) AIDS 01 July 2002 slide number SSA-62 1995 1996 1997 1998 % consistent condom use 100
Prevalence of sexually transmitted diseases among sex workers Dakar, Senegal, 1991 and 1996 50 STD prevalence (%) 1991 1996 40 30 20 10 0 Trichomonas vaginalis Chlamydia trachomatis Source: National AIDS Programme, Senegal 01 July 2002 slide number SSA-63 Neisseria gonorrhoeae Syphilis
Increase in reported condom use with non-regular partners in selected districts in Uganda: 1996 -2000 % condom use 80 60 40 20 0 1997 1999 Mbara 1996 1999 Mpigi 1997 2000 Masindi Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report 01 July 2002 slide number SSA-64 1997 2000 Pallisa
Trends in HIV prevalence among pregnant women in Kampala, Uganda: 1991 -2000 40 30 % 20 10 0 1991 1992 1993 1994 1995 1996 1997 1998 Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report 01 July 2002 slide number SSA-65 1999 2000
Guinea-Bissau* Libyan Arab Jamahiriya Sao Tome and Principe* Central African Republic* Burundi Morocco Cape Verde Congo Togo Egypt Sudan Eritrea Somalia Nigeria Botswana Niger* Cameroon* Djibouti Cote d'Ivoire Benin* Angola Gabon Tunisia Mauritius Sierra Leone* Liberia Madagascar* Kenya* Seychelles Swaziland Equatorial Guinea Mali* Ghana* Uganda* Comoros Ethiopia* Rwanda* Mauritania* Burkina Faso Lesotho Mozambique* South Africa Gambia Namibia Algeria Chad* Zambia* Guinea* Senegal* DR Congo* Malawi* UR Tanzania Zimbabwe % Expenditure on health Public expenditure on health as percentage of general government expenditure in African countries: 1998 18. 0 15. 0 Abuja Target = 15. 0% 12. 0 9. 0 6. 0 3. 0 0. 0 * Heavily indebted, poor countries Source: WHO, World Health Report 2001 01 July 2002 slide number SSA-66
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