Public spending cuts across six African countries have resulted in the incomes of health and education workers falling by up to 50 percent in five years, leaving them struggling to make ends meet, according to international NGO ActionAid.
The Human Cost of Public Sector Cuts in Africa report published on Tuesday found that 97 percent of the healthcare workers it surveyed in Ethiopia, Ghana, Kenya, Liberia, Malawi and Nigeria could not cover their basic needs like food and rent with their wages.
The International Monetary Fund (IMF) is to blame for these countries’ failing public systems, the report said, as the agency advises governments to significantly cut public spending to pay back foreign debt. As the debt crisis rapidly worsens across the Global South, more than three-quarters of all low-income countries in the world are spending more on debt servicing than healthcare.
“The debt crisis and the IMF’s insistence on cuts to public services in favour of foreign debt repayments have severely hindered investments in healthcare and education across Africa. For example, in 2024, Nigeria allocated only 4% of its national revenue to health, while a staggering 20.1% went toward repaying foreign debt,” said ActionAid Nigeria’s Country Director Andrew Mamedu.
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The report highlighted how insufficient budgets in the healthcare system had resulted in chronic shortages and a decline in the quality of service.
Women also appear to be disproportionally affected.
“In the past month, I have witnessed four women giving birth at home due to unaffordable hospital fees. The community is forced to seek vaccines and immunisation in private hospitals since they are not available in public hospitals. Our [local] health services are limited in terms of catering for pregnant and lactating women,” said a healthcare worker from Kenya, who ActionAid identified only as Maria.
Medicines for malaria – which remains a leading cause of death across the African continent, especially in young children and pregnant women – are now 10 times more expensive at private facilities, the NGO said. Millions don’t have access to lifesaving healthcare due to long travel distances, rising fees and a medical workforce shortage.
“Malaria is an epidemic in our area [because medication is now beyond the reach of many]. Five years ago, we could buy [antimalarial medication] for 50 birrs ($0.4), but now it costs more than 500 birr ($4) in private health centres,” a community member from Muyakela Kebele in Ethiopia, identified only as Marym, told ActionAid.
‘Delivering quality education is nearly impossible’
The situation is equally dire in education, as budget cuts have led to failing public education systems crippled by rising costs, a shortage of learning materials and overcrowded classrooms.
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Teachers report being overwhelmed by overcrowded classrooms, with some having to manage more than 200 students. In addition, about 87 percent of teachers said they lacked basic classroom materials, with 73 percent saying they paid for the materials themselves.
Meanwhile, teachers’ wages have been gradually falling, with 84 percent reporting a 10-15 percent drop in their income over the past five years.
“I often struggle to put enough food on the table,” said a teacher from Liberia, identified as Kasor.
Four of the six countries included in the report are spending less than the recommended one-fifth of their national budget on education, according to the UNESCO Institute for Statistics.
“I now believe teaching is the least valued profession. With over 200 students in my class and inadequate teaching and learning materials, delivering quality education is nearly impossible,” said a primary school teacher in Malawi’s Rumphi District, identified as Maluwa.
Action Aid said its report shows that the consequences of IMF-endorsed policies are far-reaching. Healthcare workers and educators are severely limited in the work they can do, which has direct consequences on the quality of services they can provide, it said.
“The debt crisis and drive for austerity is amplified for countries in the Global South and low-income countries, especially due to an unfair global economic system held in place by outdated institutions, such as the IMF,” said Roos Saalbrink, the global economic justice lead at ActionAid International. “This means the burden of debt falls on those most marginalised – once again. This must end.”
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