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Pandemic creates new billionaire every 30 hours — now a million people could fall into extreme poverty at same rate in 2022

As the cost of essential goods rises faster than it has in decades, billionaires in the food and energy sectors are increasing their fortunes by US$1 billion dollars every two days.

 For every new billionaire created during the pandemic — one every 30 hours — nearly a million people could be pushed into extreme poverty in 2022 at nearly the same rate, reveals a new Oxfam brief today. “Profiting from Pain” is published as the World Economic Forum — the exclusive get-together of the global elite in Davos — takes place for the first time face-to-face since COVID-19, a period during which billionaires have enjoyed a huge boost to their fortunes.

“Billionaires are arriving in Davos to celebrate an incredible surge in their fortunes. The pandemic and now the steep increases in food and energy prices have, simply put, been a bonanza for them. Meanwhile, decades of progress on extreme poverty are now in reverse and millions of people are facing impossible rises in the cost of simply staying alive,” said Gabriela Bucher, Executive Director of Oxfam International.

The brief shows that 573 people became new billionaires during the pandemic, at the rate of one every 30 hours. We expect this year that 263 million more people will crash into extreme poverty, at a rate of a million people every 33 hours.

Billionaires’ wealth has risen more in the first 24 months of COVID-19 than in 23 years combined. The total wealth of the world’s billionaires is now equivalent to 13.9 percent of global GDP. This is a three-fold increase (up from 4.4 percent) in 2000.

“Billionaires’ fortunes have not increased because they are now smarter or working harder. Workers are working harder, for less pay and in worse conditions. The super-rich have rigged the system with impunity for decades and they are now reaping the benefits. They have seized a shocking amount of the world’s wealth as a result of privatization and monopolies, gutting regulation and workers’ rights while stashing their cash in tax havens — all with the complicity of governments,” said Bucher.

“Meanwhile, millions of others are skipping meals, turning off the heating, falling behind on bills and wondering what they can possibly do next to survive. Across East Africa, one person is likely dying every minute from hunger. This grotesque inequality is breaking the bonds that hold us together as humanity. It is divisive, corrosive and dangerous. This is inequality that literally kills.”

Oxfam’s new research also reveals that corporations in the energy, food and pharmaceutical sectors —where monopolies are especially common— are posting record-high profits, even as wages have barely budged and workers struggle with decades-high prices amid COVID-19. The fortunes of food and energy billionaires have risen by US$453 billion in the last two years, equivalent to US$1 billion every two days. Five of the largest energy companies (BP, Shell, TotalEnergies, Exxon and Chevron) are together making US$2,600 profit every second, and there are now 62 new food billionaires.

Together with just three other companies, the Cargill family controls 70 percent of the global agricultural market. Last year Cargill made the biggest profit in its history (US$5 billion in net income) and the company is expected to beat its record profit again in 2022. The Cargill family alone now has 12 billionaires, up from eight before the pandemic. 

From Sri Lanka to Sudan, record-high global food prices are sparking social and political upheaval. 60 percent of low-income countries are on the brink of debt distress. While inflation is rising everywhere, price hikes are particularly devastating for low-wage workers whose health and livelihoods were already most vulnerable to COVID-19, particularly women, racialized and marginalized people. People in poorer countries spend more than twice as much of their income on food than those in rich countries.

  • Today, 2,668 billionaires — 573 more than in 2020 — own US$12.7 trillion, an increase of US$3.78 trillion.
  • The world’s ten richest men own more wealth than the bottom 40 percent of humanity, 3.1 billion people.
  • The richest 20 billionaires are worth more than the entire GDP of Sub-Saharan Africa.
  • A worker in the bottom 50 percent would have to work for 112 years to earn what a person in the top 1 percent gets in a single year.
  • High informality and overload due to care tasks have kept 4 million women in Latin America and the Caribbean out of the workforce. Half of working women of color in the US earn less than US$15 an hour.

The pandemic has created 40 new pharma billionaires. Pharmaceutical corporations like Moderna and Pfizer are making US$1,000 profit every second just from their monopoly control of the COVID-19 vaccine, despite its development having been supported by billions of dollars in public investments. They are charging governments up to 24 times more than the potential cost of generic production. 87 percent of people in low-income countries have still not been fully vaccinated.

“The extremely rich and powerful are profiting from pain and suffering. This is unconscionable. Some have grown rich by denying billions of people access to vaccines, others by exploiting rising food and energy prices. They are paying out massive bonuses and dividends while paying as little tax as possible. This rising wealth and rising poverty are two sides of the same coin, proof that our economic system is functioning exactly how the rich and powerful designed it to do,” said Bucher.

“Over two years since the pandemic began, after more than 20 million estimated deaths from COVID-19 and widespread economic destruction, government leaders in Davos face a choice: act as proxies for the billionaire class who plunder their economies, or take bold steps to act in the interests of their great majorities. One common economic sense measure above all will put this to the test: whether governments will finally tax billionaire wealth”.

Oxfam recommends that governments urgently:

  • Introduce one-off solidarity taxes on billionaires’ pandemic windfalls to fund support for people facing rising food and energy costs and a fair and sustainable recovery from COVID-19. Argentina adopted a one-off special levy dubbed the ‘millionaire’s tax’ and is now considering introducing a windfall tax on energy profits as well as a tax on undeclared assets held overseas to repay IMF debt. The super-rich have stashed nearly US$8 trillion in tax havens.
  • End crisis profiteering by introducing a temporary excess profit tax of 90 percent to capture the windfall profits of big corporations across all industries. Oxfam estimated that such a tax on just 32 super-profitable multinational companies could have generated US$104 billion in revenue in 2020.
  • Introduce permanent wealth taxes to rein in extreme wealth and monopoly power, as well as the outsized carbon emissions of the super-rich. An annual wealth tax on millionaires starting at just 2 percent, and 5 percent on billionaires, could generate US$2.52 trillion a year —enough to lift 2.3 billion people out of poverty, make enough vaccines for the world, and deliver universal healthcare and social protection for everyone living in low- and lower middle-income countries.

2022 Budget Reaction: Big Hearts Connected World

“We are disappointed that, once again, this government has not increased its contribution to global efforts to halt the fall of families across the world into extreme poverty,” says Big Hearts organisations Anglican Missions, Christian Blind Mission, Christian World Service, Oxfam Aotearoa, Tearfund, Trade Aid, the Wellington Anglican Diocese, UnionAid and World Vision. 

“The hardship we experience is connected. Our response must be this connected, too. As a people, we are generous. Throughout the coronavirus pandemic, the Tongan volcanic eruption and the war in Ukraine, our agencies have experienced the generosity of everyday New Zealanders who want to share what they have with people who are suffering extreme poverty and the loss of their homes. 

“When will our government match our people’s generosity?” says Big Hearts organisations. 

On top of the climate destruction and the coronavirus pandemic, the war in Ukraine has had a ripple effect across the world, where communities across the globe feel the impact of rising food prices. Between April 2020 and December 2021 there was an 80 percent increase in the price of wheat alone, making food out of reach for millions of people. 

Big Hearts organisations continue: “In the words of Gabriela Bucher from Oxfam, ‘starvation is a political failure’. It is the result of governments across the world, like here in New Zealand, refusing to help people get the food they need to survive. 

“People in Syria have never been so hungry – three in five people in Syria do not know where their next meal will come from. Families in countries like Yemen and Ethiopia exist in famine-like conditions – every day wondering if they will have the very basic fundamental of life – food – watching their children waste away in front of them. One person every 48 seconds is likely dying of hunger seconds in drought-ravaged Ethiopia, Kenya and Somalia,” say Big Hearts organisations. 

“Now more than ever, we need to pull together as one human family, so that we all make it through the triple crises of a public health pandemic, the global rise in cost of living and climate destruction.  

“As a high-income country, Aotearoa New Zealand is able to both support its own people through this hardship, as well as make a small contribution to help people who face starvation and deprivation across the world in low-income countries.” 

 

Notes 

There is a significant increase in the international development cooperation budget, but this is all comprised of last year’s welcome climate finance announcement. It is not overseas aid. There is a stated $75 million contingency for Pacific countries, but it appears that this comes from the existing overseas aid budget. Overall, there is no apparent increase in the overseas development assistance budget. 

Food prices were already high before the Ukraine crisis with an increase in wheat prices of 80 percent between April 2020 and December 2021. The FAO Food Price Index which tracks the international prices of food items, has risen to a new all-time high, exceeding the previous top of 2011. Additional price hikes and food inflation are likely, with inflation extending to fertilisers and energy.  

One person every 48 seconds is likely dying of hunger seconds in drought-ravaged Ethiopia, Kenya and Somalia, Dangerous delay 2: the cost of inaction | Oxfam International. 

Global crises, worsened by the economic turmoil of COVID-19 and more recently by the Ukraine conflict, have pushed food prices to an all-time high in March 2022 – up by 12.6 percent over February – which is putting food ever more out of reach for millions of people. See here

Dangerous Delay 2 Report: The cost of inaction

One person likely dying from hunger every 48 seconds in drought-ravaged East Africa as world again fails to heed warnings

One person is likely dying of hunger every 48 seconds in drought-ravaged Ethiopia, Kenya and Somalia, according to estimates by Oxfam and Save the Children in a report published today highlighting the world’s repeated failure to stave off preventable disasters.

More than a decade since the delayed response to the 2011 famine that killed more than 260,000 people in Somalia – half of them children under five – the world is once again failing to avert catastrophic hunger in East Africa. Today, nearly half a million people across parts of Somalia and Ethiopia are facing famine-like conditions. In Kenya, 3.5 million people are suffering extreme hunger. Urgent appeals are woefully funded, as other crises, including the war in Ukraine, are worsening the region’s escalating hunger crisis.

The number of people experiencing extreme hunger in the three countries has more than doubled since last year – from over 10 million to more than 23 million today. This is against a backdrop of crippling debt that more than tripled in under a decade – from $20.7 billion in 2012 to $65.3 billion by 2020 – sucking these countries’ resources from public services and social protection.

The report, Dangerous Delay 2: The Cost of Inaction, supported by the Jameel Observatory, examines the changes in the humanitarian aid system since 2011. It finds that despite an improved response to the 2017 East Africa drought when widespread famine was averted, the national and global responses have largely remained too slow and too limited to prevent a repeat today.

“Despite worsening warning signs over time, world leaders have responded woefully – too late and still too little – leaving millions of people facing catastrophic hunger. Starvation is a political failure”, said Gabriela Bucher, Oxfam International’s Executive Director.

Entrenched bureaucracies and self-serving political choices continue to curtail a unified global response, despite improved warning systems and efforts by local NGOs, the report finds.

G7 and other rich nations have turned inwards in response to various global crises, such as COVID-19 and more recently the Ukraine conflict, including by backtracking on their promised aid to poor countries and driving them to edge of bankruptcy with debt.

East African governments bear their own responsibility, having delayed their responses and often refused to acknowledge the scale of the crisis on their doorsteps. They have not adequately invested in agriculture or social protection systems to help people better cope with the drivers of hunger, including climatic and economic shocks.

The report sheds light on the continued failure of donors and aid agencies to prioritise local organisations at the forefront of the crisis response, which slowed down the response further, even when they were ready to act.

Climate-induced drought, compounded by conflicts forcing people out of their homes, and COVID-19 economic turmoil, has decimated people’s last ability to cope. The Ukraine conflict has also driven already soaring food prices to their highest level ever recorded, making food unattainable for millions.

Save the Children’s Regional Spokesperson for East and Southern Africa, Kijala Shako, said: “We’re seeing horrific numbers of severe malnutrition with close to 5.7 million children facing acute malnutrition through the end of this year. And with the UN warning that more than 350,000 could die if we do not act, the clock is ticking and every minute that passes is a minute too close to starvation and possible death of a child. How can we live with that if we let it happen again?”

Jane Meriwas, the director of Samburu Women Trust in Kenya, said: “The situation is devastating. Both human beings and livestock are at risk of dying, already children, pregnant mothers and elderly in some parts of Marsabit and Samburu Counties in Kenya are being reported as dying. If urgent intervention is not provided now, we are likely to witness even more death”.

Climate change has made this La Niña-induced drought in the Horn of Africa more severe and prolonged, now the worst in 40 years. The drought has eroded economic reserves, herd size, and human health and is a major factor behind the alarming numbers of people without enough to eat daily. Yet, the region is one of the least responsible for the climate crisis, emitting collectively 0.1% of global carbon emissions.

“There are no cows left. They all died. We have a few camels and goats that have survived the drought, but we are afraid we might lose them if the drought continues. We are afraid that people will start dying of famine as there is no food,” said Ahmed Mohamud, a pastoralist from Wajir, Kenya.

Just two per cent ($93.1 million) of the current $4.4bn UN appeal for Ethiopia, Kenya and Somalia has formally been funded to date. In 2017, those same countries had received $1.9 billion in emergency funding. Although donors promised $1.4 bn of aid last month, it is shameful that only $378 million of that was new money.

“People are starving not because the world lacks food or money, but for a dismal lack of political courage. Rich nations successfully, and rightly, raised over $16bn in one month to address the terrible crisis in Ukraine. They pumped over $16 trillion dollars into their economies in response to COVID-19 to support those in need. Countries can mobilize resources to prevent human suffering – but only if they choose to,” said Bucher.

“Donors, development agencies, governments and the private sector must work together with affected communities to prepare and respond to risks, rather than wait for crises to spiral out of control,” says Guyo Roba, Head of the Jameel Observatory.

Oxfam and Save the Children are calling for urgent action to tackle the catastrophic hunger crisis in East Africa:

  • To help save lives now, G7 and Western leaders must immediately inject money to meet the $4.4 billion UN appeal for Kenya, Ethiopia and Somalia, and ensure the funding is flexible enough to be used where it is most needed.
  • Donors must guarantee that at least 25 per cent of funds go to local responders at the heart of response.
  • Governments of Kenya, Ethiopia and Somalia must scale up social protection to help people cope with multiple shocks. They should invest at least 10 per cent of their budgets in agriculture, with a particular focus on smallholder and female farmers, as they had agreed in the African Union Malabo Declaration of 2014.
  • National governments must prioritize lives over politics, by acknowledging and acting on early warnings. They should be quicker to declare national emergencies, shift national resources to those most in need, and invest in response to climate related shocks.
  • Rich polluting nations must pay East Africa for its climate loss and damage. They must also cancel 2021-2022 debts for those countries, in order to free up resources to support people to mitigate and adapt to climate shocks.

Acting early on hunger not only saves lives but prevents economic loss. USAID estimates that every dollar invested in early response and resilience in Somalia saves three dollars by preventing income and livestock losses.

Notes to the editor

Emissions Reduction Plan reaction

Oxfam Aotearoa Campaigns Lead Alex Johnston said: 

 

“While this plan starts to trend emissions downwards, we need to be slamming on the brakes, not slowly taking our foot off the accelerator.  

 

“We acknowledge progress has been made to get all government departments to understand the task of tackling climate change, but there’s a failure to produce policies that will meaningfully reduce pollution from industrial agriculture – responsible for half our emissions. 

 

“We’ve got another agriculture institute for developing new techno-fixes, but no real policies that will shift production systems away from intensive, volume-based dairy. The hidden consequence of this is paying billions of dollars to other countries – countries experiencing the worst impacts of the climate destruction we caused – to pick up our slack. 

 

“When the world is required to halve emissions by 2030 to keep within 1.5 degrees, a wealthy country like New Zealand saying we’re only going to reduce them by 18 percent in that time is a death sentence for those set to experience the worst impacts of climate change.  

 

“Going slow and steady is a decision that treat the lives of billions of people who are forced into hunger from climate fuelled drought, storms and displacement as expendable. Farmers in Kenya, Ethiopia and Somalia have lost crops and entire herds of livestock to an exceptionally long and severe drought. Millions of people in East Africa are now on the brink of a hunger catastrophe. 

 

“We know what’s needed to tackle emissions from agriculture: we need big dairy and beef to be brought into the Emissions Trading Scheme at a much stronger emissions price, and turn around the farming sector, from being Aotearoa’s biggest polluter, into a solution for tackling climate change and restoring nature. That involves a phase out of synthetic nitrogen fertiliser, and investing billions in organic, regenerative agriculture.” 

Governments falling woefully short on goal to vaccinate 70 percent in each country by September

Vaccine Access Still a Concern as President Biden Hosts Second COVID Summit

World leaders have not done enough to achieve their goal of vaccinating 70 percent of people in each country by September, campaigners with the People’s Vaccine Alliance warned ahead of the second virtual summit on COVID-19 hosted by US President Biden along with Belize, Germany, Indonesia, and Senegal. The World Health Organization’s target of reaching 70 percent by mid-year is even further out of reach.

More than a year after vaccines were introduced, only 52 countries have met the 70 percent vaccination target so far, 69 have yet to achieve 40 percent coverage, and 21 countries have not yet achieved even 10 percent coverage. While more than 11 billion doses of COVID-19 vaccines have been administered worldwide, only 11 percent of people in low-income countries are vaccinated, compared with 73 percent of those in high-income countries, as of last month. At the current rate, it will take another two and a half years for low-income countries to be able to vaccinate 70 percent of their populations with an initial two doses.

Campaigners said progress had been too slow since the first COVID-19 summit in September last year and called on governments to do more to ensure doses are getting to people in countries behind target. Too many still haven’t received enough supply, have had unpredictable access, and have faced other challenges delivering doses to people in need. Campaigners have also called for urgent action to redress the spiraling COVID-19 treatment access divide caused by the same rich country hoarding and profit-driven Big Pharma business model that excludes people living in poverty throughout the world.   

Julia Kosgei, Policy Advisor to the People’s Vaccine Alliance said: “The donation model has failed to deliver vaccines, has thwarted effective vaccine roll out plans, and is completely unsustainable. More than two years into the pandemic, millions have yet to have the initial doses needed to protect them from this deadly disease.”

“How is it that my elderly grandma in rural Kenya is still unprotected from COVID, yet pharmaceutical companies are hitting unheard of profits and say the world is ‘swimming’ in doses? These corporations have repeatedly demonstrated that they are not willing to do the right thing for humanity. Governments must step in and ensure everyone; everywhere has the vaccines they need.”

The Alliance, a coalition of over 90 organizations including the African Alliance, Oxfam, and UNAIDS says that transferring technology to boost local manufacturing will help address ongoing concerns including on-the-ground distribution challenges, vaccine hesitancy, and an overall shortfall in doses.

For the past year and a half, countries have been discussing a widely supported waiver of intellectual property for COVID-19 vaccines (so-called TRIPS waiver) at the World Trade Organization (WTO), which would remove barriers to developing countries being able to produce their own doses of COVID-19 medical tools.

Despite President Biden’s declared backing of the waiver for vaccines, there has been little progress. In fact, the initiative is still being blocked by the European Union, Switzerland and the United Kingdom. Instead, the EU has backed an alternative proposal, which is not a waiver and would not deliver the goals of the original proposal by excluding testing and treatments, leaving out many countries. Worse, it adds even more barriers to countries hoping to produce generic versions of the vaccines.

The Alliance is calling on President Biden to use his influence to ensure all world leaders back the full TRIPS waiver not only for vaccines, but also for test and treatments to give countries the protection and dignity of being able to produce COVID-19 medical tools themselves, rather than relying on a handful of Western pharmaceutical companies. The Alliance is also calling on increased funding for manufacturing and vaccine delivery.

Meanwhile, more than 100 qualified manufacturers in Asia, Africa and Latin America could be producing doses of the mRNA COVID vaccines, but this capacity is going unused without the cooperation and technology transfer from Pfizer, Moderna and BioNTech. At the Annual General Meetings of Pfizer and Moderna, the companies opposed shareholder proposals by Oxfam for each to study the feasibility of transferring vaccine technology to qualified manufacturers in low- and middle-income countries.

Anna Marriott, Oxfam’s Health Policy Manager, said: “At this second COVID Summit, we should be acting urgently on the key thing low- and middle-income countries are asking for: the ability to make their own vaccines for their own people.”

“The unwillingness to share the vaccine technology and funding shortfalls are stunting our global response to COVID-19. Governments, including the US, must step up funding for immediate vaccine roll out and for the mRNA hub and the manufacturing capacity needed to build a production network in the global South. This would reduce dependence on a failing charity model and allow the world to pull out of this pandemic once and for all.”

The Alliance also says the scale of the pandemic in developing nations has been massively underestimated due to the lack of testing available. Last week the World Health Organization estimated the true global death toll from the COVID pandemic to be almost 15 million lives lost, with a death toll in lower income countries four times higher than in high income countries.

Marriott continued: “Voluntary measures from companies have delivered wild profits but also persistent vaccine inequity, new waves and new variants, unreliable and insufficient donations, and billions of people still waiting for their tests, treatments and vaccines.”

“Enough is enough. It’s time for governments to take bolder action to put people before profits.”

 

Notes:

Poverty and extreme inequality worsen in southern Africa as COVID-19 battered countries embark on a dangerous austerity path

The COVID-19 pandemic has worsened the extreme inequality in Southern African Development Community (SADC) countries and pushed millions into poverty, reveals a new analysis from Oxfam, Norwegian Church Aid (NCA) and Development Finance International (DFI).

The Commitment to Reducing Inequality Index (CRI) report shows that the fifteen SADC member states lost about $80bn in 2020 due to lower-than-expected growth. which is equivalent to around $220 for every SADC citizen.

This analysis estimates that this economic crisis could take more than a decade to reverse, erasing all hope of countries meeting their national development plan targets to reduce poverty and inequality by 2030.

The organizations say that if countries act decisively now against inequality, with policies aimed to help support citizens with public services and support, the impact of the crisis could be reversed in just three years. However, the report finds that SADC countries have responded with belt-tightening measures that are likely to do more harm to people than good.

“The poorest in our societies are bearing the brunt of Covid-19 and are now facing the extra cost of austerity policies. Governments have a choice and must act now to reverse damage of the pandemic, increase social spending and tackle the inequality crisis”, says Felix Ngosa, senior programme officer in Norwegian Church Aid.

As many as 35.5 million people in SADC countries lost their jobs in 2020 due to the pandemic, down by 26% on 2019 employment numbers. The Democratic Republic of Congo, Madagascar and Tanzania were hardest hit, with over five million jobs lost in each country.

While the majority of SADC citizens have suffered from the pandemic and its effects, the story is different for the region’s wealthiest people. The six wealthiest men in SADC – four in South Africa and one each in Tanzania and Zimbabwe – saw their wealth expand from $18.1 billion to $27.7 during the two years of the pandemic, a 42% increase in real terms. This increase is more than enough to fund a full COVID vaccination program (plus a booster) for everyone in SADC. The richest 10% earn around or above 60% of national income in eight SADC countries, and 50% in the other seven, the report finds.

This wealth concertation by a small group of people has left a majority struggling to meet their most basic needs, such as quality education, healthcare and decent jobs.

“The findings of this analysis are shocking, but they confirm the reality of many countries in this natural resource-rich but poor and unequal region” says Dailes Judge, Oxfam in Southern Africa Programme Director. “The inequalities in most countries in the region are major drivers of reduced economic growth and weakened essential services such as quality healthcare and education”.

“Sadly, a majority of the people feeling the sting are the poor – those living in vulnerable conditions with little or no assets. Women- headed households represent a distressingly large proportion of those struggling and suffering.”

In 2021, with COVID-19 infections rising, the critical health, social protection and economic programs put in place by most governments in 2020 were rolled back and replaced with austerity policies, in the context of growing debt burdens and lack of external support for country budgets.

Governments have felt pressured by their increasing debt service payments to cut social spending. Even before the pandemic, debt servicing was reaching astronomical levels with SADC governments spending almost three times as much on domestic and external debt service as there were on health. In 2020–21, debt servicing took 42.2% of government revenues on average.

The report says that many Southern African Development Community (SADC) member governments are still showing considerable commitment to fighting inequality – but still nowhere near enough to offset the huge inequality produced by the market and exacerbated by the COVID-19 pandemic.

“The combination of budget cuts, rising debt and a slow recovery due to global vaccine inequity risks raising the SADC inequality crisis to new heights,” says Mathew Martin, Development Finance International Director.

“Recovering from the pandemic, however, offers SADC governments a once-in-a-generation opportunity to do what their citizens want – to increase taxes on the wealthy and large corporations, to boost public spending especially on healthcare, education and social protection, and to boost workers’ rights in order to tackle joblessness and precarious work. With external support, for instance through debt relief and aid, SADC governments could reduce inequality drastically and eliminate extreme poverty by 2030.”

Notes

Southern Africa is the most unequal region in the world and contains the world’s three most unequal countries (South Africa, Namibia and Zambia), and another 3 of the 10 most unequal (Eswatini, Mozambique and Botswana). All SADC member states, except Tanzania and Mauritius, are in the top 50 most unequal countries.

The region has low proportions of workers with formal contracts and rights (and therefore access to sick pay, job protection, etc.), with fewer than 40% having such rights in Malawi, Zimbabwe, Angola, DRC, Zambia, Tanzania, Mozambique and Madagascar.

Many countries had limited access to essential health services, reaching under 50% of the population in seven countries, and forcing 5.4% of people to spend catastrophic proportions (i.e. more than 10%) of their income on healthcare across the region. These poor indicators reflected low commitments to healthcare spending, with this accounting for under 10% of government budgets in Zambia, Mozambique, Malawi, Madagascar and Tanzania.