By John Musenze
KAMPALA – As Africa grapples with a rising tide of non-communicable diseases (NCDs), overstretched health systems and declining donor aid, experts say the continent is sitting on an underused but highly effective solution—health taxes.
In a newly released report, The Future of Health Financing in Africa: The Role of Health Taxes, public health experts from Vital Strategies, Johns Hopkins University, and the University of Cape Town present compelling evidence that targeted taxes on products like tobacco, alcohol and sugary drinks could not only reduce preventable disease and death, but also provide much-needed domestic revenue for African governments.
“Health taxes on unhealthy products like tobacco, alcohol, and sugary drinks save lives, reduce healthcare costs, and generate revenue,” said Dr. Mary-Ann Etiebet, CEO and President of Vital Strategies.
“The ‘Future of Health Financing in Africa’ brief is a valuable resource, providing regional evidence, policy examples, and practical guidance to help African governments resist industry interference and design effective health taxes. These taxes can maximize benefits for citizens, advance government priorities, and secure a healthier future, especially given the current challenges of budget deficits, overwhelmed health systems, rising healthcare costs, and the growing burden of noncommunicable diseases,” she added.
According to the report, health taxes offer a triple win for African nations: they reduce harmful consumption, raise domestic revenue, and lower long-term healthcare costs.
NCDs—including cardiovascular disease, diabetes, cancer and chronic respiratory conditions which now account for 37% of deaths across the continent. The combination of rapid urbanisation, youth population growth, and ageing societies is exacerbating this trend.
Much as Health taxes have already been endorsed by the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC), the uptake of health taxes in Africa remains inadequate. Most countries impose excise taxes on tobacco, alcohol and sugary drinks—but at rates too low or with poor tax design to reduce affordability and consumption meaningfully.
According to the findings, the median tax component of the price of tobacco in Africa is just 41%, well below the WHO’s recommended minimum of 75% with Mauritius as the only African country to have reached this threshold.
Similarly, alcohol taxes are often outdated and ineffective with only 23% of countries with specific alcohol taxes adjust them for inflation, a critical step to maintain their impact. Taxes on sugary drinks, while implemented by approximately 80% of African countries, are usually below 20% of the retail price. Globally, the median is just 3.4%.
“The structure and design of health taxes matter,” emphasised Professor Corne van Walbeek, Director of the Research Unit on the Economics of Excisable Products at the University of Cape Town. “Taxes that are levied as a specific amount per pack, litre, or gram are more effective than those based on product value. And they must be increased regularly to account for inflation and income growth.”
According to global health experts, the economic gains could be transformative. A 50% price increase on tobacco, alcohol, and sugary beverages could generate $2.1 trillion over five years for low- and middle-income countries—revenue equivalent to 40% of their total health spending, says Dr Jeffrey Drope, Director of the Economics for Health team at Johns Hopkins University.
Experts highlight South Africa, for example which introduced an excise tax on sugary drinks in 2018 and within two years, taxed beverage purchases per person dropped by 29%, sugar intake from these drinks fell by 51% as companies reformulated products, and the government collected approximately R5.8 billion (US$319 million) in revenue.
Botswana’s 2021 sugar tax generated US$8 million in the 2023–24 fiscal year. Meanwhile, Ghana raised tobacco taxes, increasing the share of retail price from 23% in 2020 to 38% by 2024, more than doubling revenue from US$5.4 million in 2021 to US$12 million in 2023.
Dr Adam Karpati, Senior Vice President for Public Health at Vital Strategies and a co-author of the brief said, “These examples show that health taxes are not theoretical—they work,” said. “Governments around the world are acting. All countries should follow suit.”
Despite the evidence, adoption remains slow largely due to industry interference.
“Health-harming industries like Big Tobacco, alcohol and junk food are exploiting weak regulations to delay or derail tax measures. The fingerprints of these industries are all over weakened global commitments, including the upcoming UN Political Declaration on NCDs.” warned Alison Cox, Director of Policy and Advocacy at the NCD Alliance.
The current draft of the declaration, set for approval at the UN High-Level Meeting on NCDs in September, has been criticised for diluting strong language on fiscal measures and failing to hold industries accountable.
“It is a backslide,” Cox stated. “At a time of fiscal pressures and shrinking global health funding, health taxes are a golden opportunity to both generate revenue and reduce the burden of NCDs. Yet industry profits are being prioritised over public health.”
This concern was echoed by Serah Makka, Executive Director for Africa at ONE, who stressed the importance of public trust in the use of tax revenues.
“There is an openness to paying taxes where people can see what it’s used for. Taxes are synonymous with trust,” she said.
As African countries prepare for the next wave of global health financing reforms, experts are urging leaders to rise above commercial pressures and implement best-practice health taxes designed to increase with inflation and income, protected from industry manipulation, and earmarked for social benefit.
“History has taught us that ignoring the integral role of civil society, communities and people living with diseases weakens any meaningful public health response,” said Cox. “NCDs are no exception.”
The report underscores that the real cost of inaction is measured not only in missed revenue, but in lives lost, opportunities squandered, and health systems overwhelmed. Health taxes, if implemented properly, are Africa’s untapped weapon against disease, death, and donor dependence.
Experts urge African leaders and global policymakers to adopt and strengthen health taxes. Best-practice health taxes—designed to rise with inflation and income, earmarked for public benefit, and shielded from industry interference—are foundational to protecting public health.
