All African countries are signatory to the World Health Organization (WHO) Alma-Ata Declaration of 1978 wherein they committed themselves to achieve health-for-all by the year 2000. Towards the end of the twentieth century, it was recognized that achieving health-for-all was still a major challenge so renewed global commitments were made in the “World Health Declaration” of the World Health Assembly in 1998 wherein member States affirmed the need to give effect to the “Health-for-All policy for the twenty first century” through the implementation of relevant regional and national policies aimed at reducing social and economic inequities in improving the health of the whole population. At the regional level, African Governments have repeatedly highlighted the importance of bridging health inequities by improving access to health for all. The most recent affirmation of their commitment was made at the 3rd Ordinary Session of the Ministers of Health of the African Union that was held 9 -13 April 2007 in Johannesburg, South Africa, that particularly focused on the theme “Strengthening of Health Systems for Equity and Development”. In the declaration issued at the end of the meeting, the Ministers renewed their commitment to strengthen health systems for equitable health outcomes and specifically to develop social protection systems, particularly for the poor and vulnerable groups in society, aimed at promoting greater access to health care services and protecting families from debt traps due to health emergencies.

Despite these commitments, many African governments are still grappling with the challenge of devising health policies and health care systems that can ensure equity of access to adequate health care. Empirical evidence from a study undertaken by ECA “Mainstreaming health equity in the development agenda”, reveals striking evidence of inequities in accessing and utilizing health care resulting from income differences and rural urban location. The study used bivariate analysis on data from the Demographic and Health Surveys of ten African countries (Ethiopia, Kenya, Ghana, Senegal, Zambia, Malawi, Egypt, Morocco, Chad and Cameroon). The analysis revealed that in all the study countries women from the poorest quintiles are less likely than those in better off quintiles to use basic health services such as prenatal care, modern contraceptives, delivery assistance by a health professional, and immunization. Similarly the rural population group is disadvantaged in accessing health care services than urban population. Inequities are most extreme for delivery assistance. The existence of this striking evidence on health equities heightens the need for countries to take action to reduce these inequities and their root causes. This requires not only effective formulation of policies and strategies that can act on these inequities but allocation of adequate resources on a sustainable basis to help support implementation of the policies and strategies.

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