A new report reveals that deep cuts to public spending across six African countries have seen the real incomes of health and education workers fall by up to 50% over five years, leaving them struggling to afford essentials like food.

Published by ActionAid, The Human Cost of Public Sector Cuts in Africa surveyed over 600 healthcare workers and teachers in Ethiopia, Ghana, Kenya, Liberia, Malawi, and Nigeria. The findings are alarming: 97% of healthcare workers say their wages no longer cover their basic needs. Teachers report being overwhelmed by overcrowded classrooms, with some forced to manage over 200 students without books or supplies.

The report paints a bleak picture of failing public systems – especially for women and girls –caused by relentless public spending cuts pushed by the International Monetary Fund (IMF). Amid a deepening debt crisis, over three-quarters of Global South countries are now spending more to repay foreign lenders than on healthcare.

ActionAid says the International Monetary Fund (IMF) is to blame for its advice to governments to cut spending on public services in order to service foreign debts. With the accelerating debt crisis in the Global South, over three-quarters of all low-income countries in the world are spending more on debt servicing than they spend on health.

“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.

“This is not only absurd but unsustainable in the long run. The time for change is now. Governments must shift from unsustainable economic policies based on cuts and debt repayments to those that prioritise human rights. The lives of millions depend on it.”

The research highlights how insufficient budgets in the healthcare system have led to chronic shortages and a decline in service quality. Community members in all six countries revealed deep dissatisfaction with the public healthcare system and noted rising costs of services, shortage of healthcare workers, and poor infrastructure. What’s also clear is the disproportionate impact on women, as

“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, as a result, most women must seek services in Mombasa, which is expensive.”

Medicines for malaria are now ten times more expensive at private facilities. Long travel distances, rising fees and a dwindling medical workforce are leaving millions without healthcare as

“Now 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 (USD 0.4), but now it costs more than 500 birr (USD 4) in private health centres.”

“We are referred for diagnosis tests 40 km away from the [local] dispensary. Doctor’s consultation has [doubled] at the referral hospital, making it difficult for the community to access services.”

In education, the toll is equally severe. Budget cuts have resulted in failing public education systems crippled by rising costs, a dire shortage of learning materials and overcrowded classrooms. Some 87% of teachers said they lacked basic classroom materials, with 73% shelling out for equipment themselves. Meanwhile, teachers’ incomes are falling: 84% of teachers surveyed reported a drop in real income of between 10 and 50% over the past five years.

“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. Monitoring individual performance and supporting struggling students has become a daunting task,”

Four of the six countries covered by the research are spending less than the recommended one-fifth of the national budget on education and exceed the ratio of one teacher per 30 pupils, as reported by the UNESCO Institute for Statistics.

“The ministry doesn’t provide teaching aids or textbooks. I feel stressed and hopeless. We need better infrastructure and resources to cope with these changes.”

On a personal level, due to reduced income, , “I often struggle to put enough food on the table.”

The research shows that the consequences of these policies are multi-faceted and far-reaching. Workers are stretched beyond their limits and communities’ fundamental rights to healthcare and education are severely impacted. Governments and the IMF must work to reverse this damaging trend of cuts to essential services while prioritising debt repayment.

“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.

“This means the burden of debt falls on those most marginalised - once again. This must end.

She added: “It’s crucial that governments agree on new international rules on global economic governance that shift important decisions away from the IMF and towards democratic institutions, such as the United Nations, to shape a fair and inclusive global economy for all.”

ActionAid is calling on education and health ministries to work with finance ministries to allocate sufficient resources to meet global benchmarks, ensure fair remuneration for workers, and improve infrastructure to deliver quality services.

Additionally, governments should explore fair and just ways of raising income, such as progressive taxation, rather than imposing spending cuts to essential public services.

Spokespeople are available. For more information and interviews, contact the media office at [email protected] or +263776665065.

*Name changed to protect the identity of the respondent

About ActionAid

ActionAid is a global federation working for a world free from poverty and injustice. We want to see a just, fair and sustainable world, in which everybody enjoys the right to a life of dignity, and freedom from poverty and oppression. We work to achieve social justice and gender equality, and to eradicate poverty.