How Much Does 1 Dirham Spent on Prevention Return?

While health spending in Africa tripled between 2000 and 2018, systems remain largely focused on curative care, at the expense of an ambitious prevention policy. Vaccination, early screening and health education are all underused levers that can nevertheless reduce disease burden and long-term costs.

Morocco is no exception to this trend: the share of the health budget allocated to prevention remains below international recommendations. Yet global data are unequivocal: every dollar invested in prevention can generate up to 14 dollars in economic benefits.

In a context of epidemiological transition and scarce resources, this under-prioritization raises questions. How much does one dirham invested in prevention really return? And above all, why do we continue to neglect such a profitable lever?

Prevention, the Great Absentee from African Health Budgets

Despite the discourse, prevention remains barely visible in budgets. The African continent ranks fifth globally in terms of public health spending, with 5.3% of its GDP devoted to the sector. African states’ financial commitment to health remains limited: according to the WHO Health Expenditure Atlas (2023), only a few countries exceed the threshold of 15% of the national budget allocated to health, and the share assigned to prevention is generally very low or not detailed.

In Morocco, the share of the health budget devoted to prevention generally ranges between 10% and 13%, according to Ministry of Health reports and assessments by international organizations for the 2022-2025 period. This level remains below the standards recommended by the WHO, which encourages raising the ratio to 20% in countries undergoing epidemiological transition.

Yet global data leave little room for doubt: the evidence shows that one dollar invested can generate up to 14 dollars in economic benefits, by reducing future care-related costs, increasing productivity and easing pressure on health systems.

In this context of dwindling international aid and epidemiological transition, redirecting budget priorities is becoming an issue of economic sovereignty as much as public health.

A Strategic Lever for More Sustainable Systems

Investing in prevention in Africa is not only a health imperative: it is a strategic lever for the sustainability of health systems. As the continent faces a double burden, with persistent infectious diseases and the rapid rise of non-communicable diseases (NCDs), the costs linked to late-stage care are soaring.

The World Bank estimates that every dollar invested in health generates an average economic return of 2 to 4 dollars. Prevention programs, such as vaccination, have demonstrated their effectiveness by saving around 350 billion dollars in treatment costs for infectious diseases since 2000.

These investments translate into several tangible benefits for public finances:

• Reducing curative-care spending: Investing in disease prevention (vaccination, early screening, health education, promotion of healthy eating and physical activity) reduces the number of people who fall ill and, as a result, the need for costly treatments, hospitalizations and medicines. Chronic and expensive diseases, for example, weigh heavily on health budgets.
• Increasing workforce productivity: A healthier population is more productive, which means less absenteeism at work and stronger economic performance. This has a positive impact on GDP and tax revenues (income taxes, VAT on increased consumption).
• Reducing allowances and social benefits: Fewer illnesses and accidents mean fewer claims for daily allowances due to temporary work incapacity, fewer pensions for permanent incapacity and lower charges for the National Social Security Fund (CNSS) and other social protection schemes.
• Investment attractiveness: A country with a high-performing health system and a healthy population is more attractive to foreign investors, which can generate jobs and additional tax revenues.

Prevention in Africa: Proven Results and Models to Follow

One concrete example is Rwanda, often cited as a model of success in sub-Saharan Africa. Through ambitious policies and public-private partnerships, the country has invested heavily in health prevention, particularly vaccination, screening and the fight against infectious diseases. The result: between 2000 and 2020, life expectancy rose from 49 to 67 years, with a sharp reduction in preventable diseases and costly hospitalizations.

Beyond this success, however, Rwanda’s example highlights a broader challenge across the continent: Africa faces both the persistence of infectious diseases and a significant increase in non-communicable diseases (such as diabetes, cancer and cardiovascular diseases), whose mortality rate rose from 24% in 2000 to 37% in 2019. It is precisely in this context that prevention becomes fully relevant, by sustainably reducing the costs linked to heavy and chronic treatments.

These results are not isolated: other African countries confirm, through concrete examples, that prevention is a powerful lever for improving public health while controlling spending.

In Ethiopia, for example, the government introduced a prevention program based on several pillars: the large-scale distribution of insecticide-treated mosquito nets and early detection. The results are impressive: between 2005 and 2017, malaria prevalence fell dramatically, with a reduction of 48% in cases, 54% in hospitalizations and 55% in deaths linked to the disease. This decline translated into a considerable reduction in direct hospitalization costs and intensive-care spending, helping ease pressure on the health system and free up resources for other health priorities.

Another country equally invested in prevention is Botswana, whose campaign against HIV/AIDS helped significantly reduce mortality linked to the disease. Economically, this reduction in direct health costs helped free up resources that were reinvested in other social and economic sectors of the country.

Challenges and Levers for Boosting Prevention in Africa and Morocco

The challenges facing health systems in Africa and Morocco, whether structural, epidemiological or social, make prevention particularly complex. To move forward, several strategic priorities should be considered:

• Rebalancing priorities in response to the double health burden: this burden requires a balanced strategy. On one hand, efforts to prevent still-prevalent communicable diseases (malaria, tuberculosis, HIV) must continue. On the other, it is imperative to anticipate the rapid progression of non-communicable diseases (diabetes, cancers, cardiovascular diseases), whose burden continues to rise, particularly in Morocco. This shift calls for a multisectoral, targeted prevention approach adapted to new health vulnerabilities.
• Supporting sustainable and sovereign financing: The decline in international aid after Covid highlights the need for African countries, including Morocco, to rethink their prevention-financing mechanisms. Ensuring its sustainability requires more effective and coordinated mobilization of public, private and community resources. Building an autonomous financial model thus becomes a key lever for guaranteeing the resilience and independence of health systems in the face of future crises.
• Mobilizing citizens and promoting the importance of prevention through education: Communicating tangible benefits, such as risk reduction, improved quality of life and fewer complications, helps increase people’s adherence to preventive practices such as vaccination, regular screening and periodic medical check-ups. In particular, raising awareness early, from a young age, encourages the adoption of healthy behaviors that last throughout life.

Conclusion :

The results observed in Rwanda, Ethiopia and Botswana show that prevention works, provided it is designed as a genuine strategic pillar of health policy. To amplify its impact, several levers must be activated.

Innovation and digitalization now offer major opportunities: telemedicine, medical-monitoring applications and shared epidemiological databases are tools that make it possible to detect earlier, monitor more effectively and intervene more quickly, even in remote areas.

But technology is not enough. Multisectoral governance is also needed, involving education, environment, agriculture and media sectors so they can act together on health determinants. Morocco, through its multisectoral strategy for the prevention and control of non-communicable diseases, has already laid the foundations for such an approach.

Investing in prevention is not only a health decision: it is a societal choice. A choice that, for every dirham invested, can return far more than it costs.