Imagine having to choose between life-saving cancer treatment and feeding your family.This is the reality for over 1 million new cancer patients in Africa who spend over 2,300 USD on average for treatment every year. Compare this against an average income of 2,156 USD per capita. As an orthopaedic oncologist, I often resort to older, less effective treatments for my patients because newer options are unaffordable due to high taxes, highlighting the financial strain on our healthcare system. Tax policies on healthcare inputs—such as medical supplies, equipment, and pharmaceuticals—significantly hinder access to cancer care and compromise treatment quality. These policies need urgent reform towards universal health coverage. 

In many African countries, essential healthcare items are heavily taxed, with import duties ranging from 5% to 25%. Additionally, value-added tax (VAT) rates between 7.5% and 20%.  These taxes inflate the costs of cancer care,  resulting in delays in access to vital care. In some cases, patients forgo treatment. 

Comparing taxation rates on healthcare inputs between Africa and other regions highlights the disparity. In many European countries, medical supplies and pharmaceuticals are either exempt from VAT or taxed at a reduced rate to ensure access. Germany, for example, applies a reduced VAT rate of 7% on medicines, while in the United Kingdom, prescription medications are exempt from VAT altogether. 

Higher costs for medical supplies and equipment compel healthcare providers to pass these costs on to patients or limit the services they offer both in the private and public sectors. In Africa, where 429 million people live below the poverty line, even a modest increase in medical expenses can make cancer treatment unattainable. This is evident in the stark difference between the costs of generic drugs and their branded counterparts. This leads to delayed diagnoses and poorer health outcomes. 

Moreover, the quality of care also suffers. Healthcare providers - facing increased costs, often compromise on the quality of materials and equipment by opting for cheaper, less reliable options or reducing critical diagnostic tests. These cost-cutting measures can result in misdiagnoses, inadequate treatment, and higher rates of complications. Yet,  reducing or eliminating taxes on critical medical supplies and equipment could significantly lower the cost of cancer care

African policymakers must act to reform these policies to ensure that financial barriers do not prevent patients from accessing life-saving treatment. Lessons can be drawn from Rwanda, which has taken steps to reduce or exempt taxes on essential healthcare inputs, improving access to healthcare services and aligning with broader public health goals like universal health coverage. Reducing or eliminating taxes on critical medical supplies and equipment could significantly lower the cost of cancer care. 

Governments may worry about potential revenue losses from tax exemptions or reductions. However, the long-term benefits of improved public health and increased economic productivity far outweigh these concerns. For instance, the United Kingdom’s National Health Service (NHS) has shown that preventive care and affordable access to medications lead to significant cost savings in managing chronic diseases, reducing the burden on the healthcare system, and increasing overall economic productivity. Moreover,  international aid and innovative financing solutions such as trusts/endowments and the so-called “sin tax” on processed foods can help bridge any short-term revenue gaps during the transition period. 

Governments must therefore identify and prioritise critical items for managing high-burden diseases and improving public health outcomes, such as medicines and medical equipment, based on their impact and cost-effectiveness. They should then implement tax reductions while monitoring the effects on healthcare costs, access, and government revenues, adjusting policies as needed to optimise both public health and fiscal stability. 

This will require quality data on the impact of taxation on healthcare inputs. Ethiopia provides a model in Africa, having reduced taxes on essential medicines and supplies while monitoring the effects on healthcare access and affordability. The evidence from their monitoring shows that medicines are more available from a revolving drug fund and Fee-waiver system.  Ethiopia seems to have improved availability of medicines, and can improve affordability by protecting people from purchasing drugs in the private sector.

Addressing these financial barriers is not merely a matter of economic policy; it is a moral imperative. Reducing or eliminating taxes on essential medical supplies and equipment will make cancer care more affordable and improve health outcomes for millions. Until this happens,  our collective global Sustainable Development Goals (SDGs) and the  African Union's development agenda - Agenda 2063, will not be realised.