Imagine four African countries without any living soul — Botswana, Namibia, Lesotho and Swaziland — all because of deaths to preventable, treatable and manageable diseases.

Across Africa, public health systems are in a ramshackle state, as a result, over eight million African lives are being lost annually to diseases, because people have little or no access to public health services.

That figure of eight million people dying annually is easily the combined populations of Botswana, Namibia, Lesotho and Swaziland. At this rate, many countries will run out of burial space. Consequently Africa's fastest growing industry is the coffins and burial business. In 20 years the number of lives lost could be equivalent to the population of Nigeria — at 130 million — Africa's most populous country," said Rotimi Sankore, coordinator of the Africa Public Health Rights Alliance which is promoting the 15% Now! Campaign to push African governments to adopt appropriate health policies. "Investment in health is key to resolving this situation"

Maternal and child mortality, HIV/AIDS, malaria and tuberculosis are the main diseases affecting the populations, yet governments are doing little to reverse the tide of deaths.

"It is clear that the vast majority of African governments have under-invested in health systems and there has been no long-term planning and understanding of health needs of citizens by government," said Sankore

The Heads of State African Union (AU) agreed to commit at least 15 percent of national budgets to health at their meeting in Abuja, Nigeria in 2001. But, six years later, only two out of 53 AU member countries (Botswana and Seychelles) have clearly met that pledge.

"To say it is tragic that in 2007 only two out of 53 AU member countries have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy," said Sankore.

Since the pledge was signed in 2001, Africa has lost a staggering 40 million lives due to a failure by African governments to develop, implement and fund comprehensive public health policies.

Worryingly, many of the governments are relying mainly on external efforts and donor funding to resolve their numerous public health problems.

"The leadership of most of the governments have not had to depend on the health systems of their countries for treatment and are therefore not committed to resolving the problem," said Sankore.

According to the 15% Now Campaign, African governments must urgently implement their 2001 Abuja Declaration pledge to dedicate 15 percent or more of annual budgets to health care within three years. Commensurate to this must be a commitment to dedicate a significant chunk of the money to resolving the brain drain of health care workers, and addressing key concerns such as reproductive health, child mortality, HIV and TB.

"If you look at countries where health systems can meet the needs of citizens, anything from 15 to 30 percent of budgets have been spent on public health. In Africa, the lion's share of budgets goes to military and defense spending," said Sankore. "The consequence is that once a higher percentage of citizens need health services, it becomes impossible for grants to deliver services."

Currently, the doctor per patient ratio in Africa is appalling. For example, the Democratic Republic of Congo (DRC), with a population of 57 million (roughly equivalent to the populations of the United Kingdom, France and Italy), has only 5,827 doctors compared to the France's 203,000, Italy's 241,000 and the UK's 160,000.

Cuba, with a population of about 11 million, has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi's 266, Zambia's 1,264 and Zimbabwe's 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as developed countries while the average life expectancy for these African countries is 37 to 40 years.

"To come anywhere near meeting the WHO recommended health worker to patient ratio or meeting the health based millennium development goals (MDG), these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years," states the 15% Now! petition. "This is Africa's priority."

The 15% Now! Campaign urges African governments to make the adoption of comprehensive health strategies a top priority, including the involvement of health care workers and civil society in setting measurable targets of progress.

Some people argue that funding the health sector is not the solution, but if all the people are dead, what will the other sectors be for, said Sankore.

The loss of health care workers to developed nations is also a major factor contributing to the poor state of health care system in Africa. Some developed countries maintain domestic public health policies that promote the recruitment of health care workers from Africa.

Improving health care systems in Africa will require developed nations to abandon such practices. Because developed countries have benefited from poaching African health care workers, they have a moral responsibility to promote the training of healthcare workers to improve Africa's health care workforce.

However, ordinary citizens in Africa are not informed enough to lobby their governments to adopt proper public health policies.

"The citizens are not adequately informed and it's the job of organized civil society to inform and mobilize ordinary people to campaign for their right to health and life," said Sankore.

Given the critical importance of good health to national development, an obvious question is why African governments pay little attention to the matter.

"There's phenomena that health is a private matter, but the truth is every single citizen's health issue when brought together presents a collective challenge. We may die individually of TB or HIV, but collectively our deaths impact society as a whole," Sankore commented. "Ordinary citizens in Africa have two choices — either they campaign for governments to accord their right to health, or they will die."

But the fact is that if African governments do not meet their obligations, they will soon find themselves presiding over countries without people, added Sankore.

Implementing the agenda of the 15% Now! Campaign, coupled with international donor support and policy change, offers the best chance for African governments to address the health needs of ordinary citizens.

"Doing nothing is not an option because if the situation persists, some countries in Africa will cease to function," said Sankore.