Healthcare System Strain in Africa: Population Growth, Epidemiological Pressure, and Absorptive Capacity -Panel Estimation and Forecast Analysis to 2040

This paper examines whether population growth independently destabilizes healthcare system performance across African countries or whether its effects are conditional on institutional absorptive capacity. Using an annual panel of 54 African countries from 2000-2023 (1,296 country-year observations), two-way fixed effects (TWFE) models show that log population has no statistically significant independent association with under-five mortality, infant mortality, or life expectancy once country and year fixed effects and structural controls are included. Interaction specifications reveal the central result. The population mortality relationship becomes significantly more adverse where absorptive capacity is weaker (interaction coefficients:-0.016**, under-five mortality;-0.019***, infant mortality). System GMM estimates confirm near a unit root persistence in mortality outcomes (lagged dependent variable: 0.991-1.007), indicating that changes in health performance operate through slow structural dynamics rather than abrupt demographic shocks. As a forwardlooking extension of this conditional argument, the paper constructs a standardized Pressure-Capacity Gap for 2024-2040 using projected demographic, epidemiological, and institutional components. The Africa-wide population-weighted gap narrows from 0.397 in 2024 to 0.126 in 2040 under the fixed-2024 standardization, but remains positive throughout, indicating incomplete convergence toward structural balance. Approximately 70-73% of projected population resides in gap-positive systems across Africa. A counterfactual scenario with 10% slower healthcare spending growth yields a persistently higher gap (+0.018 by 2040), confirming that convergence is conditional on sustained fiscal expansion. The findings advance a conditional institutional perspective: population growth does not mechanically destabilize health systems, but structural sustainability depends on whether absorptive capacity expands sufficiently to offset demographic momentum.