It Is Time For Africa to Fund Its Health Security
Relying on foreign aid is bad for Africa’s health and it must stop if the continent is to enjoy health security.
This was the collective view of government and corporate leaders meeting at the 58th session of the Conference of African Ministers of Finance, Planning and Economic Development in Tangier hosted by the Economic Commission for Africa (ECA).
More than 40 percent of Africa’s health care funding is from donor aid, the conference heard, sparking calls for Africa to urgently devise new models and sources of finance to support the health delivery system on the continent. In July 2025, US President Donald Trump dismantled the U.S. Agency for International Development (USAID), threatening the survival of many social and health programmes in Africa funded by the aid organisation.
“Global financial conditions are tightening, the cost of capital is rising and fiscal space is narrowing. Development assistance – once a reliable pillar of health financing – is declining and increasingly uncertain, both in scale and predictability,” said Clever Gatete, Executive Secretary of the ECA, at the High-Level Forum on Sustainable Health Financing on the sidelines of the conference.
Domestic Funding Will Do
In 2022, Africa spent approximately USD 145 billion on health, with half of the money from public financing and half from donors, a situation, Gatete said, that pushes more than 150 million households in Africa into poverty annually.
Africa is in a financial fix. It is facing a high public debt of around 63 percent of GDP on average, with debt servicing costs in several countries more than their expenditure on health and welfare services.
“This is the reality we confront: rising health needs in the midst of shrinking fiscal space. However, within this constraint lies a defining opportunity, not simply to finance health differently, but to transform how our systems are structured, scaled and sustained, Gatete said at the Forum which also launched the ECA Sustainable Health Financing Initiative to promote health investment on the continent across 25 countries over 5 years.
Gatete highlighted the need to redesign how health systems were financed in Africa through increasing mobilisation of domestic resources like widening the tax base, improving
efficiency and reducing leakages. Furthermore, innovative instruments such as blended finance and debt-for-health swaps were available to finance health care.
“We cannot finance 21st-century health systems with 20th-century models. The era of aid as the primary source of health financing is behind us,” he said.
Leaders underlined that Africa’s health security cannot be mortgaged to foreign funding. Already plagued by chronic underfunding, poor infrastructure and overworked, limited staff, Africa’s healthcare is in bad shape. The situation has worsened due to the polycrisis of conflicts, the COVID pandemic, and the impacts of climate change.
It is time for Africa to fund its health care, and it should do so sooner rather than later. Health sovereignty is national sovereignty, Gatete declared.
Plugging leaks will save Africa’s health
Dr Tewodros Bekele, Senior Director, Global Programs, Susan Thompson Buffett Foundation (STBF), said Africa’s health sector was bleeding from high wastage of resources meant to save lives.
“Health is an economic imperative but much more than that, our health systems are also leading in impoverishment,” Bekele noted, highlighting that procurement prices for medical products and services in Africa were far above global benchmarks. Up to 30 percent additional resources went to procurement compared to global average prices.
“How are we turning every single dollar into the highest impact for health?,” he asked. “Our push is to really redefine how we measure health financing success; it should not be about the budget but its cost per life saved, cost per treatment delivered and about communities we protected from impoverishment.”
Less talk, more action
Africa has been challenged to put its money where its mouth is. Health is wealth, African leaders reiterated.
Mahmoud Ali Youssouf, chairperson of the African Union Commission, emphasised that sustainable health financing was an economic priority. He urged African countries to use health as a pillar for economic stability and continental integration. He pledged to ensure that health financing was not perceived as a burden but a value-added asset that will provide stability on the African continent.
In a video address to the conference, World Health Organization Director-General, Dr Tedros Adhanom Ghebreyesus noted that sudden and severe aid cuts have seriously disrupted access to life-saving services for millions of people, calling for a new model for health financing.
“Leaders in Africa are recognising that the current model of financing is no longer sustainable. Many have told me they see this crisis and opportunity to leave behind the era of aid dependence to move to self-reliance by organising domestic resources and by increasing strategic investment in health,” he said.
Ahunna Eziakonwa-Onochie, United Nations Assistant Secretary-General, Assistant
Administrator and Director of the United Nations Development Programme (UNDP) said the withdrawal of USAID aid had a crushing effect on several African countries which were highly dependent on external assistance. She described the funding cuts as a wake-up call that Africa must never subcontract its health security to outsiders.
“Financing is important but it’s not the magic bullet if not used properly,” Eziakonwa-Onochie said, adding that, “We have to tackle corruption and leakages that exist even in this sector even when we do have the money that is not used to deepen inequality in terms of services and access. She emphasised that until African decision makers start using local public health services, there will be no progress on health security in Africa.
While Dr Jean Kaseya, Director-General, Africa Centres for Disease Control and Prevention (Africa CDC), highlighted that having money was not everything but how it was used to effectively deliver health services across Africa mattered.
He cited inefficiencies in the use of health resources, ghost workers who were on the payroll but did not work, fraudulent procurement and inappropriate planning processes. He called for the reform of the health architecture.
The Africa CDC has piloted innovative financing solutions, urging member countries to invest more domestic funds in health care. It launched a new financing guide for member states. The strategy proposes innovative financing, including solidarity levies on airline tickets, alcohol, and mobile services, while exploring how Africa’s US$95 billion in annual diaspora remittances can support national health priorities.
In 2001 the African Union member countries under the Abuja Declaration on Health committed at least 15 percent of national budgets to the health sector but only 5 percent of them have met this target almost two decades later. Rwanda, Botswana, and Cabo Verde have met or exceeded this target. While more than 30 AU member states remain well below the 10 percent benchmark, some allocate as little as 5–7 percent of their national budgets to health.
According to the ECA while Africa is now much healthier than 20 years ago, it has an annual financing gap of up to $66 billion.
“Even if every African government met the Abuja Health spending, the continent will still face a $66 billion funding gap a year,” said Yemi Osinbajo, Former Vice President of Nigeria, who said the structured financing challenge cannot be addressed through public funds alone but calls for the involvement of private capital.
Osinbajo stated that citizens face the most significant financial risk in health care.
The number one threat to jobs is poor health. When citizens experience trust in public health care, there is increased trust in government, he said.
IPS UN Bureau Report
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