The traditional approach to healthcare financing in Africa is no longer effective as the continent faces declining Official Development Assistance, rising debt, and shrinking fiscal space. With the Sustainable Development Goals deadline approaching in 2030, African countries must adopt a new strategy to protect gains and accelerate progress. This requires a broad political-economy approach, treating health financing as a macroeconomic, sovereignty, and accountability imperative.
The current healthcare financing model, heavily reliant on domestic expenditure and external assistance, has produced fragmented systems and parallel structures, limiting control over national agendas. Many African countries, including Mali, face significant challenges, with approximately $40 per person per year for health services, yet having little control over financing provided by partners or how it is used. This reality highlights the need for a new approach to health financing that prioritizes domestic co-financing pathways and progressive investment.
The conventional focus on increasing domestic health financing is insufficient, as Finance Ministries must balance health spending against other pressing priorities. To address this, Africa must prioritize health financing resilience, protecting essential services and gains, improving efficiency, and reprioritizing expenditure. This approach sequences Africa's ambitions intelligently, recognizing the limitations of domestic financing and the need for innovative solutions.
High out-of-pocket expenditure on healthcare is a significant burden on African families, signaling a failure of pooling, protection, and solidarity. Reform must focus on reducing this burden, not transferring more costs to citizens. The years to 2030 must become an emergency implementation window, with countries determining which services cannot be interrupted and which reforms offer the greatest returns. Success will be measured by continuity, equity, and lower out-of-pocket expenditure.
The future of healthcare financing in Africa begins by changing how health is presented to political leaders and Finance Ministers. Health is not simply social expenditure; it is productive capital that strengthens human capital, workforce productivity, economic resilience, and national stability. Healthy children learn better, and healthy adults contribute more to the economy. Resilient systems protect economies from epidemics and shocks.
To achieve this, Africa must connect public resources with private, institutional, and development finance through innovative instruments such as blended finance, guarantees, health bonds, and public-private partnerships. These instruments must finance investment-ready opportunities, including primary healthcare infrastructure, digital systems, diagnostics, and pharmaceutical manufacturing. Public and concessional resources can absorb risk and protect equity, while private capital can finance viable infrastructure.
Ultimately, no financing model is sustainable without trust and accountability for commitments, allocation, implementation, results, and every dollar invested. Governments and partners must show not only how much was spent but whether resources improved access, outcomes, and lives. External financing should strengthen national institutions and use national systems, catalyzing transition and co-investment, not remaining perpetual landlords of African health programmes.
Key points
- Health financing must be viewed as productive capital to achieve the Sustainable Development Goals.
- Africa must prioritize health financing resilience, protecting essential services and gains, and improving efficiency.
- Innovative financing instruments, such as blended finance and public-private partnerships, can help bridge the financing gap.
