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Africa’s Health Financing in a New Era

Africa Centres for Disease Control and Prevention (Africa CDC) (2025) CC

Africa’s health sector is facing an unprecedented financing crisis, driven by a sharp decline of 70% in Official Development Assistance (ODA) from 2021 to 2025 and deep-rooted structural vulnerabilities. This collapse is placing immense pressure on Africa’s already fragile health systems as ODA ...is seen as the backbone of critical health programs: pandemic preparedness, maternal and child health services, disease control programs are all at risk, threatening Sustainable Development Goal 3 and Universal Health Coverage. Compounding this is Africa’s spiraling debt, with countries expected to service USD 81 billion by 2025—surpassing anticipated external financing inflows—further eroding fiscal space for health investments. Level of domestic resources is low. TThe Abuja Declaration of 2001, a pivotal commitment made by African Union (AU) member states, aimed to reverse this trend by pledging to allocate at least 15% of national budgets to the health sector. However, more than two decades later, only three countries—Rwanda, Botswana, and Cabo Verde—have consistently met or exceeded this target (WHO, 2023). In contrast, over 30 AU member states remain well below the 10% benchmark, with some allocating as little as 5–7% of their national budgets to health. In addition, only 16 (29%) of African countries currently have updated versions of National Health Development Plan (NHDP) supported by a National Health Financing Plan (NHFP). These two documents play a critical role in driving internal resource mobilisation. At the same time, public health emergencies are surging, rising 41%—from 152 in 2022 to 213 in 2024—exposing severe under-resourcing of health infrastructure and workforce. Recurring outbreaks (Mpox, Ebola, cholera, measles, Marburg…) alongside effects of climate change and humanitarian crises in Eastern DRC, the Sahel, and Sudan, are overwhelming systems stretched by chronic underfunding. The situation is worsened by Africa’s heavy dependency with over 90% of vaccines, medicines, and diagnostics being externally sourced—leaving countries vulnerable to global supply chain shocks. Health worker shortages persist, with only 2.3 professionals per 1,000 people (below the WHO’s recommended 4.45), and fewer than 30% of systems are digitized, undermining disease surveillance and early warning. Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face 2 to 4 million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within. Furthermore, 39 million more Africans could be pushed into poverty by 2030 due to intertwined health and economic shocks. This is not just a sectoral crisis—it is an existential threat to Africa’s political, social, and economic resilience, and global stability. In response, African leaders, under Africa CDC’s stewardship, are advancing a comprehensive three-pillar strategy centered on domestic resource mobilization, innovative financing, and blended finance. more

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Evolution and effectiveness of bilateral and multilateral development assistance for health: a mixed-methods review of trends and strategic shifts (1990–2022)

Xie S., Du S., Huang Y., et al. BMJ Global Health (2025) CC

Development assistance for health (DAH) plays a vital role in supporting health programmes in lowand middle-income countries. While DAH has historically focused on infectious diseases and maternal and child health, there is a lack of comprehensive analysis of DAH trends, strategic shifts and the... more

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The cost of austerity: The toll of IMF conditionalities on access to health in Zambia

Make Way, Wemos (2024) CC

Zambia is facing a severe economic crisis marked by high inflation, increasing poverty and a heavy debt burden that is straining both its fiscal stability and progress in health outcomes. By 2020, the country's external debt reached United States dollars (USD) 12.7 billion, representing 108% of the ... more

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Health for All – transforming economies to deliver what matters: Final report of the WHO Council on the Economics of Health for All

World Health Organization (WHO) (2023) CC

The Council was established in late 2020 by Dr Tedros Adhanom Ghebreyesus (Director-General, WHO) to provide new economic thinking – reassessing how health and wellbeing are valued, produced and distributed across the economy. An all-female group of 10 distinguished economists and area experts, t... more

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Conditioned Domestic “Co-financing” Policies in Global Health

Sparkes S., Yungrattanachai M., Fan V., et al. Center for Global Development (2024) CC

Conditioned domestic financing policy, referring to the domestic financing of health projects, programs, and national responses conditioned by global health funding agencies and recipient country governments, is one mechanism to promote sustainability and country ownership. We aim to understand how ... more

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Financing the Pandemic Cycle: Prevention, Preparedness, Response, and Recovery and Reconstruction

Fan V. Y., Kim S., Pineda D., et al. Center for Global Development (2024) CC

The COVID-19 pandemic exposed critical gaps in the global response to health crises, particularly in the financing of pandemic prevention, preparedness, response, recovery, and reconstruction. This chapter presents a comprehensive framework for pandemic financing that spans the entire pandemic cycle... more

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A healthy return: Investment case for a sustainably financed WHO

World Health Organization (WHO) (2022) CC

There has never been a more critical moment to invest in WHO, and strengthen the unique role it plays in global health. Now is the time to sustainably finance WHO and invest in a healthy return for all.

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Proposals for ODA Reform: A Review of Key Approaches

Calleja R., Casadevall-Bellés S. Center for Global Development (2024) CC

Questions concerning the relevance and reform of official development assistance (ODA), and how ODA and broader development finance could—or should—change to better reflect shifting demands are not new, with academics and policymakers suggesting a range of options for reform. In this background ... more

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The Evolution of the ODA Accounting Rules

Casadevall-Bellés S., Calleja R. Center for Global Development (2024) CC

Frequent efforts to revise the official development assistance (ODA) accounting rules have raised important questions about the integrity and relevance of what currently “counts” as ODA spending. In this note, we outline a brief history of the evolution of the ODA accounting rules to date, highl... more

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Financing for Sustainable Development Report 2024

Inter-agency Task Force on Financing for Development United Nations (UN) (2024) CC

The world is facing a sustainable development crisis. The 2024 Financing for Sustainable Development Report: Financing for Development at a Crossroads finds that financing challenges are at the heart of the crisis and imperil the SDGs and climate action. The window to rescue the SDGs and prevent a c... more

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Manual for Stratifying Malaria Risk and the Elimination of Foci

Pan American Health Organization PAHO (2022) C_WHO

All malaria-endemic countries in the Region of the Americas have taken on the challenge to eliminate the disease and to put in place measures to orient their health programs and strategies in that direction. This manual explains how to implement measures to achieve malaria elimination and prevent it... more

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Plan stratégique du Partenariat RBM pour la période 2021-2025

RBM Partnership to End Malaria (2020) C2

Le plan stratégique de la RBM Partnership to End Malaria pour 2021-2025 présente les priorités stratégiques du partenariat mondial visant à éliminer le paludisme. Le document se concentre sur trois objectifs stratégiques principaux : optimiser les programmes régionaux et nationaux, maximiser... more

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Namibia: WHO and UNICEF estimates of immunization coverage: 2022 revision

World Health Organization WHO; UNICEF (2024) C_WHO

Each year WHO and UNICEF jointly review reports submitted by Member States regarding national immunization coverage, finalized survey reports as well as data from the published and grey literature. Based on these data, with due consideration to potential biases and the views of local experts, WHO an... more

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WHO guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries
recommended

World Health Organization WHO (2025) CC

The objectives of this guideline are the same as those of the 2011 edition, namely to provide evidence-based normative guidance on interventions to improve adolescent morbidity and mortality by reducing the chances of early pregnancy and its resulting poor health outcomes. The specific objectives of... more

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Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study

Amkongo, M.; Mitonga, H. K.; Alfeus, A.; et al. (2023) CC2

BMC Infectious Diseases volume 23, Article number: 342 (2023). Tuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB bur... more

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Disability-inclusive Employment Promotion: Lessons learned from five GIZ projects

Deutsche Gesellschaft für Internationale Zusammenarbeit GIZ (2019) CC2

In the initial chapters, you will find different approaches that describe how to support job creation for entrepreneurs or employees who live with disabilities. The interventions are often initiated by the readiness to find and pick the right opportunities, such as an engaged entrepreneur or an open... more

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Safety of artemisinin and non-artemisinin antimalarials in the first trimester of pregnancy

World Health Organisation (WHO) (2024) C_WHO

Malaria in pregnancy is a significant health problem in malaria-endemic areas. It not only causes substantial childhood morbidity and mortality but also increases the risks of adverse events for pregnant women and their developing fetuses. Most of the burden in these areas is due to infection with P... more

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Theory of Change

Nutrition and Food Security Alliance of Namibia; UNFPA; UNICEF; et al. (2020) CC2

Early Identification and Early Intervention Services for Young Children with Developmental Delays and Disabilities in Namibia Republic of Namibia Namibia Regional Consultations Report

WHO guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries recommended

WHO guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries
recommended