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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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Agenda para as Américas sobre Saúde, Meio Ambiente e Mudança Climática 2021–2030

Pan American Health Organization (2021) C2

Esta publicação apresenta a Agenda para as Américas sobre Saúde, Meio Ambiente e Mudança Climática 2021–2030 (a Agenda). Esta Agenda é um apelo ao setor da saúde para que se posicione na vanguarda da abordagem aos determinantes ambientais da saúde nas Américas. A Organização Pan-Americ...ana da Saúde (OPAS) trabalhará com os Estados Membros para alcançar a meta e objetivo desta agenda: assegurar uma vida saudável e promover o bem-estar para todos, em todas as idades, usando um enfoque sustentável e equitativo que priorize a redução das iniquidades em saúde. A Agenda foi desenvolvido sob a égide da Estratégia Mundial da Organização Mundial da Saúde (OMS) sobre a Saúde, o Meio Ambiente e a Mudança Climática e se baseia nos compromissos estabelecidos na Agenda de Saúde Sustentável para as Américas 2018–2030 e no Plano Estratégico da OPAS 2020–2025. A Agenda foi desenvolvida em consulta com o Grupo Técnico Assessor (GTA), por meio de um processo decisório consensual com os Estados Membros, durante os anos de 2019 e 2020. Para alcançar o Objetivo de Desenvolvimento Sustentável 3, a Agenda enfoca: melhoria do desempenho dos programas e instituições de saúde pública ambiental; promoção de sistemas de saúde ambientalmente resilientes e sustentáveis; e promoção de cidades e comunidades ambientalmente saudáveis e resilientes. A implementação da Agenda deverá ser contextual, com base nas necessidades e realidades de cada país. Ela beneficiará países e territórios ao promover boas práticas de governança; fortalecer as funções de liderança e coordenação do setor da saúde; favorecer ações intersetoriais; focar na prevenção primária; e melhorar as evidências e a comunicação. Facilitará o acesso aos recursos humanos, técnicos e financeiros necessários para abordar os determinantes ambientais da saúde e garantir que a Região esteja totalmente engajada nos processos e acordos globais de saúde, meio ambiente e mudança climática. O objetivo desta Agenda é fortalecer a capacidade dos atores da saúde, tanto no setor da saúde quanto em outros setores, para abordarem e se adaptarem aos determinantes ambientais da saúde (DAS), priorizando as populações que vivem em condições de vulnerabilidade, a fim de atingir o Resultado Intermediário 18 do Plano Estratégico da OPAS 2020–2025, diretamente, e vários outros resultados do Plano, indiretamente. Para enfrentar e se adaptar aos desafios dos DEA na Região, será necessária uma abordagem integrada e baseada em evidências dentro do setor da saúde e entre os setores, possibilitada e favorecida por boas práticas de governança, mecanismos de gestão adequados, vontade política de alto nível e dotação adequada de recursos humanos, técnicos, tecnológicos e financeiros. more

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Results Based Financing: Engaging Communities to Strengthen Systems in Fragile Contexts

Hetty Burgman and Piet Vroeg Cordaid (2015) C2

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Projected Health Financing Transitions: Timeline and Magnitude

Rachel Silverman Center for Global Development (2018) C2

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The World Bank and financing global health

The BMJ (2019) C2

The BMJ's collection on "The World Bank and financing global health" is a series of articles providing an overview of the bank’s evolving role in international health. Accessed 22nd of May 2019.

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UN-Water GLAAS TrackFin Initiative: tracking financing to sanitation, hygiene and drinking-water at national level

World Health Organization (WHO) (2017) C_WHO

This guidance document sets out a methodology to identify and track financing to the WASH sector in a coherent and consistent manner across several countries. It is designed to help countries track financing to the WASH sector on a regular and comparable basis and analyse this information to support... more

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Managing transitions from external assistance: cross-national learning about sustaining effective coverage

Shroff Z.; Sparkes S.; Paina L. et al. Health Policy and Planning (2024) C1

The often-prominent role of external assistance in health financing in low- and middle-income countries raises the question of how such resources can enable the sustained or even expanded coverage of key health services and initiatives even after donor funding is no longer available. In response to ... more

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Trends in the alignment and harmonization of reproductive, maternal, newborn, and child health funding, 2008–13

Martinez-Alvarez M.; Achary A.; Arregoces L. et al. Health Affairs (2017) CC

Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013. However, increased spending by donors might not improve outcomes, if funds are delivered in ways that undermine countries’ public financial managemen... more

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Policy options to mitigate a drop in fiscal space for health and HIV following the COVID-19 pandemic — Case studies from the Democratic Republic of the Congo, Jamaica and Lesotho, November 2020

UNAIDS (2021) CC

To assess the impact of the COVID-19 pandemic on health and HIV expenditure, UNAIDS carried out a modelling study on fiscal space for health and HIV. From a sample of 28 countries, three countries—the Democratic Republic of the Congo, Jamaica, and Lesotho—were selected to capture health and HIV ... more

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Bundeshaushalt 2022- Eine Welt im Ausnahmezustand

Verband Entwicklungspolitik und humanitäre Hilfe VENRO (2022) CC

Stellungnahme zu Bundeshaushalt 2022

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Tracking development assistance for health to fragile states: 2005-2011

Graves C. et al. Pubmed (2023) CC

Development assistance for health (DAH) has grown substantially, totaling more than $31.3 billion in 2013. However, the degree that countries with high concentrations of armed conflict, ethnic violence, inequality, debt, and corruption have received this health aid and how that assistance might be d... more

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Global Economic Prospects

World Bank Group (2024) CC

Amid a barrage of shocks during the past four years, the global economy has proved to be surprisingly resilient. Major economies are emerging mostly unscathed after the fastest rise in interest rates in 40 years—without the usual scars of steep unemployment rates or financial crashes. Global infla... more

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Rethinking international financing for health to better respond to future pandemics

Xu Mi.; Benn C.; Reid-Henry S. et al. BMJ Glob Health (2023) CC

International financing for health has been high on the political and global health agenda since COVID-19. The recent launch of the Pandemic Fund represents the first consolidated effort of the international community to mobilise additional voluntary financial resources for the purpose of strengthen... more

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EU Facility for Refugees in Turkey List of projects committed/decided, contracted, disbursed

European Commission (2019) CC

The EU Facility has a total budget of €6 billion for humanitarian and development actions: €3 billion for 2016-2017 and €3 billion for 2018-20191. Both tranches combined, all operational funds have been committed, €4.7 billion contracted and more than €3.4 billion disbursed. The operationa... more

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Bundeshaushalt 2023- eine Welt im Ausnahmezustand

Verband Entwicklungspolitik und humanitäre Hilfe VENRO (2022) CC

Stellungnahme zum Bundeshaushalt für 2023

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Global health 2035: a world converging within a generation

Jamison D.; Summers L.; Alleyne G. et al. (2014) C1

Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment frame work to achieve dramatic health gains by 2035. Our report has four key messages, each accompanied by opportunities for action... more

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Bundeshaushalt 2021: Entwurf für den Bundeshalt 2021 und den Finanzplan bis 2024

Verband Entwicklungspolitik und humanitäre Hilfe (2020) CC

Entwurf für den Bundeshalt 2021 und den Finanzplan bis 2024

Sustainable financing mechanisms for strengthening mental health systems in Nigeria

Abdulmalik et al. Pubmed (2019) CC

Background and aims: Current coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationshi... more

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Strengthening resource tracking and monitorig health expanditure

OECD; Republic of Kenya Ministry of Health (2014) CC

Strengthening resource tracking and monitorig health expanditure

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Sustainable financing: WHO investment round

World Health Organization WHO (2023) C_WHO

Even before the coronavirus disease (COVID-19) pandemic, it was apparent that the world’s directing and coordinating authority on international health work needed sustainable financing in order for Member States to address the evolving global health threats, ranging from those rooted in climate c... more