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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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The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review

Nabyonga-Orem J., Christmals C.D., Addai K.F. et al. Journal of Global Health (2023) CC

Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal ... 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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WHO guidelines on meningitis diagnosis, treatment and care
recommended

World Health Organization WHO (2025) C_WHO

The guidelines are primarily intended for health-care professionals working in first- or second-level health-care facilities, including emergency, inpatient and outpatient services. They are also directed at policy-makers, health-care planners and programme managers, academic institutions, non-gover... more

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

New

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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Realizing Agenda 2030: Will donor dollars and country priorities align with global goals?

Sethi, T.; S. Custer; J. Turner et al. AidData at William & Mary (2017) CC

This report seeks to uncover the extent to which global goals crowd in international financing, inform domestic policy priorities, and navigate progress toward development outcomes in low- and middle-income countries (LICs and MICs). Our report: Provides a historical perspective on how ODA financin... more

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Rights in a pandemic – Lockdowns, rights and lessons from HIV in the early response to COVID-19

UNAIDS (2020) C_WHO

These include taking proactive measures to ensure that people, particularly people in vulnerable groups, can access HIV treatment and prevention services, designating and supporting essential workers, including community-led organizations, and implementing measures to prevent and address gender-base... more

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CRS Manager's Guide to PHAST Methodology

Mayling Simpson-Hebert Catholic Relief Services (2011)

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Involving Persons Living with HIV Networks in National HIV Policy Dialogue A Case Study of MANET+ in Malawi

M. L. Mattingly; A. G. Yemaneberhan; S. Feller; et al. USAID; PEPFAR; AIDS Free (Strenghtening High Impact Interventions for a AIDS-free Generation); JSI Research & Training Institute; et al. (2016) C2

AIDSFree Case study series This publication is made possible by the generous support of the American people through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID) under the terms of Cooperative Agreement AID-OAA-A-14-00046... more

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Practical guide to inclusive and rights-based responses to Covid-19 in the Americas

OAS (2020) CC

WHY THIS GUIDE? Because, in the face of crises and emergencies, it is vital to include a human rights perspective in responses. Vulnerable groups face major obstacles to accessing and benefiting from prevention, mitigation, and health care policies due to structural barriers of inequality. To offer... more

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Emergency health response plan for drought in Somalia: Early action to protect health and save lives April-December 2022

World Health Organisation (WHO) (2022) C_WHO

Nearly 260 000 people died in parts of Somalia between October 2010 and April 2012, including 133 000 children under five during the famine and food crisis in Somalia making it the worst famine in history. A study commissioned and funded by the Food and Agriculture Organization of the United Natio... more

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Management Of Drugs at Health Centre Level

WHO (2004) C_WHO

Training Manual

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Preventive chemotherapy in human helminthiasis : coordinated use of anthelminthic drugs in control

World Health Organization (2006) C_WHO

Coordinated Use of Anthelminthic Drugs in Control Interventions: a Manual for Health Professionals and Programme Managers

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Global commitments, local action

UNAIDS (2021) C_WHO

3 June 2021. After 40 years of AIDS, charting a course to end the pandemic. The report shows that countries with progressive laws and policies and strong and inclusive health systems have had the best outcomes against HIV. In those countries, people living with and affected by HIV are more likely t... more

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The Lancet Nigeria Commission: investing in health and the future of the nation

Abubakar, I.; et al. (2022) CC

Lancet 2022; 399: 1155–200 Published Online March 15, 2022 https://doi.org/10.1016/ S0140-6736(21)02488-0

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Cameroon: Disability and rehabilitation status, review of disability issues and rehabilitation services in 29 African countries

World Health Organisation (WHO) (2004) C_WHO

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Community-based health care, including outreach and campaigns,in the context of the COVID-19 pandemic
recommended

World Health Organization WHO, IFRC; UNICEF (2020) C_WHO

The COVID-19 pandemic is challenging health systems across the world. Rapidly increasing demand for care of people with COVID-19 is compounded by fear, misinformation and limitations on the movement of people and supplies that disrupt the delivery of frontline health care for all people... This g... more

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Harmonized health facility assessment (‎HHFA)‎: comprehensive guide

World Health Organisation (WHO) (2023) C_WHO

The HHFA Comprehensive guide serves as the main reference document for planning and implementing a country HHFA. This guide will promote understanding of: What the HHFA is and the information it can and cannot provide. The HHFA modules, questionnaires and CSPro electronic data collection tool. Th... more

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COVID-19 pandemic in the health of women, children, and adolescents in Latin America and the Caribbean

Castro, A. UNDP (2020) CC

WHO guidelines on meningitis diagnosis, treatment and care recommended

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

Community-based health care, including outreach and campaigns,in the context of the COVID-19 pandemic recommended

WHO guidelines on meningitis diagnosis, treatment and care
recommended

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

New

Community-based health care, including outreach and campaigns,in the context of the COVID-19 pandemic
recommended