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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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Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Global Burden of Disease 2021 Health Financing Collaborator Network The Lancet Glob Health (2023) C2

The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well ... more

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Assessment of Medicines Quality Assurance in Rwanda: Overview of Findings and Recommendations for Consideration

Coignez, V., Hajjou, M., and Smine U.S. Agency for International Development (USAID) (2009) C2

PQM conducted an assessment of the medicine quality assurance and quality control systems in Rwanda during November 9-13, 2009. Medicine quality assurance remains to be developed in Rwanda: the country has neither a medicine regulatory authority (MRA) nor a national medicine quality control laborato... more

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Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments

Snow, RW.; Okiro, EO.; Gething, PW.; Atun, R.; Hayc, SI. The Lancet (2010) CC

Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-contr... more

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Financing Maternal and Child Health—What Are the Limitations in Estimating Donor Flows and Resource Needs?

Schäferhoff, M.; Schrade, C.; Yamey G. PLOS Med (2010) CC

Marco Schäferhoff and colleagues critique funding estimates for the maternal and child health Millennium Development Goals, and make recommendations for improving the tracking of financing flows and estimating the costs of scaling up interventions for mothers and children.

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Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study

Haakenstad, A.; Moses, M.W.; Tao, T.; et al. (2019) CC

Between 2012 and 2016, development assistance for HIV/AIDS decreased by 20·0%; domestic financing is therefore critical to sustaining the response to HIV/AIDS. To understand whether domestic resources could fill the financing gaps created by declines in development assistance, we aimed to track spe... more

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Development Finance at a Turning Point: Effects and Policy Recommendations

Berensmann K., Laudage Teles S., Sommer C., et al. German Institute of Development and Sustainability (IDOS) (2023) CC

Development finance is at a turning point, as the macroeconomic environment has changed profoundly and the financing gap for low- and middle-income countries has widened. The events that led to this new situation are the multiple crises that the global economy is facing, such as the climate crisis, ... more

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Financing the SDGs: Evidence in Four Countries

Jennifer Turner AidData at William & Mary (2019) CC

Achieving the Sustainable Development Goals (SDGs) will require the international community to mobilize significant additional financing over the next decade. Tracking and analyzing this funding is central to measuring progress and making more informed choices to direct financial flows where they wi... 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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Primary Health Care As An Enabler For “Ending The Epidemics” Of High-Impact Communicable Diseases

World Health Organization WHO (2018) C_WHO

The Millennium Development Goals (MDGs) showed that global commitment and collective action could significantly reduce the disease burdens of three deadly communicable diseases: HIV/AIDS, tuberculosis (TB) and malaria. The MDGs helped focus efforts on these three deadly diseases and leveraged ... more

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Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study

Stenberg, K.; O. Hanssen; M. Bertram et al. Lancet Glob Health (2019) C1

Background: Primary health care (PHC) is a driving force for advancing towards universal health coverage (UHC). PHC-oriented health systems bring enormous benefits but require substantial financial investments. Here, we aim to present measures for PHC investments and project the associated resource ... more

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Analysis of the nature and contribution of innovative health financing mechanisms in the WHO African Region

World Health Organisation (WHO) (2023) C_WHO

Africa is off track to reach the Sustainable Development Goals by 2030 and lags behind in building resilient health systems and health security, against a backdrop of limited resources. The world envisaged a significant role for governments in funding the Sustainable Development Agenda, but inadeq... more

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Donor Financing of Global Mental Health, 1995—2015: An Assessment of Trends, Channels, and Alignment with the Disease Burden

Charlson, F.J.; J. Dieleman, L. Singh et al. PLOS One (2017) CC

Background: A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant w... more

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Neglected Disease Research and Development: The Higher Cost of Lower Funding

G-Finder (2023) CC

Each year since 2007, G-FINDER has provided policy-makers, donors, researchers and industry with a comprehensive analysis of global investment into research and development of new products to prevent, diagnose, control or cure neglected diseases in low- and middle-income countries, making it the go... more

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Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study

Su Y., Garcia Baena I., Harle A. et al. The Lancet (2020) CC

Estimates of government spending and development assistance for tuberculosis exist, but less is known about out-of-pocket and prepaid private spending. We aimed to provide comprehensive estimates of total spending on tuberculosis in low-income and middle-income countries for 2000–17.

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Countdown to 2015: changes in official development assistance to maternal, newborn, and child health in 2009–10, and assessment of progress since 2003

Hsu, J.; C. Pitt; G. Greco et al. Lancet (2012) C1

Background: Tracking of financial resources to maternal, newborn, and child health provides crucial information to assess accountability of donors. We analysed official development assistance (ODA) flows to maternal, newborn, and child health for 2009 and 2010, and assessed progress since our monito... more

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HEALTH SYSTEMS FINANCING The path to universal coverage

World Health Organization (2010) C_WHO

Promoting and protecting health is essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted that Health for All would contribute both to a better quality of life and also to global peace a... more

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Sick Development

Anna Marriott Oxfam International (2023) CC

Development finance institutions owned by European governments and the World Bank Group are spending hundreds of millions of dollars on expensive for-profit hospitals in the Global South that block patients from getting care, or bankrupt them, with some even imprisoning patients who cannot afford th... more

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From lemming to leader: Moving beyond Gross Domestic Product (GDP) to bring health financing assistance into the 21st century

Nassiri-Ansari's T., Schwalbe N., Lehtimaki S. PLOS Global Public Health (2024) CC

Nearly 90 years after Simon Kuznets first introduced Gross Domestic Product (GDP) for the limited purpose of measuring economic growth (by measuring the monetary value of all local goods and services within a given period of time), calls continue to mount for decision-makers to stop using GDP and it... more

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International Development Association Project Paper on a Proposed Additional Gran

International Development Association World Bank (2016) C1

IN THE AMOUNT OF SDR 21.8 MILLION (US$30 MILLION EQUIVALENT) WITH AN ADDITIONAL GRANT FROM THE GLOBAL FINANCING FACILITY (GFF) IN THE AMOUNT OF US$ 10 MILLION TO THE DEMOCRATIC REPUBLIC OF CONGO FOR A HUMAN DEVELOPMENT SYSTEMS STRENGTHENING PROJECT