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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
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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.
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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
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country's gross domestic product (GDP). In 2020, Zambia sought assistance through the G20 Common Framework and the International Monetary Fund (IMF) Extended Credit Facility (ECF), securing a USD 1.7 billion loan over 5 years. IMF loans, however, come with austerity measures that prioritise fiscal discipline but could potentially exacerbate social inequalities. These measures, which include increasing consumer taxes on goods and services (value added taxes - VATs), electricity tariffs and fuel prices, disproportionately impact vulnerable populations, raising concerns about their long-term effects on essential services, especially accessible and good quality healthcare services.
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This paper examines the implications of the IMF’s April 2024 macro-fiscal forecast updates on government health expenditure (GHE) across 170 economies through 2029, covering nearly all years remaining to achieve the Sustainable Development Goals (SDGs). The findings reveal wide disparities in gove
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rnments' capacities to increase health spending, with differences not only observed across income groups but also within them. Primary concerns focus to two groups of low- and lower middleincome
countries: the first group is projected to experience a contraction in real per capita GHE from 2019 and 2029, threatening to reverse progress toward the health SDG targets, while the other group faces stagnation in real per capita GHE, greatly limiting advancement. The insights presented are crucial for health policymakers and their external partners to respond to evolving macro-fiscal circumstances and stabilize investment growth in health. While increasing the priority of health in spending is a key policy option, it will not be sufficient on its own. Effective responses also
require improving spending efficiency and addressing broader fiscal challenges. Without decisive action, many countries have little chance of achieving the health SDGs.
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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
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, emphasizing the need for timely, adequate, and effective financial resources. The framework is designed to support
policymakers in both low- and middle-income countries (LMICs) and high-income nations, providing a guide to appropriate financing tools for each stage of a pandemic, from prevention and preparedness to response and recovery. Key economic concepts such as global public goods, time preference, and incentives are explored to underscore the complexities of pandemic financing.
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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
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s reestablishment by increasing the intensity and quality of interventions, reorienting initiatives, reducing delays that favor transmission, and ensuring adequate monitoring to adjust interventions.
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National Strategic Plan: Malaria Elimination 2023-27
National Centre for Vector Borne Disease Control (NCVBDC)
Ministry of Health and Family Welfare (MoHFW) - India
(2023)
C2
The National Strategic Plan for Malaria Elimination in India (2023-2027) focuses on achieving malaria elimination by 2030, in alignment with the Global Technical Strategy. The document outlines the strategies, targets, and goals for malaria elimination, aiming for zero indigenous malaria cases by 20
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27. It emphasizes district-based planning, robust surveillance systems, and enhancing case management and vector control. The plan stresses the importance of universal access to treatment, prevention, and data-driven decision-making. Furthermore, it encourages innovation and research in malaria elimination efforts, fostering multisectoral coordination and community engagement.
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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
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nmental and civil society organizations to inform capacity-building, teaching and research agendas.
Web annex A provides the quantitative evidence reports, Web annex B summarizes the qualitative and economic evidence and Web annex C presents the Evidence-to-Decision frameworks.
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This document is for public health specialists, health emergency responders, clinicians, health facility managers, health and care workers and IPC practitioners including but not limited to those working in primary care clinics, sexual health clinics, emergency departments, dental practices, infecti
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ous diseases clinics, genitourinary clinics, maternity services, paediatrics, obstetrics and gynaecology and acute care facilities that provide care for patients with suspected or confirmed mpox.
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ith a view to support the monitoring and reporting on the denial of humanitarian access against children, the Office of the Special Representative of the Secretary-General for Children and Armed Conflict and UNICEF publish today* a guidance note offering new tools to practitioners to better address
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this violation of children's rights in conflict situations. The Denial of Humanitarian Access (DHA) is one of six grave violations against children monitored by the United Nations in the framework of its Children and Armed Conflict (CAAC
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This malaria case management training manual was developed by the Federal Ministry of Health (FMOH) of Ethiopia, in collaboration with several national and international partners. Primarily based on WHO guidelines and training materials, as well as the 2022 national malaria guidelines and various te
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chnical documents, it aims to provide a standardised, simplified resource for clinical health workers in both the public and private sectors in Ethiopia. The manual aims to provide clinical health workers in both the public and private sectors in Ethiopia with a standardised, simplified resource.
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The Strategic Malaria Communication Guide for Central America is intended to facilitate the shift from malaria control to elimination by strengthening communication and advocacy initiatives throughout the region. Based on interviews and a review of literature, the guide offers National Malaria Progr
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ammes (NMPs) recommendations on messaging, target audiences, communication channels and advocacy strategies. The guide's primary goals are to raise awareness of malaria elimination, encourage long-term commitment from decision-makers and mobilise sustainable resources. The guide outlines two strategic objectives: (1) creating a shared understanding of the long-term requirements for malaria elimination, including funding, surveillance and multi-sectoral engagement, and (2) expanding support among public, private and cross-sectoral stakeholders. With malaria cases having already reduced by 88% since 2000, the guide emphasises the importance of maintaining focus and investment in order to fully eliminate the disease and prevent its re-establishment in Central America.
Accessed on 10/06/2025.
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This Communication Guide for Malaria Control Interventions is aligned with Tanzania’s Malaria Strategic Plan (2015–2020) and provides comprehensive guidance on the implementation of Social and Behaviour Change Communication (SBCC) for the prevention, diagnosis and treatment of malaria. It is int
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ended for all stakeholders and implementing partners, with the aim of ensuring harmonised messaging and coordinated communication efforts. The guide outlines strategies, key messages, communication channels and target audiences, with a focus on sustaining and improving malaria-related behaviours at the individual, family and community levels. It incorporates malaria stratification and supports the development of tailored SBCC interventions in different risk areas. Developed with contributions from the Ministry of Health and Social Welfare, the National Malaria Control Programme and various partner organisations, the guide aims to reduce the malaria burden and promote a malaria-free Tanzania. Supplemented by Standard Operating Procedures (SOPs), the guide serves as a practical tool for consistent and effective malaria communication nationwide.
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Meeting report, Kampala, Uganda,
7–8 November 2023
Preferred product characteristics and clinical development considerations
Vector control, alongside case management, remains the most effective approach to controlling and eliminating malaria. Key interventions, such as indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs), have significantly reduced malaria transmission in many African countries. This
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has enabled some countries to transition from the control phase to the elimination phase.
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Thematic brief. This brief highlights the link between climate change and VBDs in Asia Pacific. Using malaria to tell the narrative, it lists key actions that policymakers and the public health community can consider in addressing the impact of a changing climate on health. The brief also includes
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a list of resources that countries can benefit from in planning their response.
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Infographics
National Strategic Plan for Malaria Elimination in Bangladesh: 2021-2025
National Malaria Elimination Programme - Directorate General of Health Services
Ministry of Health & Family Welfare - Government of Bangladesh
(2021)
C2
The National Strategic Plan for Malaria Elimination 2021–2025 outlines Bangladesh’s roadmap to achieve zero indigenous malaria cases by 2030, with an interim goal to reduce transmission to near-zero levels by 2025. The strategy builds upon earlier successes in malaria control and shifts focus to
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ward elimination in both high- and low-endemic areas.
The plan emphasizes five core objectives: ensuring universal access to quality malaria prevention and treatment services, strengthening surveillance and case detection systems, improving vector control through long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), building community engagement, and enhancing program governance and accountability.
High-priority districts, especially in the Chittagong Hill Tracts, are targeted for intensified interventions, including active case detection and tailored outreach to mobile and vulnerable populations. The strategy also calls for robust health systems support, cross-border collaboration, and integration of malaria services into broader primary health care.
This document serves as Bangladesh’s strategic foundation to transition from malaria control to phased elimination, in line with national and global targets.
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The Manual for Indoor Residual Spraying in Urban Areas for Aedes aegypti Control is intended not only for operational personnel and middle and senior management of programs responsible for the prevention and control of Aedes-borne diseases, but also for the academic community involved in Aedes resea
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rch, private pest control personnel, and the general public.
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