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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 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 Financing Progress Matrix assessment, Kenya 2023: summary of findings and recommendations

Kenya Ministry of Health, World Health Organization (WHO) (2024) CC

This comprehensive HPFM report thoroughly explores Kenya’s health financing landscape. It provides an in-depth analysis of the current state of affairs and sheds light on required strategic changes in health financing. The report points out the need to improve public financial management within th... more

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PEPFAR: Exploring Co-Financing as a Tool for Domestic Resource Mobilization

Kates J. Kaiser Family Foundation (KFF) (2024) CC

There is growing pressure on PEPFAR, the U.S. global HIV program, to increase its planning for sustainability, including through domestic resource mobilization and, ultimately, transitioning financing at least in part to recipient countries. While this is connected to a broader push in global healt... 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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Political economy analysis for health financing: A ‘how to’ guide

World Health Organization (WHO) (2024) CC

This Guide is part of WHO’s overall programme of work on Political Economy of Health Financing Reform: Analysis and Strategy to Support UHC. The impetus for this work came from demands for more concrete evidence, recognition and integration of political economy issues within health financing, and... 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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Plan d’action pour l’élimination du paludisme 2021-2025

Pan American Health Organization (PAHO) (2022) C_WHO

Le Plan d’action pour l’élimination du paludisme 2021-2025 a été élaboré en consultation avec les pays et les partenaires régionaux comme cadre de référence pour orienter les efforts nationaux et les contributions des donateurs et partenaires dans le but d’éliminer la maladie dans la ... 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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Consequences of the US budget cuts and the dissolution of USAID: An analysis and recommendations for action for stakeholders in international development cooperation

Liebau L., Rüppel T., Schottmayer K. medmissio (2025) CC

This publication provides a problem analysis of the U.S. cuts in global health and derives concrete recommendations for action for medical actors. The focus is on analyzing the direct effects on health-specific development cooperation.

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Questions bank for healthcare workers during infectious disease outbreaks

Wilkinson, A. Social Science in Humanitarian Action Platform (2025) C1

This question bank is a menu of qualitative questions related to healthcare workers’ knowledge, perceptions and practices during infectious disease outbreaks. The question bank will generate qualitative data on healthcare workers’ subjective understandings of risks, case management, protection a... more

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Banque de questionspour le personnel de santé lors épidemiés de maladies infectieuse

Wilkinson, A. Social Science in Humanitarian Action Platform (2025) C1

Cette banque de questions est un menu de questions qualitatives relatives aux connaissances, aux perceptions et aux pratiques du personnel de santé lors d'épidémies de maladies infectieuses. La banque de questions générera des données qualitatives sur la compréhension subjective qu'ont les pr... more

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Chimioprévention du paludisme saisonnier par administration de sulfadoxine-pyriméthamine et d’amodiaquine aux enfants : guide de terrain

Organisation Mondiale de la Santé OMS (2023) CC

2ieme edtion. Cette deuxième édition s'appuie sur l'expérience de plus de 10 ans de déploiement de la CPS et reflète les changements introduits dans les lignes directrices de l'OMS pour le paludisme, le 3 juin 2022. L'objectif de cette publication est de partager ces bonnes pratiques afin d'am�... more

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Seasonal malaria chemoprevention with sulfadoxine–pyrimethamine plus amodiaquine in children: a field guide

World Health Organization WHO (2023) C_WHO

2nd edition. This second edition builds on the experience of more than 10 years of SMC deployment, and reflects changes introduced in the WHO guidelines for malaria, 3 June 2022. The goal of this publication is to share these best practices to improve SMC implementation, coverage, and monitoring and... more

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Efficacité de la chimioprévention du paludisme saisonnier à l’échelle de l’Afrique de l’Ouest et de l’Afrique centrale : une étude d’observation

Partenariat ACCESS-SMC (2020) CC

Lancet 2020 ; 396 : 1829-40

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Training community healthcare workers on the use of information and communication technologies: a randomised controlled trial of traditional versus blended learning in Malawi, Africa

Nikolaos Mastellos, Tammy Tran, Kanika Dharmayat et al. BMC Medical Education (2018) CC

Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The ‘Introduction to Information and ... more

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South Africa: Cold Chain and Immunisation Operations Manual

Department of Health, Republic of South Africa (2015) C2

Guidelines for Handling Temperature Sensitive Vaccines and Pharmaceuticals

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Enquête Démographique et de Santé - Indicateurs Clés

Institut National de la Statistique, Ministère de la Santé Publique Cameroun (2019) C1

Ce rapport présente les résultats clés de la cinquième Enquête Démographique et de Santé du Cameroun (EDSC-V) réalisée sur le terrain du 16 juin 2018 au 19 janvier 2019, par l’Institut National de la Statistique (INS), en étroite collaboration avec le Ministère de la Santé Publique. ... more

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