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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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National spending on health by source for 184 countries between 2013 and 2040

Dieleman, J.; Templin, T.; Sadat, N. et al. (2016) CC

A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at simi...lar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. Methods We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Findings Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. Interpretation Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. Funding Bill & Melinda Gates Foundation. more

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La prise en charge de la malnutrition sévère : Manuel à l’usage des médecins et autres personnels de santé à des postes d’encadrement

Organisation Mondiale de la Santé OMS (1999) C_WHO

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Manejo da desnutrição grave: Um manual para profissionais de saúde de nível superior (médicos, enfermeiros, nutricionistas, e outros) e suas equipes de auxiliares

Organización Mundial de la Salud OMS (1999) C_WHO

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Présentation d es nouveaux emballages et instructions de reconstitution des Laits Thérapeutiques F75 et F100

Organisation Mondiale de la Santé OMS (2017) C_WHO

Updated Packaging and Reconstitution Guidance for Therapeutic Milk. French Version

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WHO guidelines on drawing blood: best practices in phlebotomy

World Health Organization (2010) C_WHO

The new WHO guidelines provide recommended steps for safe phlebotomy and reiterate accepted principles for drawing, collecting blood and transporting blood to laboratories/blood banks.

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Directriz: ACTUALIZACIONES SOBRE LA ATENCIÓN DE LA DESNUTRICIÓN AGUDA SEVERA EN LACTANTES Y NIÑOS
recommended

Organización Mundial de la Salud OMS (2013) C_WHO

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Manual proporciona directrices prácticas para el tratamiento de los pacientes con malnutrición grave

Organización Mundial de la Salud OMS (1999) C_WHO

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Lignes Directrices: MISES À JOUR DE LA PRISE EN CHARGE DE LA MALNUTRITION AIGUË SÉVÈRE CHEZ LE NOURRISSON ET CHEZ L’ENFANT
recommended

Organisation Mondiale de la Santé OMS (2013) C_WHO

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Integration of childhood TB into guidelines for the management of acute malnutrition in high burden countries

L. N. Patel,and A. K. Detjen The Union (2017) C2

Public Health Action PHA 2017; 7(2): 110–115

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Introducing Updated Packaging and Reconstitution Guidance for Therapeutic Milk

World Health Organization WHO (2017) C_WHO

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Interim Guidelines Integrated Management of Severe Acute Malnutrition

Government of Southern Sudan, Ministry of Health (2009) C1

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Guide des techniques de prélèvement d’échantillons pour la confirmation en laboratoire de l’infection à Mycobacterium ulcerans (‎ulcère de Buruli)‎

Organisation Mondiale de la Santé OMS (2008) C_WHO

Guide de techniques

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Screening for Transfusion Transmissible Infections

National AIDSControl (NACO), Government of India; Ministry of Health and Family Welfare (2012) C1

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Lesotho Humanitarian Situation Report September 2017

United Nations Children's Fund (UNICEF) (2017)

Situation Overview & Humanitarian Needs | July – September 2017

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Community Management of Acute Malnutrition CMAM Guidelines

Republic of South Sudan (2017) C1

Maternal and child malnutrition is a significant public health problem in South Sudan. Among children aged 6-59 months, 31% are stunted, 28% are underweight, and nearly 23% are acutely malnourished of which 13% are estimated to suffer from moderate acute malnutrition and 10% from severe acute malnut... more

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Yemen Nutrition Cluster: PLW Acute Malnutrition treatment GAP Analysis (as 31 December 2017)

UN Children's Fund, iMMAP, Nutrition Cluster (2018)

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Management of severe malnutrition: a manual for physicians and other senior health workers

World Health Organization WHO (1999) C_WHO

This manual provides practical guidelines for the management of children with severe malnutrition. It seeks to promote the best available therapy so as to reduce the risk of death, shorten the length of time spent in hospital, and facilitate rehabilitation and full recovery. Emphasis is given to the... more

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Updates on the management of severe acute malnutrition in infants and children
recommended

World Health Organization (2013) C_WHO

This guideline provides global, evidence-informed recommendations on a number of specific issues related to the management of severe acute malnutrition in infants and children, including in the context of HIV.

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Обновление руководства по упаковке и разведению терапевтического молока. Updated Packaging and Reconstitution Guidance for Therapeutic Milk (Russian Version)

World Health Organization WHO (2017) C_WHO

Directriz: ACTUALIZACIONES SOBRE LA ATENCIÓN DE LA DESNUTRICIÓN AGUDA SEVERA EN LACTANTES Y NIÑOS recommended

Lignes Directrices: MISES À JOUR DE LA PRISE EN CHARGE DE LA MALNUTRITION AIGUË SÉVÈRE CHEZ LE NOURRISSON ET CHEZ L’ENFANT recommended

Updates on the management of severe acute malnutrition in infants and children recommended

Directriz: ACTUALIZACIONES SOBRE LA ATENCIÓN DE LA DESNUTRICIÓN AGUDA SEVERA EN LACTANTES Y NIÑOS
recommended

Lignes Directrices: MISES À JOUR DE LA PRISE EN CHARGE DE LA MALNUTRITION AIGUË SÉVÈRE CHEZ LE NOURRISSON ET CHEZ L’ENFANT
recommended

Updates on the management of severe acute malnutrition in infants and children
recommended