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.
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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
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space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation.
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Development assistance for health (DAH)
plays a vital role in supporting health programmes in lowand middle-income countries. While DAH has historically
focused on infectious diseases and maternal and child
health, there is a lack of comprehensive analysis of DAH
trends, strategic shifts and the...ir impact on health systems
and outcomes. This study aims to provide a comprehensive
review of DAH from 1990 to 2022, examining its evolution
and funding allocation shifts.
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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...e health sector, for more efficient financial systems. It focuses on better resourceraising and utilization mechanisms. The matrix highlights the need for consolidation of fragmented health financing arrangements, for a more efficient health system. It also emphasizes the need for enhancing strategic purchasing of health services, to improve the overall efficiency and quality of care. Additionally, the report stresses the critical
role of leveraging data and information systems for more evidence-based informed decision-making. These recommendations are crucial for advancing Kenya’s health financing system and moving closer to the UHC goal.
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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 ...the concept is defined and operationalized by agencies and how such policies relate to overall health spending patterns.
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For this report, the Task Force commissioned
additional background papers on health taxes to
update the evidence, assess short-term revenue
potential, and understand the role of health taxes
in the current era of multiple crises. We find that
health taxes continue to be underutilized despite th...e
powerful impact they have in reducing preventable
death and disease — a particularly glaring act of
neglect in a world that has experienced a massive
pandemic.
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Most foreign aid comes in one of two forms: either we pay a person or an institution today in exchange for delivering some beneficial activity in the future, or we observe something bad happen to them and then give them support to recover from it. This kind of aid is simple to design and deliver,
b...ut in the former case has limits in how sharply it incentivizes success and effort from a range of actors and in the latter case leads to the inefficient and undignified “begging bowl” approach to humanitarian financing. In what follows, I identify a broad family of alternative approaches, which
can loosely be grouped together as “contractually contingent financing,” and explain why they are still relatively underused.
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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..., 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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Questions concerning the relevance and reform of official development assistance (ODA), and how ODA and broader development finance could—or should—change to better reflect shifting demands are not new, with academics and policymakers suggesting a range of options for reform. In this background ...note, we briefly review the major reform proposals from 2009 onwards, highlighting the key issues underlying approaches to ODA reforms, and the main “types” of proposals typically put forward.
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Todos los países de la Región de las Américas en los que la malaria es endémica han asumido el reto de eliminar la enfermedad y de poner en marcha medidas para orientar sus programas y estrategias de salud en esa dirección. En este manual se explica cómo ejecutar las medidas con vistas a logra...r la eliminación de la malaria y prevenir su restablecimiento, mediante el aumento de la intensidad y la calidad de las medidas, la reorientación de las iniciativas, la reducción de los retrasos que favorecen la transmisión y un monitoreo adecuado que permita ajustar las intervenciones. En este sentido, se propone como primer paso estratificar el territorio —de modo que se puedan planificar y priorizar las intervenciones y grupos de población— para, a continuación, aplicar una medida de diagnóstico, tratamiento, investigación y respuesta como estrategia clave dirigida a hacer efectiva la eliminación de la enfermedad y a prevenir su restablecimiento en todos los estratos. Además, el documento trata de hacer operativo el concepto de vigilancia, como intervención promovida por la Organización Mundial de la Salud a través de la Estrategia Técnica Mundial contra la Malaria 2016-2030, y destaca la importancia de que las comunidades tengan acceso al diagnóstico y el tratamiento tempranos. Por último, en el manual también se incluyen aspectos de gestión y monitoreo que deben tenerse en cuenta para la eliminación de los focos de transmisión.
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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...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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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 ...Région des Amériques. Le plan souscrit aux objectifs et aux piliers de la Stratégie technique mondiale de lutte contre le paludisme 2016-2030 adoptée par l’OMS, et présente également des éléments clés pour relever les défis spécifiques à la Région.
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The Plan of Action for Malaria Elimination 2021-2025 has been developed in consultation with countries and regional partners as a framework of reference to guide the efforts of countries and the contributions of donors and partners towards elimination of the disease in the Americas. The Plan subscri...bes to the goals and pillars of the WHO Global Technical Strategy against Malaria 2016-2030 (GTS), while presenting key elements to address the specific challenges of the Region. The document seeks to guide national plans and promote an inter-programmatic- intersectoral approach, and joint efforts between countries and partners. The Plan is also the reference framework for PAHO technical cooperation in malaria in the period 2021-2025. The goals to be achieved require changes in action against malaria that must occur at the operations level and for which regulatory and policy adjustments are required from the national levels. Thus, the Plan promotes a systematic action of detection, diagnosis and response, which must be massively implemented and monitored programmatically. A main element of change is action aimed at recognizing the need to address key malaria foci in each country with specific, information-based operational solutions. The Plan of Action seeks to promote these changes in malaria programs in the countries and through the interactions among all actors. The model proposed in this plan is based on a cross-functional dialogue and interconnections across the lines of action (SL). Strategic lines 1, 2 and 3, which correspond to the three pillars of the WHO/GTS, complement each other, and are not designed to function independently. The idea of the consolidated supportive elements - strengthened health systems, strategic planning, financing, partnerships, advocacy, and operational research (SL 4) is to provide the platform, operational structures and alliances for the more specific malaria interventions presented in strategic lines 1, 2 and 3.
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O Plano de ação para a eliminação da malária 2021-2025 foi desenvolvido em consulta com países e parceiros regionais como um marco de referência para orientar os esforços dos países e as contribuições de doadores e parceiros em prol da eliminação desta doença nas Américas. O plano sub...screve às metas e aos pilares da Estratégia técnica mundial para o paludismo 2016-2030, da Organização Mundial da Saúde, ao mesmo tempo em que apresenta elementos essenciais para enfrentar os desafios específicos da região.
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El Plan de acción para la eliminación de la malaria 2021-2025 ha sido elaborado en consulta con los países y asociados regionales como un marco de referencia para orientar las acciones de los países y las contribuciones de los donantes y de los asociados hacia la eliminación de la enfermedad en... la Región de las Américas. El plan está en consonancia con los objetivos y pilares de la Estrategia técnica mundial contra la malaria 2016-2030 de la OMS, al tiempo que presenta elementos clave para afrontar los desafíos específicos de la Región.
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Esta nota técnica busca guiar a los programas nacionales de malaria y a las organizaciones implicadas en el apoyo de los esfuerzos para la eliminación de la malaria en la Región de las Américas, a fin de que intensifiquen las acciones políticas/estratégicas e implementen los cambios operativos... necesarios para acelerar la eliminación de P. falciparum como parte de las estrategias nacionales para la eliminación de la malaria. Con tal finalidad, orienta las acciones que deben llevarse a cabo para acelerar la eliminación de P. falciparum en zonas próximas a su eliminación, sin comprometer los esfuerzos unificados de eliminación del paludismo (P. vivax - P. falciparum) y contribuyendo al objetivo final del país de eliminar el paludismo en su conjunto. La aceleración de la eliminación de P. falciparum procura mitigar el riesgo de aparición y propagación de la resistencia a la artemisinina y de la resistencia a los fármacos asociados; acelerar la reducción del número total de casos de paludismo en zonas con una proporción importante de P falciparum; acelerar la eliminación de la malaria (P. vivax y P. falciparum) teniendo en cuenta que P. falciparum es uno de los desencadenantes de las recaídas de P. vivax; desarrollar capacidades en intervenciones para acelerar la eliminación de la malaria a partir de la experiencia de eliminación de P. falciparum, reduciendo el tiempo para alcanzar la eliminación de la malaria; y empoderar a diferentes actores, autoridades de alto nivel, donantes, municipios y otras entidades para la eliminación de la malaria con inspiración en los logros de la eliminación del P. falciparum.
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Le plan stratégique de la RBM Partnership to End Malaria pour 2021-2025 présente les priorités stratégiques du partenariat mondial visant à éliminer le paludisme. Le document se concentre sur trois objectifs stratégiques principaux : optimiser les programmes régionaux et nationaux, maximiser... le financement et faciliter le déploiement de nouveaux produits et stratégies. Le plan met l'accent sur la collaboration multisectorielle, en exploitant les partenariats au niveau mondial, régional et national pour lutter efficacement contre le paludisme. Il souligne également l'importance du partage de données, du plaidoyer et de la communication pour garantir que le paludisme reste une priorité en matière de santé. Le document met aussi en lumière les défis posés par la pandémie de COVID-19 et la nécessité de maintenir l'élan dans la lutte contre le paludisme.
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Le "Plan Stratégique National de Communication pour le Changement Social et de Comportement en Lutte contre le Paludisme" de la République Démocratique du Congo (RDC) vise à renforcer les actions de prévention et de traitement du paludisme à travers un changement social et comportemental. Ce p...lan s’inscrit dans un contexte où la RDC représente l’un des pays les plus touchés par le paludisme, avec une prévalence élevée, surtout chez les enfants de moins de cinq ans. Le plan met en avant des stratégies de mobilisation sociale, de communication et de gestion des cas de manière plus efficace. L'objectif est d'augmenter l'adhésion à l'utilisation des moustiquaires imprégnées et d'autres mesures préventives, tout en garantissant une meilleure gestion des stocks de traitements.
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The Malaria Ministerial Conference, co-hosted by WHO and the Government of Cameroon on 6 March 2024, brought together more than 400 stakeholders, including Ministers of Health and senior representatives from the African countries hardest hit by malaria, global health leaders, scientists, civil socie...ty and other partners. The pivotal meeting sought to leverage political commitment, scientific innovation and community engagement to reshape the trajectory of malaria control in high burden African countries, and beyond.
At the end of the meeting and in the weeks that followed, Ministers of Health from the 11 “High Burden High Impact” African countries (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Uganda and United Republic of Tanzania) signed the Yaoundé Declaration, pledging their “unwavering commitment” to the principle that “no one should die from malaria given the tools and systems available.” Success in reducing malaria morbidity and mortality will hinge on efforts by countries to translate this political commitment into actions and resources that will save lives.
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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...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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