---

Only a few countries, including Rwanda, Botswana, and Cabo Verde, have consistently met the 15 percent target, with some countries allocating less than 10 percent of their budget to the crucial sector.

Under the Abuja Declaration of 2001, African Union (AU) member states made a commitment to end the continent’s health financing crisis, pledging to allocate at least 15 percent of national budgets to the 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 percent benchmark, with some allocating as little as 5–7 percent of their national budgets to health.

Countries including Nigeria, Chad, and the Central African Republic are allocating as little as 5–7 percent to the sector, thanks to a myriad of political and economic challenges, including a high debt burden and narrow tax base, according to Director General of Africa Centres for Disease Control (Africa CDC), Dr. Jean Kaseya.

Competing demands for security and infrastructure financing and limited coordination between ministries of health and finance, plus the fact that the COVID-19 pandemic “hit national budgets hard,” worsened by global economic instability, haven’t helped matters, he said, while commenting on the latest annual report of the continental health body and the 2025 concept paper on Africa’s Health Financing in a New Era, both released in April.

“It also exposes just how costly underinvesting in health can be. The real story here is political will, where leaders prioritize health, and budgets follow,” he noted.

The report finds that only 16-29 percent of African countries currently have updated versions of the National Health Development Plan (NHDP) supported by a National Health Financing Plan (NHFP), the two documents being critical in driving internal resource mobilization.

“Updating National Health Development Plans (NHDPs) and National Health Financing Plans (NHFPs) is not just a matter of paperwork—it’s a heavy lift. Countries need robust data, skilled teams, funding, and strong inter-ministerial coordination,” he said.

Low funding has a consequence: it has led to many health departments being understaffed and overstretched, partly because some governments ‘deprioritize’ updating the two documents because they fear the plans won’t be implemented or be funded. “But without current, credible plans, it’s nearly impossible to make a case for more domestic or external investment. These documents are not bureaucratic checkboxes—they’re investment blueprints,” the DG told IPS.

He noted that countries that have updated and actively used their NHDPs and NHFPs have seen tangible benefits, one such country being Burkina Faso, where an updated NHFP had helped streamline funding and implementation for free healthcare policy.

In Senegal, incorporating macroeconomic forecasting into the NHFP improved budget predictability and donor alignment. “These tools are powerful when they are costly, realistic, and regularly monitored. But let’s be clear; plans must be funded and used—not just filed away—to make a real difference,” Kaseya added.

According to the documents, Africa continues to carry a disproportionate share of the global disease burden—25 percent—but with only 3 percent of the global health workforce, resulting in a “dangerously overstretched workforce,” according to the documents. Should this shortage be prioritized over all other health needs and deficiencies, or what should be addressed first?

The shortage of health workers remains a fundamental challenge, with Africa carrying 25 percent of the global disease burden but a disproportionate 3 percent of the global health workforce—a challenge that cannot be addressed “in isolation.”

However, recruiting en masse without sustainable financing or strategic deployment can strain the system, and in some countries, trained professionals remain unemployed due to fiscal constraints or wage bill ceilings. “Kenya, for example, is piloting co-financing mechanisms between national and local governments to overcome this. The key is to tackle workforce gaps through integrated, context-specific reforms that link financing, recruitment, and health system needs,” Kaseya said.

The Africa CDC has drafted a three-pronged strategy and placed it at the forefront of a health financing revolution that could potentially represent a paradigm shift from dependency to self-determination. Some aspects of the strategy can be implemented immediately without being subjected to a lot of bureaucracy in view of the emergency brought about by cuts in Overseas Development Assistance (ODA), he added.

Reductions in ODA went down by 70 percent between 2021 and 2025, exposing health systems to deep-rooted structural vulnerabilities and placing immense pressure on Africa’s already fragile health systems, with overseas financing being seen as the backbone of critical health programmes.

These include pandemic preparedness, maternal and child health services, and disease control initiatives, all of which are at risk, threatening Sustainable Development Goal 3 and Universal Health Coverage.

“Some components of our strategy can be rapidly deployed. Health taxes on products like tobacco, sugar, and alcohol are politically sensitive but technically straightforward and yield dual benefits, generating revenue and promoting healthier populations. Strengthening health financing units within ministries is a high-impact, low-cost intervention that can dramatically improve budget execution and efficiency,” Kaseya suggested.

Likewise, deploying digital tools—such as real-time dashboards to track financing flows—can happen quickly and with limited bureaucracy. Countries like Benin, South Africa, and Ethiopia are already implementing such reforms with measurable progress.

He pitched that digitization of the health sector is no longer a luxury, as it is foundational to the much-needed resilient, transparent, and efficient health systems.

On the other hand, the platforms improve decision-making, enable better resource tracking, and enhance service delivery. However, fragmentation of digital solutions remains a challenge, with many platforms developed in ‘silos,’ often “donor-driven and poorly integrated,” he commented.

He singled out Ghana, which offered a strong example of progress, having developed a national platform that integrates health and financing data. “The true value of digitization is realized when countries lead the process, ensure interoperability, and embed digital solutions into broader system reforms,” Kaseya said.

On the positive side, CDC Africa for the first time led an emergency response, putting in place a Joint Continental Incidence Management Support Team (IMST) co-led with the World Health Organization and bringing together over 28 partners to collaborate on the Mpox response. This work was done under the “One team with a One unified plan, One budget, and One monitoring framework.”

“This is a historic first that marked a significant milestone in Africa’s leadership of public health emergencies of continental significance,” the report observed.

It further supported national responses to “multiple major public health emergencies,” including the mpox outbreak in 20 AU member states and the Marburg virus disease outbreak in Rwanda. This was in declaring the former a Public Health Emergency of Continental Security (PHECS) on August 13, 2024, in consultation with the affected countries and relevant stakeholders.

Also on the positive side, the continental health body was advancing a comprehensive three-pillar strategy centered on domestic resource mobilization, innovative financing, and blended finance.

IPS UN Bureau Report

  Source