ECA launches initiative to drive sustainable funding for African health systems

The current models of health financing in Africa are unsustainable and economically damaging to both citizens and states, says Aboubakri Diaw, Chief of Staff in the Office of the Executive Secretary of the Economic Commission for Africa (ECA).

At the launch of the Sustainable Health Financing Initiative, held on the final day of this year's ECA Conference of Ministers of Finance and Economic Planning in Morocco, Diaw urged African countries to adopt and implement the programme. Speaking ahead of the launch, he emphasised that governments in Africa currently fund less than 41% of health expenditure, with the remainder borne by individuals and donors.

"Out-of-pocket payments are not just a health statistic; they are one of the continent's largest poverty multipliers," he said, noting that millions of people remain excluded from health systems, including over 40 million displaced individuals. Diaw highlighted that only a few countries are on track to meet the Abuja target of allocating 15% of national budgets to health, 25 years after it was first set. This is despite the fact that investments in health yield significant economic benefits.

Even if every African government met its Abuja commitment today, he warned, the continent would still face a financing gap of $60 billion per year.

Strengthening domestic resource mobilisatio

Built around eight core commitments, the initiative aims to make health financing in Africa more coordinated and investment-ready. It prioritises strengthening domestic resource mobilisation to reduce reliance on external funding, while improving coordination between ministries of health, finance, and planning to embed health financing in national economic strategies.

The initiative will also leverage regional integration under the African Continental Free Trade Area to support domestic pharmaceutical manufacturing at scale. Diaw argued that with an estimated $150-200 trillion in global institutional funds potentially mobilisable if the right structures are in place, the challenge lies not in the availability of capital but in the governance architecture required to make health bankable.

Policymakers are urged to view health not as a cost but as sovereign risk insurance. Diaw encouraged countries to join early adopters in committing to a 90-day plan of action to institutionalise the initiative. "The architecture is built. The partners are present. The declaration has been adopted. The only variable left is political will, and that is your power," he stressed.

Health investment as smart politics

Speakers at other discussions on the initiative highlighted that investing in health builds trust and wins votes, making it smart politics. Former Nigerian Vice President Yemi Osinbajo, a keynote speaker at the ECA's side event on changing the health narrative in Africa, cited an Afrobarometer survey showing that health is Africa's second-highest voter priority. He emphasised that the health system is the state's most direct engagement with citizens, and that functional systems build trust in government.

Osinbajo warned that failure in health services is not merely a service gap but a crisis of political legitimacy, contributing to unconstitutional changes of government in the Sahel and elsewhere. Other speakers noted that under-investing in health costs more than properly funding it and stressed the need to address both wastage and performance, focusing not only on inputs but also on outputs.

In a panel discussion following the launch, Professor Samuel Kobina Anim, director of the ECA's African Centre for Statistics, argued that weak data systems undermine both financing and policy effectiveness. The issue is not the absence of data, he explained, but the failure to integrate and apply it effectively. "All countries have data. The question is how do we bring these data sets together?"

Anim outlined ECA's efforts to develop an integrated, end-to-end data platform that will function as a governance tool rather than a mere dashboard. "It won't just look at the amount we are investing; it will give us a sense of the returns we are going to get," he said, noting that this would encourage private sector investment.

Ngone Diop, Director of the ECA Sub-Regional Office for West Africa, explained that the commission is moving from defining the narrative to addressing it in a concrete way, particularly by engaging finance ministers to prioritise health financing within broader fiscal and development strategies. In West Africa, this approach is already operational through country platforms in The Gambia, Senegal, and Ghana, where governments, creditors, and development partners discuss health funding.

Diop emphasised that countries must lead the process, with the ECA and other partners providing support. "The groundwork has already been laid, and our role is to stand behind you, providing the support needed to translate this comprehensive agenda into concrete and measurable action," she said.

Harnessing digital infrastructure

Mactar Seck, head of emerging and frontier technologies, innovation and digital transformation at the ECA's Technology, Innovation, Connectivity and Infrastructure Division (TICID), highlighted the role of technology in improving access and efficiency. "Technology can help reduce reliance on out-of-pocket payments," he said, citing mobile money platforms such as Kenya's M-Pesa, as well as digital insurance and fintech solutions in countries like Egypt and South Africa that facilitate access to healthcare financing.

However, Seck cautioned that unlocking the full potential of technology requires addressing key constraints. "Connectivity is the foundation of digital health," he said, calling for stronger investment in digital infrastructure through collaboration between finance ministries, ICT sectors, and private players. Regulations are also needed to ensure quality in digital systems, and governments must invest in building digital skills within the health workforce.