From Crisis to Opportunity: Secure Africa’s Health Future Now

Authors: Boniface Mbuthia, Rahul S Reddy Kadarpeta, David Olpengs, Charlotte Muheki

As the world marks Universal Health Coverage (UHC) Day 2025 under the theme ‘Unaffordable health costs? We are sick of it! This message resonates deeply across Africa. For more than half of the continent’s population lacking access to essential health services unaffordable healthcare is not a slogan—it is a lived reality. Each year, more than 150 million Africans are pushed into poverty by out-of-pocket health expenses  

The African health system faces growing financial pressures, driven by a sharp 70% decline in external aid between 2021 and 2025, coupled with mounting debt obligations. African countries must service $81 billion in debt repayment by 2025, a burden that severely constrains fiscal space for health investments  

This dual challenge of declining external funding and mounting debt distress further limits the African governments’ ability to generate adequate domestic resources for health. This will widen the gap between health needs and available financing, threatening equity, and progress toward UHC and the SDGs. Yet this moment of crisis is also a moment of possibility—an urgent call for decisive, transformative action. In the words of Nelson Mandela, “It always seems impossible until it is done,” reminding us that this challenge is also a chance for countries to build stronger, more sustainable health systems for the future.

What Are the Root Causes of This Crisis?

African countries face a changing health financing landscape that exposes household to payment risks: 

1. Over-reliance on out-of-pocket payment (OOP) to finance health care: More than 31 countries – More than 31 of Africa’s 53 countries report that OOP remains the dominant source of health financing accounting for over 25% of current health spending. Over 200 million face financial strain with 150 million pushed to poverty due to health costs. This delays the realization of UHC in the continent by entrenching financial hardship, suppressing care utilization, while weakening pooling and purchasing functions. 
2. Persistent underfunding: Health expenditure to GDP remains lower than 5% with more than 48 countries remaining way below the Abuja declaration targets as of 2025 . This is further complicated by declining external aid, Low tax efficiency and low domestic financing for health leaving communities to meet the widening financing gaps. 
3. Health systems inefficiencies: Continued technical and allocative inefficiencies result in wastage of available resources estimated at 20-40%  In addition, bureaucratic rigidity, delayed funds disbursements and limited audit capacity contribute to ineffective use of available resources creating stockouts and other gaps that increase costs to those who seek care. Moreover, current monitoring frameworks track inputs rather outcomes leaving health expenditure with limited linkages to service delivery. 
4. Limited private sector engagement: While there is significant contribution with over 30% to delivery of health services, it remains fragmented and poorly coordinated into national health systems. In addition, low insurance coverage and inadequate oversight prevent equitable service delivery. This increases OOP payments which drive families into poverty, widens inequalities and erodes the promise of health for all. 

Why Does the UHC Day Theme Resonate with African Health System Realities?

The theme ‘Unaffordable health costs? We are sick of it!’ is therefore not just a slogan but a cry of distress from African communities—It reflects the deepening vulnerabilities of the poor who bear the brunt of disease while struggling to meet the increased costs of care. The heavy burden of health expenditure exposes the stark reality: the promise for all remains unfulfilled. 

Health financing is more than a technical issue; it is a moral obligation and a critical political choice. Without urgent and consistent intervention, the continent risks reversing hard-earned gains in child survival, communicable disease control, and emergency response capacity. The theme is a call to leaders to prioritize health financing as an essential policy lever for resilience, dignity, and sustainable development.

What Can African Countries Do?

To overcome these systemic gaps, policymakers require courage, innovation, and accountability. We propose the following urgent actions:

1. Honor commitments & diversify financing: Governments must translate Abuja (2001) and Africa Leadership Meeting (2019) pledges to increase funding for the health sector. However, beyond the 15% target, countries must effectively broaden domestic financing through progressive taxation, sin taxes and digital public infrastructure (e-IDs, e-invoicing and mobile tax payments) to close compliance gaps. Transparent monitoring and equity sensitive budgeting are essential to ensure that funds reach the poor and improve quality. 
2. Strengthening Public Finance Management: Adopting government wide reforms such as medium-term expenditure framework (MTEF), program-based budgets and digitized Public Financial Management (PFM) systems. Reforms in Tanzania and Kenya demonstrate better procurement, revenue collection and budget execution directly improve service delivery and accountability. 
3. Elevate continental leadership: Africa CDC and African Union (AU) must lead financing reforms, negotiate global support and foster cross country learning. Institutionalized collective action ensuring that health systems promote resilience, dignity and sustainable development. 
4. Expand fiscal space and explore Debt relief: Countries in the continent need to redirect resources from servicing obligations to priority areas such as primary health care. Savings can also be invested to financing services for vulnerable populations, safeguarding progress towards UHC. 
5. Strengthen pooling and private sector engagement: Expanding social and community health insurance schemes with pro-poor benefit packages as a solution to reduce catastrophic OOP payments. Digital micro-insurance models (e.g. Ghana telecom linked products) show how to reach informal workers. Private sector investment can be leveraged to solve gaps in the supply chain for health products. Initiatives such as Senegal’s Institute Pasteur expansion and South Africa’s Aspen Pharmacare, backed by international finance institutions, are strengthening regional manufacturing capacity and building long‑term resilience in health product supply.

A Call to Leadership:

As we mark the Universal Health Coverage Day 2025, Africa must confront the reality of deep inequalities, catastrophic health spending, chronic under-funding and inefficiencies that lead to wastage of available resources for health. Together the system gaps mean that millions of people are forced into poverty and health systems unable to deliver quality services and opportunities for dignity and development squandered. 

This year’s theme is more than a slogan. It requires both political and moral action to ensure that every African can access health care without fear of financial risks. Governments, continental institutions and partners must jointly act with courage and accountability, closing financing gaps, tackling inefficiencies and investing in resilient and equitable systems. 

Government action is the decisive force that secures promises and ensures that health care is delivered as a right for every African!