The $40 Question: Can Africa Close the Health Financing Gap?

KIGALI, Rwanda – On average, African Health Ministers only have $40 per capita for health expenditure in comparison to $4,000 that ministers in many high-income countries have. 

How the continent can provide the maximum level of healthcare with such limited resources is one of the key questions that delegates to the Sixth Africa Health Agenda International Conference (AHAIC) in Kigali are trying to answer.

There is consensus that aid is no longer a reliable solution in light of overnight funding cuts by the United States, and more incremental cuts from Europe.

’“To be honest, we cannot afford healthcare for everyone, but we can afford health, which will reduce our overall healthcare costs,” admitted Amref Health Group CEO, Dr Githinji Gitahi.

Prevention Over Treatment

The first short-term solution to manage the $40 well is by focusing on the basics and prioritizing prevention over treatment.

“The foundation of health is clean water for everyone. It is sanitation for everyone. It is access to nutritious food to reduce the risk of non-communicable diseases. It is a strong emphasis on immunization. If we prioritize these, we will save significantly on future healthcare costs,” Gitahi explained.

More investment in community health workers than expensive medical equipment like PET scans and MRI machines is also prudent.

“Health is built at home – hospitals are there to repair,” he added. “We need to redesign our health systems to make prevention, primary care, and community health the core pillars.”

Increasing the $40

However, even with careful management and efficiency, stakeholders agree that $40 is simply not enough. 

“We need political action now. Within our national budgets, health is not at the forefront. How many countries have actually reached the commitment of allocating 15% of their national budget to health? Just two—South Africa and Cape Verde,” said Aminata Wurie, project manager at Resilience Action Network Africa (RANA).

This year, only one out of the 55 African countries allocated more than 5% of GDP to health while only two out of 55 countries have met the 15% Abuja Declaration commitment.

Last month, Rwandan President Paul Kagame, the African Union’s (AU) Champion on Domestic Health Financing, hosted a High-Level Health Financing Conference in Addis Ababa to discuss alternative domestic sources of health funding.

One of the key outcomes was a mandate for the Africa Centre for Disease Control and Prevention (Africa CDC) to develop a framework for domestic health financing. 

Africa CDC’s Dr Claudia Shilumani confirmed that efforts are already underway: “We are working with the African Medicines Agency and other partners to create a framework that will outline tangible actions governments can take to increase health sector funding. This will be presented to heads of state in the coming months for a decision.”

Meanwhile, Rwanda is already setting an example by integrating existing health financing mechanisms to support long-term goals. 

In response to health system funding cuts, they have reassessed spending priorities to ensure critical programs remain operational. For example, instead of discontinuing workforce training, they have shifted many in-person trainings to online platforms and redirected the funds to essential programs.

Public-private partnerships

More attention is also being paid to public-private partnerships (PPPs) and innovative financing models to ensure the long-term sustainability of health programs.

The pharmaceutical company Roche has committed to significantly increasing access to diagnostic testing across Africa, aiming to conduct over 3.4 billion tests by 2031 and reach more than 500 million people with quality diagnostics.

“Reaching these ambitious goals, especially as Africa’s population continues to grow exponentially, cannot be done alone. Public-private collaboration is key,” said Roche’s Policy and Government Affairs Partner, Johnpaul Omollo.

“First, we must ensure decentralisation – this is where localization plays a crucial role. As we expand local production, we must also understand what the market truly needs and identify the most essential products we can manufacture locally,” he added.

Another area where increased partnership and collaboration will be essential is in vaccine distribution. The US withdrawal from the World Health Organization (WHO) might mean disruptions to vaccine distribution, which could delay availability and hinder efforts to achieve widespread immunity. 

However, vaccine manufacturers like Serum Institute of India (SII) are stepping up their efforts to ensure the continued supply of life-saving vaccines. Speaking with Health Policy Watch on the sidelines of the conference, the company highlighted its partnerships with African manufacturers to promote local vaccine production.

“We are collaborating with South Africa’s Aspen and Egypt’s Vacsera to establish fill-and-finish vaccine facilities within the continent,” said Anil Kulkarni, SII’s Senior Manager of International Business and Product Management. “In the coming years, we plan to expand these partnerships to more African countries.”

SII has also committed to maintaining affordable vaccine prices to ensure that African countries can continue to get vaccines despite global funding challenges.

But health experts stress that, for local pharmaceutical production to succeed, it will require a coordinated effort across multiple sectors.

“The success of local production will require all hands-on deck. This means the private sector must be involved in understanding community needs, governments must create an enabling policy environment, and supply chains must be strengthened to ensure medicine accessibility,” said Omollo.

Charles Okeahalam, president of Amref’s Board, described the current challenges facing Africa’s health systems as a wake-up call for the continent.

“If we improve ourselves and systems by just 20%, we could see an 80% improvement in healthcare outcomes. The challenge is real but not as difficult as it might appear.”

Article first published on https://healthpolicy-watch.news/the-40-question-can-africa-close-the-health-financing-gap/