In Africa, health systems are at a crossroads. At the Africa Health Agenda International Conference 2025 held in Kigali, the critical issue of our continent’s health system funding, investment, and reform was at the forefront of discussions. As we look toward achieving Universal Health Coverage (UHC), it is clear that without a bold rethinking and redesigning of the way we approach health, the continent will continue to face insurmountable challenges in delivering quality, affordable healthcare to all. Listen to this commentary by Dr Githinji Gitahi.