African countries are under growing pressure to find more reliable ways of paying for healthcare as governments face tighter budgets and continued dependence on external funding.
The issue is putting domestic health financing at the centre of discussions at the 81st United Nations General Assembly (UNGA81) in New York, where African governments, development partners and health organisations are examining how countries can maintain essential services and prepare for future health threats.
The debate is increasingly about how countries can build their own capacity to finance health programmes instead of relying heavily on donor support.
Amref Health Africa, which is participating in the discussions, is calling for country-led approaches that give governments greater control over health priorities and the resources used to address them.
This includes exploring new financing models that can increase the money available for healthcare while strengthening the ability of national institutions to manage and sustain health programmes.
The issue has implications for public finances. Governments must fund healthcare alongside education, infrastructure, climate adaptation and other demands, making it difficult to maintain health spending when external support changes.
For health systems, the challenge is also about predictability. Short-term or project-based funding can make it difficult to plan investments in health workers, facilities, equipment and essential services over several years.
Amref is therefore placing greater emphasis on domestic capability, including the ability of countries to identify their own health priorities, mobilise resources and decide how those resources are used.
Climate change is adding to the financing burden.
Amref is calling for climate and health assessments to be followed by costed and funded national plans. The aim is to move from identifying climate-related health risks to financing specific measures that can protect communities and health facilities.
Health security is another part of the discussion. The organisation is advocating wider access to lifesaving health tools and greater involvement of communities in preparing for health emergencies before they occur.
The underlying concern is that African health systems can be vulnerable when financing decisions are made outside the countries that ultimately have to deliver the services.
Greater domestic financing would not remove the need for development assistance, but could give governments more control over longer-term health planning and reduce the disruption caused by changes in external funding.
The discussions at UNGA81 will also feed into preparations for the Africa Health Agenda International Conference (AHAIC) 2027, scheduled for February 28 to March 3, 2027, in Kigali.
The conference is expected to bring together African governments, health institutions and development partners to consider how global health commitments can translate into action at country level.
For African governments, the financing question is becoming closely linked to the broader issue of health sovereignty: having the financial and institutional capacity to maintain essential health services and respond to emerging threats without depending on outside funding for every major intervention.
