Africa risks turning universal health coverage into a political slogan rather than a functioning system unless governments confront chronic underinvestment, weak leadership and structural governance failures, former World Health Organization Deputy Director-General Dr. Anarfi Asamoa-Baah has warned.
Speaking under the theme of The African Summit “Building a New United Africa,” in a plenary session titled, “Universal Health Care Coverage in Africa: Opportunities & Challenges,” Dr. Asamoa-Baah framed the debate as both urgent and unfinished, arguing that Africa has made progress over decades but continues to underperform relative to its potential.
“I must confess, I feel a little schizophrenic this afternoon,” he told delegates. “I’m happy because the idea of a united Africa is not new. But I’m sad because the idea of a united Africa is not new.”
He said while the continent has taken “baby steps” and passed numerous resolutions over the years, it is still “punching below our weight,” despite having the foundations to do better.
A central focus of his address was the dominant global narrative of Africa as a continent defined by disease and deprivation. Dr. Asamoa-Baah rejected that framing, but acknowledged the scale and complexity of the health burden facing African countries.
“One of the common but unfortunate narratives about Africa is that it’s a continent of poverty and disease,” he said, citing the historic association of HIV, tuberculosis and malaria with the continent. He noted that non-communicable diseases such as hypertension, diabetes and cancer, once considered uncommon in Africa, are now rising rapidly and affecting people at younger ages, often with severe complications.
He said Africa is now contending with multiple, overlapping crises including mental health disorders, road traffic injuries, armed conflict, substance abuse, environmental degradation and climate change, all of which are straining fragile health systems.
“If you look at any typical health indicator, our continent is at the bottom of the league table,” he said. “This cannot be the narrative of the Africa we want.”
Dr. Asamoa-Baah described universal health coverage as a critical pathway to changing that narrative, stressing that the concept goes beyond slogans and requires a fundamental shift in mindset and policy priorities.
“Universal health coverage takes inspiration from the health for all movement, which is also rooted in the belief that health is a fundamental human right,” he said.
Breaking down the concept, he said “universal” means no one should be excluded, including those without identity documents or bank accounts, and those living in hard-to-reach communities. He warned against celebrating partial coverage.
“With the concept of universality, 80% means 20% are not covered and that is not acceptable,” he said, adding that reaching the final segment of the population is often more complex and costly, requiring tailored strategies rather than one-size-fits-all solutions.
On health itself, Dr. Asamoa-Baah criticised the tendency to equate healthcare with hospital construction and treatment alone. He argued that most people fall into a third category, neither sick nor healthy, and need preventive and promotive care to avoid future illness.
“Universal health coverage is not only about sickness care,” he said. “It’s also about preventive care, like immunizations and vaccinations, and also about services that are needed to promote good health.”
He added that addressing the social and economic determinants of health, including poverty, sanitation, housing, clean water and air quality, is essential, even though such issues are often absent from political discussions on healthcare.
Turning to financing, Dr. Asamoa-Baah said Africa continues to underinvest in health and rely too heavily on external funding, particularly for immunisation and preventive services.
“In health, you reap what you sow,” he said, arguing that the real issue is not percentages of national budgets, but the actual level and quality of investment. “15% of 100 is not the same as 15% of 1,000.”
He also highlighted major gaps in service delivery, especially in rural areas, where limited facilities force people to seek care only in emergencies. He criticised poor emergency readiness, weak hospital management and declining quality of care, warning that medical negligence is increasing.
“Every hospital is a hotel,” he said. “Our hotels are cleaner, better managed. You are likely to get better food in our hotels than in our hospitals.”
Health workforce challenges, he said, are driven less by training gaps and more by poor conditions of service, which are fuelling renewed health worker migration.
“Their take-home pay cannot take them home,” he said, adding that without better incentives and leadership development, universal coverage will be unattainable.
Dr. Asamoa-Baah also pointed to Africa’s dependence on imported medical products, weak health information systems and governance models that remain dominated by risk-averse public sector approaches.
“Leadership in the health sector is a big problem,” he said, warning that promoting clinicians into management roles based on seniority often results in the loss of good doctors and the creation of ineffective managers.
Despite the challenges, he said Africa has a significant opportunity to transform health into both a social and economic driver, describing healthcare as a fast-growing industry capable of generating jobs, innovation and revenue.
“We have a golden opportunity, not only to improve health and the well-being of Africans, but also to promote the healthcare industry,” he said.
He concluded with a caution that efforts toward deeper continental integration in health and development would face resistance.
“Not everybody is happy about a united Africa,” he said, urging leaders to pursue reform with realism, confidence and unity. “Let’s be proud of who we are and what we have. Long live united Africa.”
