The UN Economic Commission for Africa (ECA) and former Vice-President Yemi Osinbajo are leading a new push to promote sustainable domestic health financing across Africa.
The initiative seeks to help African governments mobilise predominantly domestic resources to strengthen health systems amid declining external health aid and rising debt pressures.
According to the ECA in a statement on Friday, the initiative builds on the Tangier Declaration, adopted by African finance, planning and economic development ministers in March 2026.
The declaration recognises health spending as an investment in human capital and economic resilience, rather than simply a cost to be managed.
ECA Pushes Domestic Health Investment
ECA Executive Secretary Claver Gatete said sustainable health systems were essential to Africa’s economic development.
“Nothing can be done without people. We need them to be healthy to contribute.”
Gatete said the initiative was particularly important as official development assistance for health declines and growing debt burdens restrict the fiscal space available to African governments.
He called for stronger coordination between health and finance ministries, alongside domestic resource mobilisation, innovative financing and private investment.
Osinbajo Calls for Greater Domestic Ownership
Osinbajo, the initiative’s champion, said the constitution of the High-Level Advisory Group represented a shift from aid dependency towards greater domestic ownership of health financing.
He said ministries of finance and health must work jointly rather than operate separately to address Africa’s health financing challenges.
Senait Fisseha, vice-president for Global Programmes at the Susan Thompson Buffett Foundation, said philanthropy should act as a catalyst rather than replace government funding.
She said philanthropic support should ultimately be judged by the institutions and systems it helps establish, rather than by grants that require repeated renewal.
Five Priorities for Africa’s Health Financing
Representing the African Union Commission Chairperson, Julio Rakotonirina, Director for Health and Humanitarian Affairs, outlined five guiding areas for the initiative.
“These include domestic resource mobilisation, efficiency, equity, financial protection and fiscal space, aligned with Agenda 2063 and other continental health frameworks.”
Rakotonirina said the ongoing Ebola outbreak response in the Democratic Republic of the Congo also demonstrated the close link between health financing and health security.
He added that the initiative comes as African countries face declining external health financing, narrow domestic revenue bases and increasing debt-service pressures.
Africa Faces Health Financing Gaps
Africa’s average tax-to-GDP ratio is about 16 per cent, while out-of-pocket payments remain the primary source of health financing in roughly half of African countries.
Botswana, Ethiopia, Guinea, Sierra Leone and Togo are participating as early adopters, with technical assessments and country-led financing solutions under development.
The inaugural meeting brought together ministers and senior officials from across Africa to examine pathways towards sustainable, domestically financed health systems.
The High-Level Advisory Group subsequently entered closed deliberations to advance efforts to strengthen health financing across the continent.
