Africa harbors about 17% of the world's population but endures a disproportionately large share of global disease and death. In 2023, the continent accounted for more than 70% of maternal deaths worldwide, on the order of 182,000 women lost to pregnancy-related complications. Every year, the world loses 4.8 million children younger than 5, half of these deaths within the first month of life. Africa accounts for nearly 58% of under-5 deaths and nearly 50% of newborn fatalities. These grim figures underscore a brutal reality: The lives of women, children, and adolescents in Africa are being sacrificed to persistent underinvestment in health, especially in sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH).

These health outcomes bear a heavy economic toll. Frequent illness and disability among children reduce educational attainment and future earnings. Maternal deaths or disabilities impose financial burdens on households and communities. Health shocks force governments to redirect budgets from investment to crisis response, weakening long-term growth. Estimates suggest that health-related losses in productivity and increased health spending subtract several percentage points from gross domestic product (GDP) growth over time in many African countries. In 2015 alone, the region lost 630 million healthy life years—equivalent to $2.4 trillion in output.

The root of this tragedy is chronic underfinancing of health. Many countries lack the fiscal space to fund essential SRMNCAH services, primary health care, emergency preparedness, and the health workforce. Weak supply chains, fragmentation, and inefficiencies further deepen the resource gap. Equally, chronic underinvestment in research and development, innovation, and the protection of intellectual property rights for vaccines and health technology development has left the continent dependent on external solutions.

For decades, external financing—particularly Official Development Assistance (ODA)—has played a vital role in Africa's health landscape, supporting immunization campaigns, HIV and malaria programs, and maternal and child health services. This narrative of aid dependency tells only part of the story. African countries already finance the majority of their health expenditures. In low-income African countries, external financing constitutes about 30% of total health spending, meaning that national governments shoulder more than 70%. Between 2012 and 2020, external sources accounted for less than 20% of current health expenditure in most countries of the WHO African region—a testament to the continent's growing domestic commitment to health.

At the eighth Ordinary Session of the African Union Specialized Technical Committee (STC) on Finance, Monetary Affairs, Economic Planning and Integration, delegates converged on a shared vision: to elevate health financing as a core element of fiscal and economic policy.

The Fiscal Drain: Illicit Flows, Weak Tax Systems, and Debt

Africa loses vast resources every year that could instead fund health. Illicit financial flows, tax evasion, and profit shifting account for a loss estimated at $88.6 billion annually, roughly 3.7% of the continent's GDP. These leaks rob countries of the means to invest in SRMNCAH, infrastructure, and social services.

Weak tax systems compound the problem. Large informal sectors, limited digital taxation, and weak enforcement capacity prevent many states from collecting revenue commensurate with their economic activity. Meanwhile, mounting debt burdens further squeeze budgets. In 2024, African countries paid about $74 billion in debt service payments, up from $17 billion in 2010, of which $40 billion was due to private creditors. In more than 40% of African countries, debt service now exceeds or rivals public spending on health or education.

Expanding the Fiscal Base and Promoting Health Sovereignty

To close the health financing gap, Africa must not only recover lost revenues but also expand its resource envelope through innovation and self-reliance.

Innovative taxation. Levying fair, progressive taxes in emerging or undertaxed sectors such as digital services, carbon, extractives, and health taxes can yield dedicated funds for health financing. Additionally, excise duties on harmful products such as tobacco, alcohol, and sugary beverages can serve the dual purpose of improving health outcomes and generating revenue, which could then be earmarked for health financing.

Diaspora and remittance finance. Africans abroad send home more than $90 billion to $100 billion annually. Leveraging remittance-linked investment instruments, diaspora bonds, or health-linked capital vehicles can unlock a powerful source of funding for SRMNCAH.

Public-private partnerships. Thoughtfully structured public-private partnerships can bring in capital, technology, and managerial efficiency to scale health infrastructure, diagnostics, and supply systems. At the UN General Assembly, President Duma Boko of Botswana announced a private-public partnership health accelerator that seeks to do exactly this.

Local manufacturing of health products. Africa depends almost entirely on imports for medicines, diagnostics, and vaccines. Currently, fewer than 1% of vaccines used in Africa are produced on the continent. The African market for medicines and vaccines is estimated at around $50 billion annually, nearly all imported. Promoting regional manufacturing through platforms such as the Platform for Harmonized African Health Products Manufacturing can reduce import costs, strengthen supply chains, generate jobs, and retain value within Africa.

Bridging Health and Finance: Institutional Alignment Matters

Raising more money means little unless health and finance sectors can work together confidently. Finance ministries need compelling, evidence-based health investment plans showing returns in productivity, fiscal savings, and social resilience. Health ministries must enhance their capacity in costing, budgeting, and economic modelling to speak the language of finance. Within health, fragmentation must be broken: SRMNCAH; nutrition; water, sanitation, and hygiene (WASH); education; and social services should coordinate to present unified priorities. Governments must institutionalize joint health-finance platforms, task forces or committees to align budgets, avoid overloading finance ministries, and ensure coherent prioritization.