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Health financing is one of the major challenges facing African countries. Despite continental and international commitments to ensure universal access to care, most African health systems remain fragile, chronically underfunded, and dependent on external aid.
As needs explode with demographic growth, the epidemiological transition (the double burden of infectious and chronic diseases), and health crises (Ebola, Covid-19), new financing strategies are becoming imperative.
This editorial analyzes three essential levers for sustainable health financing in Africa: health taxes, public-private partnerships (PPPs), and African health funds, exploring their potential, their limitations, and the conditions for their success.
I. Health Taxes: Smart Fiscal Policy Serving Public Health
A dual objective: public health and tax revenue
Health taxes target products whose consumption is associated with high health risks: tobacco, alcohol, sugary drinks, ultra-processed foods, and polluting fuels.
The objective is twofold:
reduce risky behaviors,
and mobilize financial resources that can be allocated to health.
Encouraging experiences in Africa
South Africa introduced a tax on sugary drinks in 2018, generating more than USD 200 million per year and contributing to a decline in sugar consumption.
Kenya, Uganda, Nigeria, and Botswana have applied taxes on tobacco and alcohol for several years, with measurable effects on public health.
Togo adopted a law in 2021 to tax harmful products in order to finance universal health insurance.
Challenges to overcome:
Despite their potential, these taxes face several obstacles:
Industry lobbying (sugar, tobacco, alcohol) slowing their adoption.
Political and social acceptability sometimes low.
Lack of traceability: tax revenues are not always reinvested in health due to the absence of clear budget allocations.
II. Public-Private Partnerships (PPPs): Investment Catalysts, But Vigilance Required
A tool for pooling resources
PPPs make it possible to mobilize the resources, expertise, and innovation of the private sector to meet public health needs. They can involve infrastructure construction, service management, or technological development (telemedicine, digital platforms, logistics).
African examples
Morocco: construction of regional hospitals through PPPs.
Côte d’Ivoire: partnership with a private consortium to modernize biomedical laboratories.
Rwanda: collaboration with Babylon Health to deploy large-scale telemedicine through connected health centers.
Conditions for success
However, health PPPs carry risks if not well regulated:
Risk of commodification of care, to the detriment of equity.
Legal loopholes in contracts that may disadvantage states.
Need for strong regulatory bodies to protect the public interest.
III. African Funds: Towards Budgetary Sovereignty in Health
Ambitious pan-African initiatives
Faced with chronic dependence on international aid, African initiatives are emerging to create endogenous financing mechanisms:
Africa CDC proposed a pan-African epidemic fund, in response to the limits revealed by the Covid-19 pandemic.
The African Union is discussing the creation of a continental fund for universal health coverage.
National initiatives such as Senegal’s CMU Fund or Ghana’s Health Benefit Package Fund serve as examples to follow.
Innovative financing and continental actors
The African Development Bank (AfDB) supports health insurance projects, community financing, and health bond issuance.
The African Guarantee Fund backs private investments in health through loan guarantees.
Structural challenges
National contributions remain low: on average less than 5% of national budgets are allocated to health, far below the Abuja commitment (15%).
Insufficient coordination between different funds and partners.
Lack of transparency and accountability in resource use.
IV. Rethinking Health Financing in Africa: Key Recommendations
To ensure equitable and sustainable health coverage, Africa must:
Increase the budget share allocated to health, in line with Abuja commitments.
Institutionalize health taxes and ensure their allocation to health.
Strictly regulate PPPs so they benefit the most vulnerable populations.
Strengthen progressive taxation to reduce inequalities and broaden the contributory base.
Involve citizens and civil society in fund governance.
Invest massively in prevention: every dollar invested in prevention saves several in curative care.
Health financing in Africa can no longer rely on outdated models or volatile external aid. It must be anchored in responsible fiscal policies, balanced partnerships, and a firm political will to build resilient, equitable, and sovereign health systems.
The urgency is not only financial but also ethical and social: to guarantee every African, wherever they live, effective access to quality healthcare.
Dr F Abolore
References (selection)
Africa CDC – Africa’s Health Financing in a New Era (April 2025): highlights a 70% drop in external aid between 2021 and 2025, Abuja commitment (15% of national budgets), and the only countries meeting it (Rwanda, Botswana, Cabo Verde).
Africa CDC – Africa’s Plan to Fill Health Funding Gaps Amidst Declining Coffers: stresses the need to mobilize domestic resources to sustain public health gains.
Lancet Planet Health (2021) study on the impact of South Africa’s sugary drinks tax: 29% reduction in purchases and 51% reduction in calories consumed in some populations.
Reuters / WHO “3 by 35” report (July 2025): recommends raising sugar, alcohol, and tobacco taxes by 50% by 2035 to generate up to USD 1 trillion and reduce non-communicable diseases.
The Guardian (January 2025): sugary drinks responsible for 21% of new diabetes cases in sub-Saharan Africa; calls for stronger taxes.
Scoping review on innovative financing in Africa: PPPs used for infrastructure, laboratories, training; but mixed results on equity and sustainability due to regulatory gaps.
Critical analysis in Review of Evolutionary Political Economy (2024): World Bank’s role and impact of financialization through PPPs, with risks for health equity.
World Bank blog (March 2024) on PPPs to accelerate universal health coverage in sub-Saharan Africa, with case studies (Ethiopia, Togo, Cabo Verde).
Africa CDC (Dec. 2024): describes Rwanda’s community-based health insurance model (mutuelles de santé), over 90% coverage, integration of community health workers, and their remuneration through local income-generating cooperatives.
Wikipedia / Healthcare in Rwanda: mandatory health insurance introduced in 2008, 90% coverage by 2010, mixed financing (premiums, state, donors), spending around 6.5% of GDP in 2013.
WHO feature story (May 2022): Ghana’s national framework for sustainable health system financing, strengthening primary coverage and health investment planning via SDG3 GAP and the Medium-Term Health Development Plan.
Wikipedia / Healthcare in Ghana: description of NHIS launched in 2003, estimated coverage at 36% in 2018 and 51% in 2021, challenges with informal sector contributions and reimbursement delays.
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Lusaka — African health ministers and partners are calling for increased investment in integrated health services to address the growing burden of severe noncommunicable diseases (NCDs), particularly those affecting women and underserved populations across the region. At a high-level side event during the Seventy-fifth session of the WHO Regional Committee for Africa, delegates emphasized the urgent need for equitable access to prevention, screening, treatment, and rehabilitation across the continuum of care for NCDs. Disparities are especially pronounced in rural areas, where health infrastructure and services remain inadequate. Breast and cervical cancers are among the leading causes of cancer-related deaths among women in sub-Saharan Africa—particularly cervical cancer, which is both preventable and treatable. It remains the most common cause of cancer death for women in the region. In 2022, Africa accounted for nearly a quarter (23%) of the 76 000 global cervical cancer deaths. Meanwhile, severe NCDs such as Type 1 diabetes, sickle cell disease, and heart conditions claim more than half a million lives annually, including among children, adolescents, and young adults in some of the continent’s poorest communities. Inequitable access to health services continues to hinder efforts to reduce this burden. To improve cervical and breast cancer care in the region, urgent investment is needed in leadership, governance, and financing. Strengthening these foundations is critical in the current funding landscape. Advancements in strategic planning, healthcare infrastructure, workforce training, and—most importantly—equitable access to screening, diagnostic, and treatment services are essential. To address these challenges, WHO and its partners showcased successful integrated models such as the Women’s Integrated Care for Cancer Services (WICS), the BEAT Breast Cancer Project, and the PEN-Plus Strategy. WICS strengthens early detection, treatment, and integration of women’s cancer services into primary health care systems in Côte d’Ivoire, Kenya, and Zimbabwe. The BEAT Breast Cancer Project is a transformative multi-year initiative aimed at reducing breast cancer mortality among women in Tanzania and Ghana through early detection, timely diagnosis, and comprehensive treatment access. “PEN-Plus, WICS and the BEAT Breast Cancer Initiative are models for a new standard of care, rooted in equity, access and health justice. I urge countries to prioritize policies that embed these models into broader health system strengthening, said Dr Mohamed Janabi, WHO Regional Director for Africa”. Côte d’Ivoire offers a compelling example of progress, combining high HPV vaccination coverage—reaching over three million girls (91.4%)—with WICS-supported community-based screening campaigns to strengthen cervical cancer prevention. In Kenya, cervical cancer screening has been successfully integrated into national health services. “This gathering marks a pivotal moment to accelerate action for breast cancer prevention in Africa. We deeply value the leadership of the Ministries of Health of Ghana and Tanzania, and the steadfast support of the Pfizer Foundation in helping us achieve this milestone. The side event builds momentum for the policy prioritization of women’s cancers, partnerships to strengthen the broader women’s cancer ecosystem, and advance a health-systems approach to breast cancer prevention and management”, said Dr Somesh Kumar, Senior Director, Jhpiego. PEN-Plus expands access to care for severe NCDs at the district hospital level. Since its implementation, 20 countries in Africa have increased access to services for severe NCDs. Over 15 000 people are currently receiving treatment for chronic conditions such as sickle cell disease and Type 1 diabetes through PEN-Plus clinics.