As Africa grapples with mounting health challenges and suspension of aid from the United States, leaders at the Africa Health Agenda International Conference (AHAIC 2025) called for urgent reforms in health financing to ensure sustainability and reduce dependence on donor funding.
The three-day conference, held from March 3-5, 2025 in Kigali, focused on strategic approaches to strengthening health security, financing and service delivery across the continent. With external funding for healthcare dwindling, leaders emphasised the need for homegrown solutions and regional collaboration to achieve health equity.
Raji Tajudeen, acting deputy director-general of the Africa Centres for Disease Control and Prevention (Africa CDC), highlighted the importance of addressing social, economic and environmental determinants of health to ensure accessible and affordable healthcare for all.
AHAIC 2025, held at Kigali, Rwanda from March 3-5, 2025, was organised by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa and Africa CDC.
The continent is facing deepening health inequalities, fiscal constraints and the growing threat of emerging diseases — challenges exacerbated by extreme weather events linked to climate change. Themed 'Connected for Change: Addressing Socio-Ecological Dynamics of Health', AHAIC 2025 spotlighted digital health innovations as a key driver of self-reliance in healthcare delivery.
Githinji Gitahi, chief executive of Amref Health Africa, emphasised the urgent need to shift from reactive, curative models to a prevention-first approach. “The foundation of health is prevention. We must redesign our health systems to prioritise prevention, because health is made at home — hospitals are merely garages for repair,” Gitahi stated.
Gitahi called for renewed commitment to the Alma-Ata Declaration, advocating primary healthcare (PHC) as the bedrock of universal health coverage (UHC). He warned that despite PHC being the most cost-effective and equitable pathway to UHC, many African countries continue to underfund it.
The 1978 Alma-Ata Declaration remains a landmark in global public health, recognising PHC as essential to achieving Health for All. Yet, despite repeated commitments to increase health financing, progress remains sluggish.
In 2001, African Union member states pledged to allocate at least 15 per cent of their annual budgets to health, but as of 2021, the average stood at just 5.7 per cent. The Africa Scorecard on Domestic Financing for Health 2024 revealed that Nigeria — the continent’s most populous nation — allocates only 4.1 per cent of its annual budget to health.
With many health systems heavily reliant on external funding, concerns over long-term sustainability are growing. Gitahi cautioned that healthcare investments will continue to be insufficient unless there is domestic resource mobilisation, public-private partnerships, and more effective budget allocation.
Charles Okeahalam, chairperson of Amref’s International Board of Directors, described the decline in donor funding as a wake-up call for Africa to take full ownership of its healthcare systems. “We must build resilience, prioritise health financing and develop sustainable, homegrown solutions to address our unique challenges,” Okeahalam emphasised.
AHAIC 2025 underscored the critical need for community-based healthcare and the integration of technology, including artificial intelligence (AI), to improve healthcare efficiency and accessibility. However, achieving this vision requires substantial investment in Community Health Promoters (CHP), who are often unpaid or underpaid, stated representatives from Living Goods, Africa Frontline First and VillageReach at the conference.
Innovative financing models are essential for ensuring that CHWs receive adequate support within primary healthcare systems. Speaking on behalf of Living Goods’ Uganda country director Christine Namayanja emphasised the vital role of Community Health Workers (CHW) in bridging healthcare gaps across the continent. “CHWs are the first — and often the only — point of care for millions across Africa. Investing in CHWs is a cost-effective way to strengthen health systems, yielding high returns through healthier communities and economic empowerment, especially for women, who make up the majority of this workforce. To achieve universal health coverage, governments and donors must prioritise sustainable CHW financing,” she stated.
Major funding cuts by global donors are placing immense pressure on Africa’s health systems. In 2024, USAID spent around $12 billion in sub-Saharan Africa, primarily on humanitarian and health aid. However, much of this funding has now been slashed, threatening hard-won progress in combating infectious diseases such as tuberculosis (TB) and AIDS.
These severe cuts have jeopardised decades of progress against TB — the world’s deadliest infectious disease, according to WHO.
Africa, alongside Southeast Asia and the Western Pacific, remains one of the hardest-hit regions, as many national TB programs depend heavily on international support. Despite these challenges, the WHO Africa Regional Office has pledged to continue working with countries to accelerate progress toward universal health coverage and health security.
As the continent grapples with a more intricate health environment, specialists at AHAIC 2025 emphasized the need for innovative funding strategies, regional collaboration, and digital advancements to ensure the future of health in Africa.
The leaders concluded by strongly urging African nations to fully take control of their health systems and promoting sustainable change. The way ahead requires courageous reforms, targeted investments, and a steadfast dedication to health equity throughout the continent.