Development assistance for health in Africa has declined sharply from about $80 billion in 2021 to roughly $39 billion in 2025, Dr Claver Gatete, the Executive Secretary of the Economic Commission for Africa (ECA) has said.
Speaking at the High-Level side event on Africa’s health sovereignty at the 2026 AU Summit in Addis Ababa, Ethiopia, Dr Gatete noted that at the same time, debt service pressures have risen and fiscal space has narrowed.
He noted that although Africa spends approximately $145 billion annually on health, governments finance less than half, which, unfortunately, leaves households to bear heavy out‑of‑pocket payments.
“Across many countries, families sell productive assets to pay medical bills, workers exit employment and children are forced to leave school. These are not only social but macroeconomic consequences,” he said.
Africa spends approximately $145 billion annually on health, governments finance less than half, which, unfortunately, leaves households to bear heavy out‑of‑pocket payments.
Pointing out that the international system itself is being re‑ordered, Dr Gatete stated that the era of hyper‑globalisation is giving way to an era of strategic resilience.
“Today, nations are reconsidering dependence in critical sectors and are redesigning supply chains to protect their national security, economic stability and social welfare. In this new global landscape, health is no longer viewed simply as a social service. It has become a strategic economic sector, alongside food, energy and technology,” he said.
He said access to medicines, vaccines and medical inputs now shapes national stability, labour productivity and economic competitiveness.
Making reference to the recent crises following the outbreak of the COVID-19 pandemic, he said that revealed a sobering reality, to the extent that even advanced economies struggled to secure essential medical supplies when borders closed and exports were restricted.
Noting that the impact was not limited to hospitals, he indicated that it slowed factories, reduced labour participation, disrupted education and weakened growth.
“So, health shocks quickly became economic shocks, and economic shocks became development setbacks. The question before us, therefore, is fundamental: who finances health, who produces medicines and who ultimately determines the health future of Africa? And Africa today finds itself at a structural turning point,” he said.
Dr Gatete argued that if the effects are economic, the response must also be economic, stating that as a result, health financing cannot be an auxiliary budget line.
He said health financing must be integrated into national fiscal frameworks and financed predictably, just as nations finance infrastructure, energy and security.
He however said no financing solution will be sufficient so long as limited public funds are used to purchase externally produced inputs.
Dr Gatete pointed out the fact that the issue Africa is confronted with is not only fiscal; it is structural and industrial.
“It is unacceptable that a continent of over 1.5 billion people, carrying nearly a quarter of the global disease burden, is served by fewer than a thousand pharmaceutical manufacturers and produces only a small share of the medicines it consumes,” he said, adding that import dependence exposes Africa’s health systems to external prices, external decisions and external disruptions.
Acknowledging that no single African country can generate the scale required for competitive pharmaceutical production alone, he said that was precisely why the African Continental Free Trade Area (AfCFTA) is indispensable.
“Through pooled procurement, regulatory harmonisation and regional value chains, the AfCFTA can become a health security instrument. However, a continental solution requires continental economic coordination,” he said.
By Emmanuel K Dogbevi
