Africa: Smart Aid Still Matters As Africa Ramps Up Domestic Health Financing

Nairobi — As donor funding for Africa’s flagship health programmes declines, African leaders are pushing for greater self-reliance anchored in domestic resource mobilisation, even as they stress that targeted external support remains critical.

At the Africa Health Systems Forum hosted by Strathmore Business School’s PRISM Centre with support from the Bill & Melinda Gates Foundation, policymakers, financiers and health experts examined how to protect hard-won gains in maternal and child health, HIV, TB, malaria and primary health care amid tighter global budgets and waning trust in multilateral health systems.

Under the theme “Resilience in Transition: The Case for Sustainable Health Financing and Africa’s Way Forward,” participants highlighted a dual track: expand country-led financing while maintaining catalytic aid to strengthen data, disease surveillance, AI applications, locally led R&D and manufacturing, and regulatory capacity.

Dr Ouma Oluga, Principal Secretary, State Department for Medical Services, said steady and predictable funding must be built on domestic resources. “Many people don’t appreciate the input of health in driving countries and economies, in terms of productive populations and lost man hours… If you look at health as an economic imperative then you begin to see the opportunity cost of failing to invest in it,” he said, outlining a two-pronged approach centred on taxes and insurance contributions.

Speakers tracked the evolution from aid-led models to country-driven systems and explored efficiencies through service integration and better supply chains. With major replenishments on the horizon, delegates pointed to mechanisms such as Gavi and the Global Fund as essential to sustain routine immunisation and programmes against HIV, TB and malaria, even as governments raise domestic outlays.

Trust emerged as a recurring theme. Dr Kanyenje Gakombe, Chair of the Kenya Healthcare Federation, called for rebuilding “trust capital” between public and private actors to unlock investment: “Capital is shy, and business likes predictability. If there is too much noise in the sector and lack of trust… we cannot unlock the capital or efficiency gains we need.”

On partnership design, Dr Elizabeth Irungu, Regional Technical Advisor for Implementation Science at Jhpiego, said aid should be catalytic, not a substitute for public investment. “There is no country that can be entirely self-sufficient… When we talk about self-sufficiency we should also be talking about how we work with our partners,” she noted, urging more disciplined use of domestic systems.

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