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Africa: Pressure Points – Africa’s Health Systems Amid Global Aid Contraction

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Africa: Pressure Points – Africa’s Health Systems Amid Global Aid Contraction


Africa’s health systems amid global aid contraction

Key findings

  • On average across 38 surveyed countries, health ranks as the most important problem that Africans want their governments to address, overtaking unemployment at the top of citizens’ policy agenda.
  • Seven in 10 Africans (70%) say their governments should ensure that all citizens have access to adequate health care, even if that means raising taxes.
  • Among Africans who had contact with a public clinic or hospital during the previous year: o Half (51%) say it was “difficult” or “very difficult” to obtain the care they needed. o Almost two-thirds (63%) indicate that high costs prevented them from getting the care or medicines they needed. o Majorities report encountering a variety of other problems, including long wait times (79%), a lack of medicines or other supplies (71%), facilities in poor condition (58%), and/or absent doctors or other medical staff (56%).
  • Among Africans who had contact with a public clinic or hospital during the previous year: o Half (51%) say it was “difficult” or “very difficult” to obtain the care they needed. o Almost two-thirds (63%) indicate that high costs prevented them from getting the care or medicines they needed. o Majorities report encountering a variety of other problems, including long wait times (79%), a lack of medicines or other supplies (71%), facilities in poor condition (58%), and/or absent doctors or other medical staff (56%).
  • On average across 36 countries, most citizens (79%) say they do not have any form of medical-aid coverage.
  • The most common reasons for not having medical aid are that people can’t afford it (35%), don’t know of any available health-insurance schemes (33%), and find enrolment procedures complicated (11%).
  • More than half (53%) of Africans say they worry “a lot” that if they or someone in their family gets sick, they will not be able to obtain or afford needed medical care. Another 35% say they worry “somewhat” or “a little.”
  • More than half (53%) of Africans say they worry “a lot” that if they or someone in their family gets sick, they will not be able to obtain or afford needed medical care. Another 35% say they worry “somewhat” or “a little.”
  • Fewer than half (45%) of Africans say their government is performing “fairly well” or “very well” on improving basic health services, though assessments vary widely by country.


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Since the COVID-19 pandemic, African governments have been compelled to reassess how best to protect hard-won public health gains while ensuring equitable and reliable care. These reassessments are taking place against a background of shifting geopolitical alignments, tightening fiscal space, and growing public expectations of quality public services. This reckoning intensified in 2025 with the disbanding of the United States Agency for International Development (USAID) and the cancellation of major foreign-funded health programmes, effectively dismantling one of the pillars of Africa’s health-support architecture.

For more than two decades, USAID served as the operational backbone of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), translating the initiative’s strategic vision into the clinics, supply chains, community programmes, and health-systems infrastructure that sustained much of Africa’s HIV response (KFF, 2025). The loss of USAID introduced profound uncertainty regarding PEPFAR’s future and signalled the erosion of the institutional machinery that had underpinned progress in HIV prevention and treatment across the continent (UNAIDS, 2025). Although a temporary waiver by the U.S. government permitted the continued supply of essential antiretroviral medicines, available estimates indicate that roughly 65% of USAID-managed PEPFAR awards were terminated or left in limbo, leaving millions of beneficiaries across sub-Saharan Africa exposed (Godbole, 2025, KFF, 2025).

Crucially, the shock to HIV/AIDS programming has reverberated beyond the HIV sector, exposing systemic vulnerabilities across health systems. Facilities, supply chains, and human resource systems originally built around PEPFAR had evolved into core components of primary health care in several countries. As these platforms falter, the ripple effects have been immediate and far-reaching: drug shortages, supply-chain breakdowns, staffing disruptions, and widening health-care-delivery gaps (Cullinan, 2025). These consequences, documented by Médecins Sans Frontières (2025) and echoed in national health ministry reports, point to a broader destabilisation of the health-system foundations upon which many African countries have come to rely since 2000.

At the same time, persistent fiscal constraints have weakened African governments’ ability to cushion the shock. The last three years have seen recurrent health-worker strikes and service disruptions in South Africa (Al Jazeera, 2023), Uganda (Abet, 2024), Kenya (Reuters, 2024), and Ethiopia (Human Rights Watch, 2025) as frontline staff protest unpaid allowances and deteriorating working conditions. In August 2025, Botswana declared a public-health emergency after its national medical supply chain failed, forcing the army to distribute scarce medicines across major hospitals (Al Jazeera, 2025). The Malawian government also warned of imminent tuberculosis-drug stockouts amid global aid cuts and domestic logistics bottlenecks (Masauli, 2025). In Zambia, revelations of widespread theft of donated medicines led the U.S. government to suspend $50 million in health aid and prompted forensic audits (U.S. Embassy in Zambia, 2025).

Together, external uncertainty and internal fiscal strain have deepened the cracks in health system resilience, reinforcing the urgency to rethink Africa’s health-financing architecture. Across the continent, reform and experimentation toward universal health coverage (UHC) are underway. In Ghana, the government increased National Health Insurance Scheme funding from GH¢ 5.9 billion in 2024 to GH¢ 9.8 billion in 2025 (Ghana Ministry of Finance & Economic Planning, 2025a, b), and enrolment was reported at around 18 million members in mid-2025, though official figures vary across government sources (Ghana National Health Insurance Authority, 2025). In Kenya, the National Hospital Insurance Fund has similarly undergone major reforms, including benefit expansion, civil-servant schemes, and subsidy mechanisms. That said, formal social health-insurance uptake remains limited: Only 17% of the population was covered in 2023, comprising just 27% of informal-sector workers (Nungo, Filippon, & Russo, 2024). In Nigeria, the passage of the National Health Insurance Authority Act of 2022 and the rollout of its implementation plan between 2023 and 2025 marked an important policy shift toward mandatory health coverage for all residents (Ilesanmi, Afolabi, & Adeoya, 2023). Replacing a voluntary model, the act provides for a unified system that pools risk across federal, state, and private schemes. Yet despite this reform momentum, insurance penetration in Nigeria remains extremely low – fewer than 5% of Nigerians are enrolled, and roughly 70% of households still pay out of pocket for medical expenses (Okechukwu, Iseolorunkanmi, & Adeloye, 2024).

Vaccine-production hubs in Senegal, South Africa, and Egypt illustrate Africa’s growing ambition to localise supply chains and strengthen health sovereignty (World Health Organization, 2021; Abdullahi et al., 2025). Meanwhile, digital health innovations – from mobile health to data-driven monitoring platforms – are beginning to fill gaps left by retreating donor programmes, though their impact remains uneven (Ahmed et al., 2025; Qoseem et al., 2024).