Securing Africa’s Health Demands Domestic Resource Mobilisation and Political Courage, says AHF

JOHANNESBURG, South Africa — Africa stands at a defining moment in health financing. As global aid contracts and donor priorities shift, the future of the continent’s health depends increasingly on domestic political commitment and resource mobilisation. 2025 has been a tumultuous year for the HIV landscape. The AIDS Healthcare Foundation (AHF) is calling on African governments to demonstrate leadership, accountability, and courage by investing sustainably in health systems and securing the continent’s health sovereignty, supporting strong calls from the Conference on Public Health in Africa and recommendations from the C20 Working Group on Equitable Health for All.

“Africa is at a defining moment in health financing sustainability. With shifting donor support, 2025 offered an opportunity for reflection and renewed advocacy for explicit commitment to health financing for governments,” said Ngaa Murombedzi, AHF’s Southern Africa Regional Advocacy and Policy Manager. “The future of our health must not be dependent on deliberations off the continent but on galvanising political will on the continent. Failure to secure our health financing, we risk undermining decades of progress against HIV, TB, and preventable diseases.”

Shrinking Aid, Rising Need

According to Africa CDC’s 2025 Strategic Plan on Health Financing and Self-Reliance, donor funding for Africa’s health response is projected to decline by up to 70% between 2021 and 2025, while disease outbreaks have surged by 41% over the same period. The UN Africa Renewal (2025) further reports that over 200 million Africans rely on out-of-pocket payments for healthcare, with 150 million pushed into poverty annually because of medical costs.

Despite commitments made under the 2001 Abuja Declaration, where African Union member states pledged to allocate 15% of national budgets to health, only a handful—such as Rwanda, Botswana, and Cabo Verde—have consistently met or exceeded this target. In 2024, the average health spending across African governments remained below 8%, leaving critical programs underfunded and communities vulnerable.

“We cannot outsource the future of our health,” said Dr. Nombuso Madonsela, AHF South Africa Country Program Director. “Domestic resource mobilisation is no longer optional; it is an urgent political and moral responsibility.”

African Solutions Exist—but Need Scale

Despite widespread shortfalls, several African countries have developed home-grown mechanisms to strengthen health financing. Zimbabwe’s National AIDS Trust Fund and Nigeria’s HIV Trust Fund are notable examples of locally financed sustainable health initiatives. 14African countries were exploring innovative financing mechanisms such as digital transaction levies, solidarity taxes, and health bonds to expand their domestic health budgets, according to WHO Africa.

“These models show that African-led solutions are possible,” says Murombedzi. “What is missing is replication, scale, and the courage of governments to prioritise them. Finance is policy—if it does not reach the most vulnerable, the system fails.”

Health financing must be inclusive, transparent, and responsive to the needs of those most affected. Inclusive and participatory budgeting ensures resources are not only mobilised but also equitably distributed.

“Citizens have the right to know where health funds go and how they are spent,” added Murombedzi. “Transparency, civic oversight, and equity form the foundation of sustainable health financing.”

This emphasis on accountability was central to the 2025 Nairobi Health Financing Convening, co-hosted by AHF Kenya, the Resilience Action Network Africa, and the Pandemic Action Network, where regional leaders urged governments to increase domestic investment, implement debt reforms, and ensure fiscal space for health.

Resilience in a Changing Climate

The continent’s health challenges are being compounded by climate shocks, zoonotic diseases, and ecosystem degradation—all of which demand adaptive, well-funded systems.

“We cannot build resilient health systems without recognising these interconnections,” said Dr. Madonsela. “Regional coordination, domestic investment, and accountable implementation must guide our response if we are to avoid future crises like COVID-19.”

“Investing in health requires confrontation of social determinants of health, which are reliant on financing for sustainable integrated socio-economic response” adds Murombedzi

A Call to Action for Governments

AHF urges African governments to keep financing an ongoing conversation and meet or exceed the 15% Abuja Declaration target for health spending. Nations must adopt gender-responsive and inclusive budgeting to ensure equitable access to health services. Evidence shows tax systems reform is progressive, with leveraging “sin taxes” and digital levies to expand fiscal space as strategies. Additionally, Africa must pursue debt restructuring or swaps that free resources for health, education, and social protection and institutionalise community participation in budget planning, monitoring, and evaluation. Finally, proven innovative domestic financing models need to be scaled up and replicated at the national level.

“These are not utopian demands,” emphasised Madonsela. “They are the minimum commitments required if Africa is serious about health sovereignty.”

Securing Health is Securing the Future

Africa’s health systems must stand on their own. Sustaining life-saving programs for HIV, TB, and maternal health depends on political courage and financial accountability. Civil society, regional bodies, and citizens all have a role to play in holding leaders accountable.

“The choice before African governments is simple - mobilise our resources with transparency and courage or leave the next generation with broken systems and empty promises,” concludes Madonsela