It is time for Africa to transition to sustainable health financing, turn commitments into action

BOTSWANA: ACROSS health facilities in Africa, there is a scene that repeats itself every day. A parent or guardian walks into a clinic carrying a sick child. As they wait in line, they are not thinking about national strategies, continental roadmaps, or political promises.

They are wondering whether a doctor or nurse is there, whether medicines are available and whether their child will recover. Our communities do not experience health service delivery through declarations or frameworks, but through implementation and positive outcomes.

They experience it when a child is protected from malaria or survives malaria because treatment was available in time; when a mother gives birth safely, when quality health services are within reach and when diseases no longer dictate the future of their children and families.

As we gather in Accra for the African Union Extraordinary Summit on Health, my focus is less on new commitments and more on delivering those we have already made. Africa has no shortage of vision for the health and prosperity of its people. The question is not whether we know what to do – various frameworks, including the AU Roadmap to 2030 and Beyond are clear – but whether we are acting with the urgency this moment demands.

A perfect storm continues to rage

The warning signs are clear. Due to a perfect storm of challenges, ranging from drug and insecticide resistance to climate change effects, shortage of funding, as well as population growth, fundamental progress against malaria has stalled and Africa is off track to meet our malaria elimination targets.

Africa’s health financing gap has grown wider. External health aid to Africa has fallen by 70 per cent between 2021 and 2025 and the recent Global Fund and Gavi replenishments fell short of their targets.

The era of relying primarily on external financing is ending. We must accelerate efforts towards sustainable financing and advance our own health security.

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Meanwhile, diseases are not waiting. Climate change is driving changes in the transmission patterns and reach of diseases like malaria and dengue. Our brothers and sisters in the Democratic Republic of Congo and Uganda are courageously responding to an Ebola outbreak once again.

Covid-19 exposed the cost of fragile health systems and disrupted supply chains. Those lessons demand that we build stronger, more resilient and better prepared health services.

Implementation is now our greatest responsibility

We must now ensure we implement the African Union Roadmap to 2030 and Beyond.

As leaders, our task now is to hold ourselves accountable for turning the ambitious vision of the roadmap into a visibly healthier and more empowered population. In one Big Push, we must deliver what we have already envisioned for our citizens.

The good news is that momentum is already building. Across the continent, countries are advancing several of the roadmap’s key pillars.

Sustainable financing

Diversified and Sustainable Financing is the foundation for all the other pillars.

We must increase domestic investment in malaria and make every dollar count. Using sub-national tailoring, we can target available resources to the highest-burden areas to maximise impact, whilst improving efficiency and mobilising public-private partnerships and multisectoral financing.

Nigeria, Benin, Zambia and Ethiopia have already increased domestic malaria funding and this needs to become the continental norm. Malaria remains concentrated in African countries, as operating environments get more complex and donor funding continues to decline.

This makes transitional financing from global partners essential. In pursuit of this, countries must ensure malaria features prominently in World Bank Health Compacts to support national malaria programmes. National End Malaria Councils and Funds demonstrate that domestic resource mobilisation works.

Now active in 12 countries, they have raised over 228 million US dollars by bringing government, the private sector, traditional leaders, youth and civil society together behind national end malaria goals. I urge every Member State to introduce this model and establish End Malaria Councils and Funds, just like we are doing in Botswana.

Health security and systems strengthening

The ongoing Ebola outbreak, alongside warnings from global experts that another global pandemic will happen – it is a matter of when, not if – shows we must strengthen our prevention and preparedness.

This is why we must pay special attention to pandemic prevention and preparedness by reinforcing our health security, strengthening our health systems and bolstering our health information, monitoring and evaluation systems. Digital data-driven scorecard tools for accountability and action offer a proven framework for tracking essential interventions across malaria, NTDs and RMNCAH.

The Sahel Integrated Malaria and NTDs Scorecard, for example, has enabled joint surveillance and other interventions across neighbouring countries, strengthening regional collaboration.

Local manufacturing for enhanced access to medicines

We must also urgently change the fact that half of our Member States lack reliable access to essential medicines, and up to 90 per cent of our drugs are imported.

Local manufacturing is the answer. The continental target of producing at least 60 per cent of health products on Africa’s soil, paired with integrating malaria into primary health care and financing our response domestically, will make elimination sustainable.

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Malaria will be the strongest proof for our selfreliance: a disease Africa can defeat with our own leadership, resources and manufacturing. We are already seeing encouraging progress, with WHO prequalification for antimalarial medicines, Insecticide Treated Nets and spatial repellents manufactured in Africa. These milestones demonstrate Africa’s growing capacity to produce the medicines and technologies our people need.

Governance and oversight for accountability

I began by noting that it is time we hold ourselves accountable to our people for the commitments and bold visions we have set for the Africa we want. Commitment without followthrough will not change the story for the mother, father or guardian standing in a clinic line, seeking care for their ailing child.

The Big Push Monitoring & Accountability Framework tracks what governments commit to and the ALMA-supported scorecard tools measure progress against those commitments, giving leaders a clear view of where our malaria programmes are on course and where they are slipping.

Let Accra be remembered for action and delivery Africa’s Heads of State have reaffirmed that domestic health financing is a continental priority; from the African Union’s African Leadership Meeting on Investing in Health, to the President Paul Kagame-led 2024 Kigali High-Level Health Financing Conference and most recently, the President John Dramani Mahamaled Accra Reset Agenda.

Together, these initiatives signal a shared commitment to moving beyond dependency towards sustainable, domestically financed health systems grounded in accountability, results and impact. As we gather in Accra, let us build on that momentum.

Let us leave with a shared understanding of where we stand against the roadmap and a common resolve to close that gap together. In the end, none of our frameworks will be what a parent, a family, or Africa remembers. What will be remembered is whether the nurse was there, whether the medicine was on the shelf and whether their child got better.

The AU Roadmap to 2030 and Beyond has already set out Africa’s vision for better health. Our task now is to accelerate its implementation, anchored in sustainable financing and accountability for results.

President Advocate Duma Gideon Boko, President of the Republic of Botswana, is also the Chair of the African Leaders Malaria Alliance (ALMA)