What Africa should do to boost health sovereignty

Across much of Africa, health financing remains fragmented across public, private, and donor channels. [Courtesy]

Africa’s health financing discourse is at an inflection point. Historically anchored on resource mobilisation, particularly from external sources, the agenda is now reshaped by plateauing donor flows and shifting global priorities. This transition reframes the central policy question. It is not merely about how resources are mobilised, but whether health systems are structurally designed to deliver sustainable, efficient, and resilient outcomes over time.

Health sovereignty is not about eliminating external support. It is about reducing structural dependence by building systems that can finance, deliver, and manage healthcare with greater reliance on domestic capability and institutional strength. Across much of Africa, health financing remains fragmented across public, private, and donor channels. As external support recedes, these fractures become more visible. 

The scale of the challenge is significant. Out-of-pocket spending still accounts for a substantial share of healthcare financing across the continent, rising sharply in lower-income settings. This exposes households to financial shock and contributes to millions being pushed into poverty each year. At the same time, risk pools remain fragmented, weakening the system’s ability to absorb cost and volatility. Incentives are often misaligned, with providers rewarded for volume rather than outcomes. Taken together, these patterns point to the same conclusion: System performance is determined less by the volume of funding than by how effectively that funding is structured and deployed.

If Africa is to move toward health sovereignty, four interconnected levers must be deliberately redesigned and aligned.

The first is financing discipline. No health system can function sustainably without effective risk pooling, yet fragmented pools limit the capacity to manage cost and volatility. Risk pools must be expanded and better structured across public and private mechanisms to improve predictability, enable cross-subsidisation, and reduce catastrophic expenditure. Rwanda offers a useful illustration. Over the past two decades, community-based health insurance has significantly expanded coverage while reducing reliance on out-of-pocket spending. However, the model has also faced persistent financial pressures.

The second is delivery model transformation. Hospital-centric systems are inherently expensive and reactive, organised to respond to illness rather than prevent it. Sustainable systems shift care upstream toward primary healthcare, prevention, and chronic disease management. Across the region, community-based care is being integrated into formal health systems, with growing recognition of the role that primary care plays in shaping utilisation patterns early in the care continuum. 

The third is data infrastructure. Many systems still operate with limited visibility into utilisation, cost drivers, and outcomes, a constraint that weakens decision-making and purchasing discipline. Integrating data across enrolment, claims, and provider performance enables more precise resource allocation, stronger utilisation management, and greater accountability.

The fourth is supply-side resilience. Progress has been made in local pharmaceutical and medical manufacturing, but affordability remains constrained by fragmented demand, high input costs, and limited economies of scale. This is where regional integration becomes critical. The African Continental Free Trade Area provides a pathway to aggregate demand, harmonise regulation, and support cross-border supply chains at a scale no single market can sustain independently. 

Ms Jomo is CEO and Principal Officer of Jubilee Health Insurance Limited