Africa Health Financing Initiative

Background: Africa’s health financing model remains structurally fragile. Governments finance less than 41 per cent of total health expenditure on average, while out-of-pocket payments push over 150 million people into poverty annually. Rising debt distress and declining concessional flows are further compressing already limited fiscal space.

This configuration is unsustainable against the backdrop of demographic expansion, epidemio­logical transition, and climate vulnerability. Health financing must be repositioned from a residual social expenditure into a macroeconomic stabili­zation and growth instrument, embedded in fiscal frameworks, public financial management systems, and regional integration strategies.

ECA’s initiative — “Transforming Health Financing in Africa” — proposes a systemic architecture built on seven interlinked outcomes that combine fiscal embedding, innovative instruments, digital governance, primary health care modernisation, regional public goods, institutional capacity, and narrative transformation across 25 countries over 5 years (2026–2030).