Massive cuts to global health-care funding have had a huge impact on the continent, but a more resilient system can be built from within.
Universal health care must be a priority for African nations.Credit: Hajarah Nalwadda/Getty
One Plan, One Budget, One Report.
There is little doubt that this is what African countries need if they are serious about universal health coverage — ensuring that every member of their populations has access to this fundamental human right. But such an approach has never been implemented in Africa. Some of the reasons for this are outlined in a report on health financing by the Africa Centres for Disease Control and Prevention (Africa CDC), the continent’s public-health agency based in Addis Ababa, published last week (see go.nature.com/3o9wxfc).
But if ever there was a time to put the idea into practice, this is it. Africa faces a seismic challenge: finding a way to protect public health when financial assistance for health care from Europe and the United States has halved. In 2021, it amounted to US$26 billion; last year, the figure was $13 billion. What might happen going forwards remains unclear. Initial estimates suggest that the cuts will increase the death toll from preventable diseases such as malaria, HIV/AIDS and tuberculosis by millions (D. M. Cavalcanti et al. Lancet 406, 283–294; 2025).
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The one plan, one budget, one report (OPBR) approach is not new. In this instance, it encapsulates the idea that African countries must be able to control their nations’ health-care policies. It means forging a single plan, to be owned and funded by the nations themselves. It means building capacity from the ground up, with more emphasis on nations’ needs, less on the (often competing) priorities of donors, and with centralized accountability for delivery. Considering the burden of preventable infectious diseases in many parts of Africa, a policy for immunization is a top priority (see go.nature.com/4rmcirr).
The call must now be heeded, by the continent’s leaders and by all those in and outside Africa who work in or support health and science on the continent. They face a daunting task. It will require a step-change in public spending on health care, and ways must be found to fund the sector that do not involve burdening households with greater taxation. A wholly new approach is also needed for relationships with donors, replacing what Africa CDC describes as “asymmetric power”.
The scale of the challenge is evident in the numbers: just 35% of African health-care expenditure is funded by the governments themselves. Almost one-quarter of funding comes from donor countries elsewhere in the world. Most of the remainder is described as “out-of-pocket spending”. This is health-policy jargon to describe personal spending on health, which often means individuals having to sell assets, go without essentials or take on debt just to be able to see a doctor or access treatment.
Last August, African leaders met in Accra and pledged to increase health-care spending. In April, they will meet on the sidelines of the World Health Summit in Nairobi to discuss how to achieve this in concrete terms.
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