As aid declines, Africans must take a greater lead on health financing

African governments must prioritize health investment amid shrinking international aid and rising economic pressures, global health experts said at a recent Devex event on the sidelines of the 78th World Health Assembly. “Health has been consistently deprioritized in national budgets, especially in poorer countries, and it's not clear why that happened,” said Kalipso Chalkidou, director of health financing and economics at the World Health Organization. But one possibility is that it was due to too much aid funding for health, so “governments felt that it would be inefficient to put more of their own money there.” This moment, though, with the numerous shocks countries are facing, including the sudden U.S. aid freeze, presents challenges. Donald Kaberuka, former president of the African Development Bank, said it will require “thinking out of the box” and innovating. Local leadership will have to navigate this complex environment, they said. Africa must take the lead to ensure that health spending meets local priorities. Local leaders need to determine what they will pay for with scarce resources, how they will get more for their money, and how they can identify and protect the most vulnerable populations, Chalkidou said. “We’re seeing that the gap that aid is leaving is causing more and more people to spend out of pocket and become poor or poorer, and that that’s what governments need to look out for in the short term, identify who these populations are and protect them,” she said. But that’s easier said than done given the poor data systems, Chalkidou added. “It will be interesting to see Africa rise up, the institutions in Africa, the leaders in Africa, to take control and make those decisions that will be critical. And for that, you don’t necessarily need the money, but you do need systematic approach and then action,” she said. But Africa’s debt burdens make some of these investments more difficult. Kaberuka called for a shift in how international institutions analyze debt. He described a “trilemma” faced by many African countries: rapid population growth, shrinking fiscal space, and waning global solidarity. He argued that current debt metrics fail to reflect the long-term returns of investing in human capital.