On December 5, Rwanda signed a five-year, $228 million partnership with the United States—an investment framed as a commitment to save lives, strengthen Rwanda’s health system, and build resilience against future health threats. It promises accelerated action on infectious disease control, reductions in maternal mortality, and a stronger foundation for a sustainable health system. What does this new partnership reveal about the ongoing struggle with health financing? Let's go back a little in the past. When the United Nations adopted the Sustainable Development Goals (SDGs) in 2015, Universal Health Coverage became the global ambition: a world where everyone can access quality care without financial strain. Nearly a decade later, Africa remains far from that vision. Donor-funded programmes have undoubtedly saved lives; however, essential health services still suffer from chronic underfunding. The simple truth is that countries fund what they prioritize, and the unfunded, in this case, health, often falls through the cracks. Africa has been discussing health financing for decades. In 2001, the Abuja Declaration boldly committed African Union member states to allocate at least 15% of their national budgets to health. Twenty years later, only three countries, Rwanda, Botswana, and Cape Verde, have met or exceeded that pledge. Meanwhile, more than 30 countries still spend less than 10%, with some barely hitting 5%. Rwanda remains an example of what political will looks like in practice. Despite limited resources, the country has consistently invested in healthcare, resulting in a reduction in maternal and neonatal mortality rates, improved outbreak preparedness, and expanded access to care. These gains are not accidental; they reflect deliberate and principled prioritization. The community-based health insurance scheme has brought millions under coverage. Investments in digital health have improved the quality and reach of services, particularly in rural areas. A strong governance approach has enabled the system to respond to pandemics with impressive coordination. This new Rwanda–U.S. partnership should serve as a wake-up call, not just a milestone. It shows that global cooperation still matters, and if Africa wants to achieve Universal Health Coverage by 2030, it must rethink its approach to financing. That means investing in research that reflects local realities rather than donor priorities. It means elevating young African health professionals who understand the context and can drive innovation from within. And it means exploring homegrown solutions from public–private partnerships to national health investment funds. Healthcare must stop being treated as a privilege granted by circumstance or geography. It is a right. And if Rwanda and the continent act boldly now, the next five years could be remembered not for missed opportunities, but for the moment we changed the history of healthcare financing systems. Dr Marie Merci Cyuzuzo is a global surgery consultant at University of Global Health Equity (UGHE).
