Amb. Gatete: Africa must rethink health financing amid shrinking foreign aid

Ambassador Claver Gatete, the Executive Secretary of the UN Economic Commission for Africa (ECA), has called on African countries to rethink how they finance health systems amidst a decline in global development assistance for health over the past four years. Gatete said this during a High-Level Side Event on Africa’s Health Sovereignty held on the margins of the African Union’s 39th Ordinary Summit in Addis Ababa on Sunday, February 15. “Development assistance for health has declined sharply from about US$80 billion in 2021 to roughly US$39 billion in 2025,” he said. ALSO READ: What decline in global development assistance means for Africa According to Gatete, the continent is facing a new global reality where external support is shrinking, debt pressures are rising, and households continue to shoulder the heaviest burden of health spending. “In this new global landscape, health is no longer viewed simply as a social service. It has become a strategic economic sector, alongside food, energy and technology.” Gatete noted that the consequences of health crises extend far beyond hospitals. “The impact was not limited to hospitals. It slowed factories, reduced labour participation, disrupted education and weakened growth.” “So, health shocks quickly became economic shocks, and economic shocks became development setbacks,” he added. Against that backdrop, Gatete said Africa’s health systems are now facing a major financing challenge as donor support falls sharply. ALSO READ: Nsanzimana calls for resilient African health systems amid shrinking funding “At the same time, debt service pressures have risen and fiscal space has narrowed.” Despite Africa spending about $145 billion every year on health, Gatete said governments contribute less than half the amount, leaving households exposed to high out-of-pocket payments. He warned that the impact is devastating for families and has long-term economic consequences for countries. “Across many countries, families sell productive assets to pay medical bills, workers exit employment and children are forced to leave school.” “These are not only social but macroeconomic consequences,” he added. Gatete said the decline in donor funding should force Africa to shift its response away from short-term budgeting and towards predictable, long-term national financing. “As a result, health financing cannot be an auxiliary budget line. It must be integrated into national fiscal frameworks and financed predictably, just as nations finance infrastructure, energy and security.” Bridging to solutions He stressed that the shift away from donor dependency requires coordinated action beyond ministries of health. “Health sovereignty cannot be achieved by ministries of health alone. Finance, trade, industry and planning authorities must act together,” he added. In his proposed priorities for collective action, Gatete urged governments to integrate health financing into national development plans. “We need to mobilise domestic resources through more efficient, digitised tax administration, health promoting taxes and innovative instruments such as blended finance, diaspora bonds and debt for health swaps,” he said.

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Amb. Gatete: Africa must rethink health financing amid shrinking foreign aid