“Africa needs health without aid,” former Nigerian president Olusegun Obasanjo told the continental health sovereignty summit in Accra, Ghana, on Tuesday.

He appealed to leaders to establish a health fund under the auspices of the African Development Bank, funded initially by an airline tax on tourists flying to African countries – an idea that has been floating around the African Union for the past few years.

Obasanjo addressed the opening of the summit, convened by Ghana’s President John Mahama in response to the 40% reduction in development aid in the past two years – the steepest cuts taking place over the past eight months since US President Donald Trump assumed office.

Obasanjo, one of the sponsors of the summit, urged leaders not to “wring their hands” but “find solutions” to the funding crisis.

Mahama said he was building on the momentum from other countries, including Rwandan President Paul Kagame, to mobilise more funds for health during a time of “overlapping and intensifying global crisis” – caused by wars, pandemics, climate shocks, economic volatility and widening inequalities.

“This is not merely a funding gap. It is a crisis of imagination, a vacuum of solidarity and a deep failure of shared responsibility,” said Mahama.

Presidential task team

He announced the formation of the Presidential High Level Task Force on Global Health Governance, a platform for African leaders to engage with global and continental partners and to redesign the health governance system.

“The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations.”

He acknowledged that the abrupt loss of US funding had brought the country’s community-based health delivery model “to its knees”.

In response to the cuts, Ghana has uncapped its national health insurance scheme financing and launched the Ghana Medical Trust Fund, to mobilise capital to tackle chronic diseases.

Mahama also announced that a health tool called SUSTAIN is being rolled out to assist governments to identify all their domestic and international sources of health funding, identify gaps and plan for sustainability.

SUSTAIN (an acronym for Scaling Up Sovereign Transitions and Institutional Networks), will also assist countries to mobilise funding from the private sector, philanthropic partners and the Africa diaspora, said Mahama.

The World Health Organization (WHO) has also offered technical assistance to countries to mobilise more resources.

Opportunity for self-reliance

WHO Director General Dr Tedros Adhanom Ghebreyesus told the summit that the “sudden and steep cuts to aid” is “causing the most severe disruptions to health systems since the peak of the COVID-19 pandemic”.

Tedros added that, according to WHO’s latest analysis, “health aid is projected to decline by up to 40% this year compared to just two years ago. This is not a gradual shift – it is a cliff edge. Lifesaving medicines are sitting in warehouses, health workers are losing jobs, clinics are closing, and millions are missing care.”

However, within the crisis lies “an opportunity to shake off the yoke of aid dependency, and embrace a new era of sovereignty, self-reliance, and solidarity”, Tedros said.

“Africa does not need charity. Africa needs fair terms.”

He urged countries to develop health benefit packages for essential services, and raise money from health taxes on tobacco, alcohol and sugary drinks.

African countries can also save through pooled procurement for medicines, investment in domestic manufacturing and better budget execution using digital public financial management systems.

But Tedros warned that up to 13% of health budgets in low- and middle-income countries go unspent due to weak public financial systems.

Tedros warned that debt service burdens are crowding out social investments, while the illicit flow of money is weakening economies.

“In 2023, Africa received $74 billion in aid – but lost $90 billion to illicit financial flows and $55 billion to corporate tax exemptions,” said Tedros. “Africa lost much more than it gained. This is unacceptable.”

Mahama urged countries to reject the “outdated notion” that health drains their economies, instead insure that finance ministers frame health as a capital investment and a “productivity multiplier and not a consumption expense”.

“The WHO has shown that for every $1 invested in health resilience yields up to $4 in returns. This return is even greater in Africa, where youthful populations represent latent economic dynamism.”