On the eve of the African Union’s annual meeting, leaders need to secure their countries by increasing spending on health.

The year 2025 will go down in history as the moment the traditional model of global health financing ruptured. Sudden, sweeping aid cuts exposed a reality African policymakers have warned about for decades: while foreign aid can save lives, it cannot sustainably build strong health systems. 

In a split second, the shock reverberated through HIV clinics, vaccination campaigns, maternal health services, mental health and health information systems – critical infrastructure largely financed by resources beyond national control.  

For Africa, the lesson is unmistakable. Health security cannot rest on external priorities or volatile funding cycles. It must be anchored in Africa’s sovereignty and predictable domestic financing.

Months following the aid cuts, African leaders and policymakers have been exploring  permanent solutions that can protect lives and livelihoods today while laying the foundation for resilient health systems in a post-2030 development era.

Stronger domestic financing

One such solution has been with us for years. In 2019, African Heads of State, led by Rwanda’s President Paul Kagame, convened the first-ever African Leadership Meeting (ALM) on Investing in Health in Addis Ababa. 

It was a defining moment of collective introspection where leaders acknowledged that Africa could not build strong health systems dependent on donor priorities or external timelines. They affirmed that health is not merely a development issue but a strategic investment foundational to economic, human security and long-term development.

The ALM Declaration, adopted unanimously, called for stronger domestic financing, enhanced mutual accountability and a new partnership between Ministries of Health and Ministries of Finance – two institutions that had too often approached healthcare challenges from opposing perspectives.

That foundation is now bearing fruit and should be among the first frameworks policymakers turn to as they confront the current financing crises and seek durable solutions for the years ahead.

To date, 12 African Union Member States including Burundi, Kenya, Malawi, Mauritius, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe have convened national health financing dialogues under the ALM framework in alignment with African Health Strategy (2016–2030). 

These dialogues, co-led by Finance and Health Ministries, are breaking long standing silos and developing more coherent approaches to mobilising domestic and blended finances, prioritising pandemic preparedness and increasing local manufacturing and innovation. Critically, they are translating political commitments into concrete budget reforms, parliamentary oversight and fiscal accountability.

Health is a pillar of national security

Anchored in the African Union’s Agenda 2063 and its vision of self-determination, the ALM takes a long-term view of Africa’s health agenda. It positions health spending not as a humanitarian cost vulnerable to shifting geopolitical shifts but as a pillar of economic resilience and national security.   

The tools now emerging from the ALM process are already reshaping decision-making across the continent. Regional health financing hubs, a continent-wide ALM tracker, the AU scorecard and new digital platforms for financing data are introducing levels of transparency, coordination and evidence-based planning that were once unimaginable. These mechanisms enable governments to track progress, monitor reforms and gaps that have long been obscured by fragmented systems.

Early results are beginning to emerge, with several countries – including Ghana, Nigeria and Rwanda – registering increases in domestic health spending and improved efficiency in allocation.

Yet the central vulnerability remains. External financing and out-of-pocket payments by patients account for most of Africa’s health financing. 

In the case of HIV, foreign aid makes up roughly 70% of financing — a figure that leaves households and national programs dangerously exposed to global political and economic shocks. Achieving universal health coverage will require confronting this structural risk directly, not tiptoeing around it.

Increased and smarter spending

The ALM offers one of the clearest paths forward. It calls for increased and smarter spending, with primary health care at its core. It embeds accountability in the flow of public funds and reframes domestic health financing as a high-return investment in productivity, stability and social cohesion.

The decade ahead will test Africa’s resilience more severely than the last. Climate shocks, emerging pathogens and demographic change will continue to strain already fragile systems. As the world approaches the final years of the SDGs, Africa must define its post-2030 agenda in its own terms. ALM shall become the backbone of that vision.

Success will require more than technical reforms or political goodwill. The ALM implementation must be people-centred. 

Citizens must have a meaningful voice in shaping, monitoring and scrutinising health budgets. Communities should become the active drivers of the process, holding governments accountable and ensuring that commitments translate into improvements in quality care.

Africa stands at a pivotal crossroad. The era of donor-driven health investment is ending. In its place, the continent must build systems capable of withstanding political transitions, economic volatility and shifting alliances.

Through the ALM, Africa has begun constructing that foundation — a continental pathway from vulnerability to sovereignty, from dependency to sustainability.

What remains is to strengthen it, scale it and ensure it delivers results for every African.

Ambassador Amma Adomaa Twum-Amoah is the African Union’s Commissioner for Health, Humanitarian Affairs and Social Development.

Image Credits: USAID Press Office, UNAIDS.