Africa is at a crossroads in its health journey – not simply because of shifting geopolitical dynamics or shrinking donor aid, although these are real challenges, but because we must confront a deeper structural flaw in how our health systems are designed.

The continent, home to over 1.4 billion people and projected to house one in five of the world’s population in the coming decades, faces a critical paradox. Despite progress in tackling infectious diseases, African health systems remain fragile, underfunded, overstretched, and trapped in a cycle of curative interventions. These systems prioritise expensive, hospital-based care that waits for disease, while neglecting prevention, health promotion, and community engagement to reduce the disease burden.

This model is neither sustainable nor equitable, and it keeps us locked in the “curative consumption trap.” It drains our already limited resources, perpetuates inequities, and undermines our vision for universal health coverage (UHC).

Community-driven systems

It’s time to shift from a reactive, hospital-centric model to one that invests in health production — resilient, community-driven, people-centred systems that prevent disease, empower people, and build a healthier future for all Africans.

A quick back-of-the-envelope calculation shows that high-income countries spend around $4000 per capita on healthcare, mostly through public financing. In sub-Saharan Africa, that figure is closer to $40 –  and that is assuming countries meet the aspirational goal of allocating 15% of national budgets to health. Most do not.

Can Africa afford healthcare as currently structured? The answer is clearly no.

This consumption-based model has colonial roots built for the rich who came to Africa and needed a health system that reflected their needs, as they were used to back in their home countries, reinforced by political incentives that favour short-term infrastructure projects over long-term people-centred reforms. 

During the recent Africa Health Agenda International Conference (AHAIC) 2025 in Kigali, it was evident that many African health systems still focus on treating disease rather than preventing it — a legacy that must be urgently overcome.

Vicious cycle of curative consumption trap

Hospitals and clinics often serve as the epicentre of care, with resources skewed toward expensive, tertiary-level interventions that politicians prioritise to appeal to voters. This curative bias comes at the expense of preventative measures needed to reduce the disease burden, particularly the rising tide of non-communicable diseases (NCDs) like diabetes, hypertension, and cancer.

In 2019, NCDs accounted for 37% of deaths in sub-Saharan Africa, up from 24% in 2000, and the burden is rising. Our systems are ill-equipped to manage this growing crisis.

The curative consumption trap is fuelled by several factors. First, a post-colonial bias for infrastructure-heavy, specialist-led care over community-based approaches informed by the health needs of those who built the health systems. 

Second, a health workforce trained to treat illness, not promote wellness. In medical school, I spent just one lethargic month on community health, compared to years learning about diagnosis, surgery, and pharmacology. This narrative is supported by political incentive as infrastructure is a vote driver for politicians and historical budgeting approaches prioritise infrastructure and equipment procurement. 

Third, a lack of trust in unfriendly, distant, supply-driven health systems leads people to seek care only when they are really sick, resulting in late diagnoses and high treatment costs.

This isn’t just a health issue, but a social and economic crisis. When systems focus on curing instead of preventing, they consume scarce financial and human resources while ignoring root causes such as unsafe water, poor sanitation, undernutrition, and the proliferation of unhealthy processed foods full of industrial trans fats and sweetened beverages. 

The result is high costs for health services, with families pushed into poverty by catastrophic healthcare costs from out-of-pocket expenditure. The result is a vicious cycle where illness perpetuates poverty, and poverty perpetuates illness.

Shifting the focus to health production

To break this cycle, we need to embrace a model of health production that keeps people healthy, empowers communities, and addresses social determinants of health. 

It should be proactive, equitable, people-centred and sustainable, ensuring that every African has access to the tools and knowledge to live a healthy life, including reproductive health services for adolescents and women. 

This requires two major shifts. First, we must prioritise preventive and promotive health. Prevention is the cornerstone of health production.

Evidence shows that primary healthcare, with a focus on primary care and prevention, community empowerment and engagement and multi-sectoral approaches, improves health outcomes, enhances equity, and increases system efficiency. Yet, only 48% of Africans have access to primary healthcare services, leaving 615 million people without adequate services. 

To address this, we need to invest in community health systems including community health workers (CHWs), who are the backbone of primary healthcare.

CHWs are often the first and only point of contact for underserved communities. They deliver preventive services such as vaccines, they educate communities on healthy practices, and detect early warning signs of disease, yet, many remain underpaid, under-trained, and disconnected from formal health systems. 

Governments need to commit to financing and integrating CHW programmes into national health systems, as outlined in the 2018 WHO guidelines – not as stopgaps, but as core pillars of national health strategy. 

Promotive health also means tackling the social determinants of health – poverty, education, clean water and sanitation, nutrition, and environmental factors. We also need policies that tackle risk factors. 

Taxing unhealthy products like industrial trans fats, tobacco, alcohol, and sugar-sweetened beverages can reduce the burden of NCDs while generating revenue for health programmes. These funds can be channelled into community-led initiatives that promote clean water, sanitation, and nutrition, addressing the root causes of disease.

Second, we need to empower communities as active participants in their health. Health systems cannot succeed without the trust and participation of the people they serve. 

Too often, African health systems are designed around institutions and diseases rather than people. Some have jokingly referred to our ministries of health as “ministries of disease” — a reflection of how disconnected the system can feel from lived realities.

Communities – including youth, women, and marginalised groups – must have a seat at the decision-making table. Health policies should be co-designed and governed by those they are meant to serve. 

It is time to update the current WHO framework and recognise “people” as the seventh building block of effective health systems, alongside service delivery, health workforce, information systems, health financing, access to medicines and health technologies, as well as leadership and governance.

Empowering communities also requires fostering accountability. Civil society-led mechanisms can hold governments, the private sector and other partners accountable for delivering on UHC commitments, ensuring that policies align with the principles of social justice. By giving communities a stake in their health systems, we can build trust, encourage early health-seeking behaviour and reduce the reliance on curative care.

Moreover, African governments must address inefficiencies and corruption, optimising the use of limited resources. By embracing digital technology and artificial intelligence, we can improve health data systems, enhance service delivery and target interventions more effectively. Technology must be deployed at the community level, not just in hospitals, to enhance equitable access, particularly at the last mile.

Building health systems of the future 

The curative consumption trap is a legacy of colonial health systems and misaligned global priorities. It is not inevitable. Africa has the opportunity to redefine its health agenda, leveraging its youthful population, rich cultural heritage, and growing technological innovation. But this requires bold leadership and collective action.

African governments should prioritise health in national budgets, recognising that health is not a cost but an investment in human capital for socioeconomic development. 

Donors and global health partners must shift their focus from short-term, disease-specific interventions to long-term health system strengthening in line with the Lusaka Agenda, an effort for all to prioritise strengthening health systems, promoting sustainable health financing and enhancing equity through national-level co-ordination. 

At Amref Health Africa, we are committed to this vision. Our work with community health workers, youth, and local leaders across 35 countries for over 67 years demonstrates that health production is possible when people are at the heart of the system. 

As we approach 2030, the deadline for achieving UHC, we must decide: do we continue down the path of reactive, costly care with limited returns or do we embrace a model that produces health, dignity, and opportunity for all?

The curative trap may be the legacy we inherited, but health production is the legacy we must build.

Dr Githinji Gitahi is the Group CEO of Amref Health Africa and a passionate advocate for pro-poor universal health coverage.

Image Credits: Last Mile Health, Eduardo Soteras Jalil/ WHO, Community Health Impact Coalition @Mapbox @OpenStreetMap, Cecille Joan Avila / Partners In Health.