Africa seeks healthcare self-sufficiency amid US aid cuts
From right, Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa, Dr Githinji Gitahi, group CEO, Amref Health Africa, Dr Sabin Nsanzimana, Minister of Health, Rwanda and Dr Claudia Shilumani, director of External Relations and Strategic Management at Africa CDC, speaking at AHAIC 2025 in Kigali, Rwanda.
What you need to know:
- Kenya faces a Sh25 billion malaria funding gap, while Africa grapples with a $1.5 billion shortfall to maintain current interventions.
More than 20 African countries, including Kenya, have gathered in Kigali, Rwanda to develop strategies for healthcare independence following recent changes to US foreign assistance programmes.
The week-long meeting, which started on Monday, comes at a critical juncture for African healthcare systems as they confront declining international aid, ongoing disease outbreaks, and climate-related health threats.
Attended by 2,000 delegates, the 6th Africa Health Agenda International Conference focuses on domestic resource mobilisation to build resilient and self-sufficient health systems across the continent. It takes place against the backdrop of President Donald Trump's recent decisions affecting USAID funding. While US Secretary of State Marco Rubio has approved an emergency humanitarian waiver to ensure continuation of lifesaving treatment for diseases like HIV/Aids, malaria and tuberculosis across 55 countries, African health leaders are urgently seeking more sustainable funding solutions.
"We need to map funding gaps and work closely with African governments to find sustainable solutions. The focus must shift toward internally driven strategies while remaining open to strategic collaborations," said Dr Chikwe Ihekweazu, acting World Health Organization regional director for Africa.
Dr Ihekweazu highlighted Rwanda as a model for strong domestic health financing, calling for greater investment in health systems and leveraging private-sector expertise to complement public healthcare efforts.
“With strategic investment and governance, African nations can fund their health priorities effectively. This means prioritising internal revenue generation for healthcare, reducing out-of-pocket costs, and expanding universal healthcare coverage,” he told the delegates.
Global and African health leaders underscored the urgency of tackling pandemics, climate-driven health threats, and declining health aid through homegrown solutions and strategic investments.
They pointed out that healthcare systems have been stretched by recent Mpox and Marburg outbreaks, increasing climate-related diseases, and dwindling international health aid, and that the Kigali conference serves as a pivotal platform to drive African-led health solutions and forge sustainable partnerships.
“Africa must take ownership of its healthcare future. Reducing dependency on external aid requires strengthening local healthcare capacity—not just focusing on how much funding we receive, but on how efficiently we use resources to improve health outcomes,” Dr Sabin Nsanzimana, Minister of Health, Rwanda said while reaffirming his country’s commitment to building a resilient and sustainable healthcare system, emphasising that health is a foundation for national development.
“By prioritising homegrown solutions, strengthening innovation, and taking ownership of our health systems, Africa can secure a healthier and more sustainable future for all,” he told delegates at the conference themed ‘Connected for Change: Addressing Socio-Ecological Dynamics of Health’.
The urgency of these discussions is illustrated by the continent's struggle against malaria. Last month, Dr Willis Akhwale, senior advisor at End Malaria Council, revealed that Kenya faces a Sh25 billion malaria funding gap, while Africa grapples with a $1.5 billion shortfall to maintain current interventions.
"The US President's Malaria Initiative/USAID has been contributing $500 million annually towards ending malaria on the continent at a time when $400 million is needed for new, but more expensive commodities to address insecticide and drug resistance," Dr Akhwale explained.
According to Kenya's Malaria Strategy 2019-2023, implementing the five-year plan requires Sh61.92 billion, with projected available funding of only Sh37.84 billion, leaving a gap of Sh24.07 billion.
The challenge is compounded by emerging threats. Researchers have detected mutations indicating artemisinin resistance in more than 10 per cent of malaria-infected individuals in Uganda, Tanzania, Ethiopia, Eritrea, and Rwanda.
Artemisinin is the vital component in Coartem®, Kenya's first-line treatment for malaria.
The Anopheles stephensi mosquito, which thrives in both rural and urban environments, has been detected in 10 countries, including Kenya, threatening urban centres where population growth is fast.
"Growth in urban malaria transmission will strain already weak health systems and could result in half a billion cases and 2.8 million deaths annually by 2050," Dr Akhwale warned.
Dr Githinji Gitahi, Group CEO of Amref Health Africa, called for a fundamental shift in how health is funded across the continent.
"Sub-Saharan Africa is facing an economic crisis, and the lack of fiscal space is a major issue. Investing in health must be tied to population development, ensuring that every girl and woman has the right to make informed reproductive health choices," he said.
Dr Gitahi emphasised redirecting investments toward Primary Health Care (PHC), warning that disproportionate funding for tertiary care leaves millions without access to essential services.
"For decades, we have called for prioritising primary healthcare, as outlined in the 1978 Alma-Ata Declaration. Yet, we continue to mop the floor instead of fixing the leaking tap. If we want sustainable health systems, we must redirect investments to PHC, where 80 per cent of our people seek care."
Chris Getonga, chairperson of End Malaria Council, highlighted the role of the private sector in filling funding gaps. Since 2019, End Malaria Councils & Funds have engaged more than 2,500 companies, reached over 100 million people with malaria messaging, and mobilised commitments worth more than $125 million.
"How can we build on this success to accelerate the fight against malaria?" Mr Getonga asked, urging African governments and private sector stakeholders to leverage domestic resources at a time of "donor fatigue."
Dr Caroline Boulton, head of drug development at Novartis, confirmed that the pharmaceutical company is developing "the next generation of antimalarial drugs" in response to emerging resistance.
"We have noted partial resistance in Rwanda and we will soon be having trial sites in Kenya. The efficacy of artemisinin derivatives, the cornerstone of current treatments for malaria, is being compromised in the region," she explained.
Dr Akhwale outlined several approaches for sustainable malaria eradication:
"We need to build bridges between members and secretariats of national End Malaria Councils & Funds, share best practices for advocacy and resource mobilisation, and set collective targets to accelerate progress against malaria," he stated.
Dr Gitahi added that addressing fundamental health determinants is critical: "By ensuring access to clean water, improved sanitation, and proper nutrition, we build sustainable systems that can withstand shocks and drive Africa's socio-economic growth."
