There has been a global decline in aid to Africa since 2018, as donors shift their funding priorities in response to domestic and international agendas. Countries such as Germany, France, and Norway have reduced their aid in recent years, while in 2020, the UK government cut its Overseas Development Aid from 0.7% to 0.5% of gross national income.
Many health services across Africa depend heavily on foreign aid to provide essential care, funding everything from vaccines and HIV treatment to maternal health programs. Cuts to aid can have severe consequences. For instance, between 2021 and 2022, around 72 million people missed out on treatment for neglected tropical diseases due to UK aid reductions.
The freeze of US aid to Africa in January 2025 is the latest setback, significantly affecting the continent’s health systems. Vaccination campaigns for polio and HIV/AIDS treatment under the President’s Emergency Plan for AIDS Relief (PEPFAR) have been halted, putting millions at risk. In South Africa alone, the loss of PEPFAR’s $400 million annual funding for HIV programs could lead to rising infection rates, treatment defaults, and increased mortality.
Africa’s dependence on foreign aid exposes it to the changing priorities of donors and limits self-determination in setting health priorities. Many aid-funded programs focus on single diseases like HIV, leading to fragmented healthcare services. A shift toward sustainable local funding is necessary to reduce reliance on external support.
Strategies for Reducing Aid Dependency
1. Strengthening Country Leadership and Ownership
African nations face the dual burden of communicable diseases like malaria and HIV/AIDS and rising non-communicable diseases such as diabetes and cardiovascular conditions. However, health systems remain underfunded, with governments spending less than 10% of GDP on healthcare. The estimated annual investment needed to meet evolving health demands is $26 billion, but current capital expenditure is only $4.5 billion.
Foreign aid has helped fill this gap, with half of sub-Saharan African countries relying on external funding for over a third of their health expenditures. While beneficial, this dependency leaves countries vulnerable to donor decisions and shifts priorities away from integrated healthcare.
2. Expanding Domestic Financing Options
With global aid increasingly directed toward other challenges like conflict and migration, Africa must develop alternative financing strategies. Several options are available:
- Commodity taxation: Taxes on products like tobacco can generate revenue for health programs. Zimbabwe successfully implemented a 3% AIDS levy in 1999, funding HIV/AIDS prevention, care, and treatment through individual and corporate taxes.
- Government budget prioritization: Nigeria has demonstrated that domestic financing is possible by absorbing 28,000 health workers previously paid by USAID.
3. Encouraging Public-Private Partnerships
Collaborations between governments and private sector players can help close funding gaps. A successful example is Kenya’s 2015 partnership with GE Healthcare, which provides radiography equipment and services on a government payment plan. This model allows long-term budgeting and investment in health infrastructure.
4. Boosting Local Production Through Regional Integration
Reducing reliance on imported medicines can strengthen Africa’s healthcare sector. The African Union’s Africa Medicines Authority has established a harmonized drug registration system, creating a continental market for medicines. This initiative supports local manufacturers, enhances cost efficiency, and improves accessibility to essential drugs.
5. Leveraging Development Finance Institutions
Organizations like the African Development Bank, African Export-Import Bank, and the Development Bank of Southern Africa offer capital and expertise for health-related investments. The AfricInvest investment platform, backed by development finance institutions from the US and Europe, has raised over $100 million for African healthcare. It has funded at least 45 dialysis centers, delivering over 130,000 sessions annually to underserved communities at affordable rates.
By combining these approaches at national, regional, and continental levels, Africa can accelerate its transition away from aid dependency and build a more resilient healthcare system.
