During UNGA80 in New York, African health policymakers and advisers are urging a shift in how health is financed across the continent. Obinna Ebirim, senior technical advisor on youth health and policy research, argues that African countries should demand fairer donor partnerships and strengthen domestic accountability for health spending. He accepts that international aid has been essential for disease programmes, but warns that overdependence leaves systems exposed when donor funding shifts or ends.
Ebirim lists the consequences: disruptions to HIV, TB, malaria and nutrition programmes, shortages of commodities, some hospitals reducing services and donor-supported health workers losing jobs. In Nigeria, overseas partners fund large parts of vaccination campaigns, disease surveillance and health worker incentives. Primary healthcare centres often rely on ad hoc staff, sometimes called volunteer health workers, whose pay depends on transient donor projects. Nigeria has not met the Abuja Declaration target of 15 per cent; in recent years health received between four and six per cent of the national budget.
He points to two structural problems that weaken systems: a chronic shortage of health personnel — doctors, nurses, midwives and community health workers — and inadequate infrastructure, with some hospitals lacking reliable electricity, running water or basic supplies. Ebirim highlights youth-focused workforce policies such as the National Health Fellows Programme under the Health Sector Renewal Investment Initiative, which recruited 774 young people (one per local government area) and employed many after their fellowship to build skills for supply chains, digital health and research.
At UNGA80 several meetings will address health financing in Africa, including events on 23 and 24 September. Ebirim urges African leaders to make health financing a top priority, to highlight the human resources crisis, to promote regional collaboration and to demand accountability from governments. He says donors should prioritise capacity building and align support with government priorities so domestic systems can survive beyond aid.
- VitalTalks Live at UNGA — The Future of Health Financing in Africa (23 September)
- Foreign Policy’s Health Forum (24 September)
- UNITAID side event on women’s health and innovative financing
Difficult words
- policymaker — person who plans government actionspolicymakers
- donor — organization or country that gives funds or supportdonors
- overdependence — reliance on external aid that is too strong
- disruption — sudden problem that stops normal servicesdisruptions
- commodity — basic goods or supplies used by health programmescommodities
- accountability — responsibility to report and justify spending
- infrastructure — buildings and systems needed for public services
- fellowship — temporary training placement with financial support
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Discussion questions
- What practical steps could African leaders take to make health financing a higher priority in national budgets?
- How might stronger domestic accountability for health spending affect services such as vaccination and nutrition programmes?
- What are the possible benefits and challenges if donors prioritise capacity building and align support with government priorities?
