Investing in Africa’s Health: Strengthening Systems and Advancing Sustainable Solutions 

With Africa’s population projected to nearly double by 2050, the demand for primary health care systems will only intensify. Strengthening and adequately funding these systems is critical, especially as countries seek to reduce donor dependency. Integrating policies into evolving structural frameworks, increasing domestic resource pooling, and implementing innovative financing mechanisms must be prioritized to ensure long-term sustainability. 

At the recent African Health Economics and Policy Association (AFHEA) Conference in Kigali (March 10-14, 2025), policymakers, researchers, health leaders, and health advocates convened under the theme Resilient and Strong African Health Systems: Contributions of Health Economics and Policy. The five-day event explored solutions to Africa’s health financing challenges and shared best practices to build resilient health systems across the continent and beyond. 

Rethinking Traditional Health Financing Models  

A core theme of the conference was the urgent need to move beyond traditional funding models and drive private-sector investment in healthcare. Discussions emphasized the expansion of social health insurance schemes, strengthened public-private partnerships, technology-driven efficiencies, and actionable reforms to enhance financial sustainability. 

With decades of experience in health systems strengthening, MSH shared evidence-based approaches that integrate financial sustainability with service delivery. MSH’s contributions focused on malaria prevention, strengthening primary health care (PHC), and advancing health technology assessment (HTA) to drive equitable health access and financial resilience.   

The role of primary health care in achieving health equity  

During a panel discussion alongside Africa CDC and UNICEF, MSH’s Justice Nonvignon, highlighted the critical role of PHC and sustainable financing in preventing setbacks in health progress.  

 “Primary healthcare is essential. The world aspires to ensure that everyone, regardless of location, has access to basic services, but aspirations alone do not implement themselves. Health financing remains a major constraint. Even where funding exists, efficiency is crucial. We must prioritize financing, integration, and sustainability to turn aspirations into tangible progress.” 

Dr. Nonvignon underscored the need for country-driven, sustainable health financing strategies.  Citing Zimbabwe’s HIV levy as a successful example, he emphasized how domestic revenue generation can bridge funding gaps and reduce reliance on external funding. 

Strengthening Leadership for PHC Performance 

MSH’s Ishani Mathur presented insights from the Gates Foundation-supported PHC Performance Management Activity, which integrates MSH’s Leadership Development Program to strengthen PHC. She discussed the pivotal role of district leadership in tracking and improving PHC performance, and how through the use of structured challenge models, district leaders are driving their performance, defining their obstacles, and allocating resources effectively. While capacity strengthening remains a key challenge, supporting local stakeholders with the knowledge and tools to sustain results beyond program lifecycles will help optimize health investments and enhance accountability. 

Beyond financing, discussions addressed the prioritization of PHC in national budgets. Experts, including Dr. Landry Dongmo Tsague, Director of the Africa CDC Center for Primary Health Care, explored strategies to prevent funds from being lost to inefficiencies or corruption.  Ms. Lieke van de Wiel, UNICEF’s Country Representative to Rwanda, stressed that investing in health is an investment in economic growth, reinforcing that a strong health system not only ensures a healthier population but also strengthens the healthcare workforce. “Prioritizing PHC extends beyond health—it fosters social cohesion, strengthens workforces, and promotes national independence,” she added. 

Spending Better, Not Just More: The Role of Health Technology Assessment  

With competing demands in healthcare, effective priority setting is essential to achieving equitable and improved health outcomes. “If countries can’t spend more, they need to spend better,” emphasized Marion Murungi during a discussion co-led by MSH and KEMRI-Wellcome. The conversation focused on institutionalizing Health Technology Assessment (HTA) in Africa, drawing lessons from Ukraine, Ghana, Malawi, and Rwanda. 

Murungi highlighted MSH’s support for HTA in Ukraine, where a small technical working group within the Ministry of Health and evolved into an independent department. Despite the absence of a formal HTA agency, strategic planning led to significant reforms, including using HTA principles to determine inclusions to the national essential medicines list (EML) which lead to improved procurement practices.  

Lessons from Ghana, Malawi, and Rwanda reinforced the importance of defining each country’s HTA scope. Strong partnerships are key—KEMRI highlighted the HTA Network, which offers capacity-building opportunities for HTA bodies across Africa. Strengthening these collaborations can guide policymakers in institutionalizing HTA within their national frameworks, reducing reliance on external consultants, and ensuring cost-effective and sustainable healthcare investments. 

Dr. Nonvignon emphasized that better financing isn’t just about more money but about using existing resources strategically. “Financing, especially in this context, means being efficient with what you have.  The goal is not just to highlight specific countries but to understand different contexts, assess the state of HTA, and determine the next steps for institutionalizing it. We must move beyond ad hoc use to an integrated, sustainable approach.” 

Moving Forward: Strengthening Africa’s Health Systems 

The AfHEA Conference provided a platform for learning, networking, and sharing best practices. Through insightful sessions and dynamic discussions, MSH reaffirmed its commitment to strengthening financially sustainable, resilient health systems across Africa. As we continue to support country-driven solutions, evidence-based policy development, and innovative financing mechanisms, we remain dedicated to ensuring that Africa’s health systems are strong, equitable, and sustainable for generations to come.