Advancing domestic health financing in Africa: Engaging in progress review and planning with regional economic communities and the African Union
7 May 2024

In 2019, African Heads of State committed to tackle the persisting health financing challenges on the continent through a continental framework popularly referred to as the Africa Leadership Meeting (ALM) Declaration. In the Declaration, the leaders committed to, among others, increase domestic allocations to health, and, address the inefficiencies in health budget expenditure. Among the strategies to realising these goals, was the need to establish a regional health financing hub in each of the regional economic communities (RECs), to steer member country efforts, provide technical assistance, and facilitate sharing and learning.

On April 24–26, 2024, the African Union Development Agency (AUDA-NEPAD), which is the African Union agency tasked with providing technical leadership in the implementation of the ALM Declaration, convened the East African Community (EAC), the Southern African Development Community (SADC), and the Economic Community of West African States (ECOWAS), through its West African Health Organisation (WAHO), to review progress on the implementation of ALM Declaration and plan for the next two years.

The meeting, held in Accra, Ghana, provided an opportunity for the African Institute for Development Policy (AFIDEP) and the Partners in Population and Development Africa Regional Office (PPD-ARO) to link their current joint initiative, Advance Domestic Health Financing (ADHF), to these regional efforts. The ADHF initiative, funded by the Bill and Melinda Gates Foundation, works to support country and regional efforts to increase domestic investments in health and promote efficient utilisation of health budgets, with a focus on primary healthcare (PHC), girls’ and women’s health. The ADHF initiative is currently implemented in Kenya, Zambia, Malawi and Uganda.

The ALM meeting provided opportunity for AFIDEP and PPD-ARO to cultivate critical relationships with AUDA-NEPAD, EAC, SADC and WAHO as well as identify specific areas of collaboration. At regional level, the ADHF initiative seeks to provide the evidence needed by regional bodies to inform their actions, as well as, strengthen political commitment for the ALM implementation.

In line with this focus, AFIDEP and PPD-ARO together with the representatives of AUDA-NEPAD, EAC, SADC and WAHO, identified key evidence gaps that need to be filled in order to strengthen the regional efforts to enhance health financing. These include: Assessment of new financing models for health including tax studies for the different countries, viability studies for public health insurance which address vulnerable households and the informal sector, and efficiency studies particularly addressing leakages in health financing.

On advocacy for political commitment, the institutional partners agreed to leverage the various political platforms operated by PPD-ARO for ALM advocacy, including the annual forums of the Network of African Parliamentary Committees of Health (NEAPACOH), the Eastern Africa Reproductive Health Network (EARHN), the PPD Partner Country Coordinators Forums, the International Inter-ministerial Conferences, and the several national advocacy events involving parliamentarians, government technical people, civil society organisations, researchers, champions and the media that PPD-ARO conducts.

The ALM meeting reported notable progress in the EAC and SADC regions, mainly the formation of the regional health financing hubs (RHFHs), and, the hosting of national health financing dialogues in several countries that generated multi-stakeholder commitments towards tackling health financing challenges. Although the WAHO region had not established a hub, it reported various ongoing efforts to strengthen health financing in the sub-region, and for which the ALM Declaration should build on.

The three sub-regions reported a major challenge with funding to conduct the activities to support member states’ health financing efforts. Indeed one of the key action points was for each region to boost its resource mobilisation efforts in order to be able to implement its identified actions.

We (AFIDEP and PPD-ARO) are excited about our budding partnership with AUDA-NEPAD, EAC, SADC and WAHO on health financing, and will continue strengthening this partnership through the joint activities agreed upon on evidence generation and use, and political advocacy.

Authors: Dr Rose Oronje (Director of Public Policy and Knowledge Translation, & Head of Kenya Office, AFIDEP), Dr Jackson Otieno (ADHF Project Director, AFIDEP), Patrick Mugirwa (Programme Manager, PPD-ARO) and Doreen Kansiime (Policy Engagement and Communications Officer, PPD-ARO)