Claver Gatete, the UN Under-Secretary-General at the Economic Commission for Africa (ECA), says Africa must urgently overhaul health financing as aid declines and debt pressures tighten fiscal space across the continent.

Speaking in Tangier, Morocco, on Wednesday, Mr Gatete said, “The era of aid as the primary source of health financing is behind us.”

At the 58th Session of the Conference of African Ministers of Finance, Planning and Economic Development, he urged governments to adopt sustainable, domestically driven funding strategies for resilient health systems.

The event, with the theme ‘High-Level Forum on Sustainable Health Financing’, was held virtually.

Mr Gatete said Africa spent about $145 billion on health in 2022, with less than half sourced from public financing.

“The rest was borne largely by donors and households, pushing many into poverty,” he said, warning of worsening inequality in access to care.

He added that public debt averaged 63 per cent of GDP, with several countries spending more on debt servicing than on healthcare systems.

“This is the reality we confront: rising health needs amid shrinking fiscal space,” Mr Gatete said, stressing urgency for reform. 

He described the moment as a turning point to transform health systems through scale, integration and innovative financing mechanisms.

Mr Gatete highlighted the African Continental Free Trade Area (AfCFTA) as central to unlocking continental health solutions beyond its traditional trade mandate.

“It is a development architecture for a market of 1.5 billion people with a combined GDP exceeding $3.4 trillion,” he said.

He noted Africa imports over 70 per cent of its pharmaceuticals, leaving countries vulnerable to global supply disruptions and rising costs.

“Through AfCFTA, isolated gains can become a continental system—linked, scaled and competitive,” Mr Gatete said, urging coordinated action.

He pointed to emerging pharmaceutical hubs in Morocco and Algeria, alongside growing manufacturing capacity in Rwanda and South Africa.

“These developments show progress, but they must be integrated to achieve scale and sustainability,” he said.

Mr Gatete outlined four priorities, beginning with stronger domestic resource mobilisation to reduce reliance on external funding sources.

“We must broaden the tax base, improve efficiency and reduce leakages in public financial systems,” he said.

He called for innovative financing tools, including blended finance, debt-for-health swaps and risk-sharing mechanisms to attract private capital.

“Financing is not only about mobilising resources; it is about structuring them to deliver measurable impact,” Mr Gatete added.

On insurance, he urged wider risk pooling to reduce the burden on households and governments across African countries.

He cited Ghana’s National Health Insurance Scheme and Rwanda’s community-based model as examples of expanding equitable healthcare access.

“When risks are pooled at scale, systems become more affordable, predictable and equitable,” he said.

He noted that coverage across Africa remains uneven and requires urgent expansion, especially for vulnerable and underserved populations.

Mr Gatete also called for deeper private sector participation across healthcare delivery, logistics, pharmaceuticals and digital health innovation.

“Public financing alone will not meet the scale of our needs,” he said, highlighting the sector’s growing role.

“Capital does not respond to intention. It responds to incentives,” Mr Gatete said, urging stronger regulatory and investment frameworks.

He stressed the need for effective public-private partnerships to unlock financing and improve service delivery across the health value chain.

On capacity, Mr Gatete warned that financing alone cannot deliver results without skilled personnel, strong institutions and adequate infrastructure.

“We must invest in people, systems and institutions to ensure financing translates into better health outcomes,” he said.

He highlighted digital health tools, including data systems and telemedicine, as critical to expanding access and improving efficiency.

“Preparedness is not optional; it is indispensable,” he warned, citing lessons from Ebola and COVID-19 outbreaks.

Launching the #InvestInHealthAfrica campaign, Mr Gatete said health must be recognised as a driver of economic growth and development.

“Health is not expenditure. It is investment in people, productivity and prosperity,” he said.

He added that Africa’s greatest asset is its people, whose potential depends on sustained investment in healthcare systems.

“The question is not whether we can act, but whether we will act at the scale and speed required,” Mr Gatete said.

He reaffirmed that the Economic Commission for Africa stands ready to support countries with policy guidance, partnerships and financing solutions. 

(NAN)