Kenya: Amref Warns of Health System Strain As Global Aid Falls, Urges African Governments to Boost Funding

Nairobi — Amref Health Africa has called on African governments to increase domestic health financing and strengthen primary healthcare systems as declining international aid threatens the sustainability of essential health services across the continent.

The health organization warned that Africa must reduce its vulnerability to unpredictable external funding by investing in health workers, community-based services and locally led systems, while maintaining international partnerships to support countries facing severe fiscal constraints.

The call comes as global health leaders meet in Berlin for the World Health Summit, where Amref is advocating for reforms that place African governments and institutions at the centre of health financing and service delivery.

Amref cited a 23.1 per cent decline in official development assistance in 2025, warning that funding reductions expose weaknesses in health systems that rely on short-term external support to sustain HIV treatment, immunization, maternal and newborn care, nutrition programmes and other essential services.

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"Africa does not lack health priorities and what is missing is financed delivery," said Amref Health Africa Group Chief Executive Officer Githinji Gitahi.

He said health systems must be rooted in primary healthcare and aligned with African priorities to protect communities against disease outbreaks, climate shocks and financial uncertainty.

The organization argued that governments need greater domestic fiscal capacity and stronger public institutions, while international partners should provide predictable funding aligned with national priorities rather than establish parallel systems.

Amref said stronger primary healthcare systems are essential to improving access to services, strengthening disease surveillance and preparing communities for public health emergencies.

It emphasized the need for adequately financed and fairly remunerated health workers, particularly community health workers who often serve as the first point of contact between communities and the formal healthcare system.

According to the organization, effective health security begins at the community level, where outbreaks are first detected and where access to reliable information, routine immunization and essential services can determine the scale of an emergency.

Amref also called for increased investment in health facilities and workers to ensure services remain operational during floods, droughts and extreme heat, as African countries contend with the combined effects of climate change, conflict, displacement and changing disease patterns.

The organization urged governments to treat health spending as an investment in economic resilience and human development rather than simply a public expenditure.

It called for increased domestic allocations to prevention, primary care, financial protection and the health workforce, alongside stronger public financial management to ensure available resources translate into services.

Predictable international funding

While pushing for greater African self-reliance, Amref cautioned against an approach that leaves countries to manage growing health needs without adequate international support.

The organisation said global institutions and donors should restore predictability in health financing and direct resources towards countries and communities facing the greatest health and fiscal pressures.

It also called for dedicated and flexible funding to safeguard essential services in fragile, conflict-affected and climate-vulnerable settings, as well as greater investment in surveillance, emergency preparedness, vaccines, medicines and diagnostics.

Other priorities include expanding African pharmaceutical and medical production, strengthening regulatory capacity, improving data governance and connecting climate finance to practical health-system needs.

Amref said such investments would help African countries reduce exposure to external supply disruptions and strengthen their ability to respond to future emergencies.

The organization is using its participation at the World Health Summit to build partnerships with governments, funders and implementation partners ahead of the Africa Health Agenda International Conference (AHAIC) 2027.

The conference, co-hosted by Amref Health Africa, Rwanda's Ministry of Health, Africa Centres for Disease Control and Prevention and the World Health Organization Regional Office for Africa, is scheduled to take place in Kigali, Rwanda, from February 28 to March 3, 2027.

Under the banner "Connected for Change" and the theme "From Dialogue to Delivery: Redesigning Africa's Ecosystem for a Healthy, Sovereign Future," the conference is expected to extend discussions on African-led health reform, resilient systems and sustainable financing.

Amref said its engagement at the Berlin summit includes three co-hosted sessions, seven speaking engagements and six bilateral meetings, aimed at advancing practical collaboration on health-system delivery and primary healthcare transformation.

The sessions cover health-system performance, cross-regional cooperation and translating national policies into local action, including discussions on Ethiopia's pathway towards Sustainable Development Goal 3 through primary healthcare reform.

Gitahi said Africa's leadership in health reform must be matched by adequate resources, accountability and partnerships that strengthen, rather than substitute for, African institutions.