Navigating Africa´s health financing in the post-aid era

In 2025, the global health financing architecture shifted. While the cuts in aid were an unwelcome disruption for many across health systems in Africa, they offer an opportunity to build a new and sustainable health system framework going forward. I propose a framework consisting of three pillars that recognize the diverse economic landscape on the continent and that could ensure that the most vulnerable are not left behind. The three pillars are fiscal capacity, outcome-based targets, and strategic efficiency. Fiscal capacity covers the mechanisms of revenue mobilization. Outcome-based targets emphasize tangible health metrics of success, and strategic efficiency encourages learning from the best performers on the continent. Ultimately, health spending is merely a means. The end goal is a continent where a child's survival is assured by the resilience of their national health system. The disruption in aid if managed correctly, could lead to an African health architecture that is robust and sustainable.