Transition from dependence to self-reliance: financing and governing health systems in Africa

Recent cuts in development assistance for health (DAH) have caused reactions that range from apocalyptic forecasts of doom for health in Africa to political declarations of sovereignty for health systems on the continent. Amidst the upheavals and proclamations, many African countries face a practical challenge of transitioning their health systems from chronic dependence on DAH to self-reliance in financing and governance. Viable transitions depend on recognizing the crisis of legitimacy for governments that do not ensure basic health services for their populations and deploying levers of public policy to execute two concurrent transitions-quantitative and qualitative. Policy makers have four levers at their disposal: legislation and policy; regulations and institutions; financing, including generation, allocation, purchasing, and incentives; and learning, monitoring, and evaluation. By deploying these levers to bear upon challenges in the quantitative and qualitative dimensions of transition, African countries can achieve self-reliance in financing and governing their health systems.