Download logoThe United Nations Economic Commission for Africa (ECA) today convened the inaugural meeting of the High-Level Advisory Group (HLAG) on health financing, meeting at ECA headquarters in Addis Ababa in a closed, hybrid session that opened with remarks setting out the scale of the financing challenge facing African health systems and the mandate the HLAG has been asked to carry forward. The Initiative supports African governments in mobilizing sustainable, predominantly domestic financing for health, building on the Tangier Declaration adopted by African ministers of finance, planning and economic development in March 2026 and is coordinated by ECA in collaboration with partners.
Opening the meeting, the ECA’s Executive Secretary Claver Gatete, emphasized stronger coordination between health and finance ministries, alongside domestic resources, innovative financing and private investment. “There’s nothing that can be done without people. We need them to be healthy to be able to contribute.”
Mr. Gatete framed the HLAG’s work around the sharp contraction in official development assistance for health and the debt burdens narrowing the fiscal space available to African governments, and grounded its mandate in the Tangier Declaration, which frames health spending as an investment in human capital and economic resilience rather than a cost to be managed.
Prof. Yemi Osinbajo, former Vice President of Nigeria and Champion of the Initiative, welcomed the High-Level Advisory Group's constitution as the moment the continent's health financing debate moves from aid dependency toward domestic ownership, with ministries of finance and health expected to work jointly rather than in parallel.
Joining virtually, Prof. Senait Fisseha, Vice President for Global Programs at the Susan Thompson Buffett Foundation, who co-organized the April 2025 meeting of African health ministers that launched the Initiative, echoed that shift, speaking to philanthropy's role as catalytic rather than a substitute for government financing, to be judged by the institutions and systems it leaves behind rather than by grants renewed.
Representing the African Union Commission Chairperson, Prof. Julio Rakotonirina, the Commission's Director for Health and Humanitarian Affairs, set out five guiding areas identified by the AUC for the Initiative: domestic resource mobilization, efficiency, equity, financial protection and fiscal space, calling for alignment with Agenda 2063, the Africa Health Strategy and the Abuja Commitment, and pointing to the continent's ongoing Ebola outbreak response as a reminder that health financing and health security cannot be treated separately.
Underlying these remarks was the urgency behind the High-Level Advisory Group's work. External financing for health is contracting sharply, a decline accelerated by the closure of USAID and a broader retrenchment in concessional resources, leaving up to half of health budgets in many African countries dependent on external funding. Domestic revenue bases remain narrow, with an average tax-to-GDP ratio of about 16 percent across the continent, and out-of-pocket spending remains the primary source of health financing in roughly half of African countries, while debt servicing continues to consume fiscal space that would otherwise be available for health and other essential services. Five countries, Botswana, Ethiopia, Guinea, Sierra Leone and Togo, are already engaged as an early-adopter cohort under the Initiative, with technical assessments under way and country-led financing solutions in development.
Following the opening remarks, the High-Level Advisory Group moved into closed deliberations for the remainder of the afternoon. The sessions brought together ministers and senior officials from across the continent, including from Guinea, Seychelles, and Togo, reflecting the Initiative's emphasis on countries learning directly from one another's experience as they build sustainable, domestically financed health systems.
Distributed by APO Group on behalf of United Nations Economic Commission for Africa (ECA).
