Reported by Weng Patrick Atokor l Journalist at Weng Global
African health and finance experts are increasingly calling for stronger domestic financing systems as declining international donor support puts additional pressure on healthcare systems across the continent.
The growing debate centres on how African countries can mobilise their own financial resources, including domestic capital markets, pension funds, taxation, health insurance and public-private partnerships, to build more sustainable healthcare systems.
The shift comes amid concerns that traditional external development assistance for health is becoming less reliable, leaving governments to confront rising healthcare needs with fewer international resources.
Africa Faces a Changing Health Financing Landscape
For decades, international development assistance has played an important role in supporting healthcare programmes across Africa. External financing has helped fund areas including infectious disease control, maternal and child health, health-system strengthening and access to essential medicines.
However, recent reductions in international assistance have increased pressure on African governments to identify alternative and more sustainable sources of funding.
A June 2026 analysis by Africa Presents reported that development assistance for health to Africa had fallen substantially from its 2021 peak, citing reductions in funding from major international donors. The report argued that the changing environment is forcing African policymakers to reconsider the continent’s dependence on external financing.
The issue is not simply about replacing foreign aid. It also raises questions about how African countries can create financial systems capable of supporting healthcare over the long term.
Domestic Capital Seen as Part of the Solution
One emerging argument is that Africa already possesses significant pools of domestic capital but lacks sufficient mechanisms to channel those resources into healthcare.
Jonathan Mwangi, writing on the subject of African health financing, argued that the continent’s challenge is increasingly about connecting available capital with investable healthcare opportunities.
He pointed to institutional investors, including pension funds, as potential sources of long-term financing for healthcare infrastructure, pharmaceutical manufacturing, diagnostics and healthcare delivery.
This approach would shift part of the healthcare financing conversation from dependence on grants towards investment models capable of attracting domestic institutional capital.
Potential areas for investment include hospitals, diagnostic centres, pharmaceutical production, primary healthcare infrastructure and other health-related services.
However, experts say such investment requires credible institutions, transparent governance, appropriate regulation and projects capable of providing both social value and sustainable financial returns.
Nigeria’s Healthcare Financing Challenge
Nigeria provides an important example of the wider challenge.
A 2024 review published in the Nigerian Postgraduate Medical Journal examined domestic resource mobilisation as a pathway towards sustainable healthcare financing in the country.
The researchers identified general tax revenue, social health insurance, community-based health insurance and development of the domestic capital market among possible mechanisms for strengthening healthcare financing.
The study also identified persistent obstacles, including inadequate budgetary allocations, inefficiencies, poor database management, governance challenges and the loss of health workers through emigration.
The researchers concluded that stronger domestic resource mobilisation could help Nigeria reduce its dependence on external financing while creating a more resilient healthcare system.
For Nigeria, the discussion is particularly significant because the country’s large population and substantial healthcare needs require financing that can be sustained beyond individual donor programmes.
Pension Funds Could Become a Larger Source of Health Investment
Pension funds are also attracting attention in discussions about domestic healthcare financing.
A 2026 report published by AllAfrica highlighted Nigeria’s pension industry as a potentially important source of long-term domestic capital for healthcare infrastructure. The report noted that Nigeria’s pension sector had accumulated more than ₦27 trillion in assets under management.
Pension investments are generally designed around long-term horizons, making them potentially suitable for infrastructure projects that require substantial capital and take years to generate returns.
Healthcare infrastructure could include hospitals, diagnostic centres, pharmaceutical manufacturing facilities and primary healthcare facilities.
But using pension assets for healthcare investment also requires strong safeguards. Pension contributions belong to workers and retirees, meaning investments must meet appropriate risk, governance and return requirements.
The objective, therefore, would not be to divert pension funds into healthcare simply because the sector needs money. Rather, the challenge is to create properly structured investment opportunities that can support healthcare while protecting contributors’ savings.
Domestic Financing Goes Beyond Investment
Experts also emphasise that domestic health financing should not be understood only as attracting private investment.
Governments can strengthen healthcare financing through improved domestic revenue collection, broader health insurance coverage, better allocation of public budgets and measures designed to reduce financial waste.
The Nigerian postgraduate medical review identified taxation and social insurance among the mechanisms that can contribute to domestic resource mobilisation.
Improving how existing public resources are spent can also be important.
If additional money enters a system with weak procurement controls, poor accountability or inefficient allocation, increased funding alone may not produce better healthcare outcomes.
This makes governance an important part of the financing debate.
Africa’s Health Financing Debate Is Also About Sovereignty
The growing emphasis on domestic capital reflects a broader debate about health sovereignty in Africa.
Ghana’s 2026 State of the Nation address, for example, called for African countries to mobilise domestic capital to finance their own development and reduce dependence on external systems. The address linked health sovereignty with broader economic sovereignty and argued for stronger continental cooperation.
The argument is becoming increasingly relevant as African governments face simultaneous pressures from population growth, infectious diseases and the rising burden of non-communicable diseases such as cancer, diabetes and cardiovascular conditions.
A healthcare system that depends heavily on external funding can become vulnerable when donor priorities change or international budgets are reduced.
Domestic financing does not eliminate international cooperation. Instead, it could give African governments greater control over their health priorities while allowing international partners to complement rather than substitute domestic resources.
Why the Shift Matters
The healthcare financing challenge has implications beyond hospitals and medical services.
A poorly financed health system can affect workforce productivity, household incomes, education and broader economic growth.
Conversely, stronger healthcare systems can support healthier populations and reduce the financial burden associated with preventable illness.
For businesses and investors, this also creates an opportunity to develop healthcare infrastructure and services while contributing to national development.
But the opportunity will depend on whether governments and financial institutions can build credible frameworks that encourage investment without compromising public health priorities.
Africa therefore faces a dual challenge: mobilising more money for healthcare and ensuring that the money already available is used effectively.
What Happens Next
The direction of Africa’s healthcare financing will likely depend on how governments respond to declining external assistance.
Possible approaches include expanding domestic revenue mobilisation, strengthening national health insurance systems, creating investment vehicles for institutional capital, improving public-private partnerships and developing financial instruments designed specifically for healthcare infrastructure.
For countries such as Nigeria, the challenge will also involve strengthening governance and ensuring that new sources of financing translate into accessible and quality healthcare.
The evidence increasingly points to a need for a broader financing model in which governments, domestic investors, pension funds, insurers, development institutions and private healthcare providers work within transparent and properly regulated systems.
Africa’s healthcare financing problem cannot be solved by one source of money. But reducing excessive dependence on external funding while unlocking domestic capital could give African countries greater control over the future of their health systems.
The central question is therefore no longer only how much money is available for healthcare, but whether African countries can build the institutions and investment structures required to direct their own capital towards long-term health needs.
Weng Global — Stories beyond borders
Sources
- Nigerian Postgraduate Medical Journal — Domestic Resource Mobilisation for Sustainable Healthcare Financing in Nigeria: A Review.
- PubMed / U.S. National Library of Medicine — research record for the Nigerian healthcare financing review.
- Africa Presents — analysis of Africa’s changing health financing environment and declining development assistance.
- AllAfrica — report on Nigeria’s pension funds and potential healthcare financing opportunities.
- Ghana State of the Nation address — discussion of health sovereignty and mobilisation of domestic capital.
