On the 21st and 22nd of July 2026, The African Union, convened its Extraordinary Summit on Health in Accra, Ghana. This summit was as a result of the decision taken at the 38th Ordinary Session of the Assembly of Heads of State and Government, held in Addis Ababa, Ethiopia, which called for a dedicated summit to address health priorities. It was convened under the theme ‘Advancing Justice, Equity and Universal Health Coverage (UHC): Ending AIDS and TB, Improving Maternal Health, and Addressing Endemic, Non-Communicable and Neglected Tropical Diseases and Conditions in Africa.’
The story of the continent’s healthcare system is well documented. It is fragile and remains beyond reach for several citizens of this continent. But to understand what factors drive these challenges we must all appreciate the historical context of this region. Failure to do so, we will be engaging in a dishonest discussion. Colonialism and Apartheid left lasting legacies that continue to affect the health system of the region. These negative legacies have hamstrung African states capabilities of building efficient and strong public health systems. A case in point, South Africa; which is regarded to have a very strong public health system compared to other states on the continent but still continues to reel from the past injustices of apartheid.
Concomitant to the effects of colonialism are what I term post-colonial issues/modern-day challenges. These modern-day challenges include a lack of proper governance, misuse of allocated funds, and a misunderstanding of the principles that govern health economics, just to list a few. Just to list a few.
Now that I have briefly highlighted an important context regarding the continent’s public health system, I turn to discuss in detail what we need as a continent to achieve our health objectives. From the onset, I must highlight that strengthening the region’s health capacity to address both communicable and non-communicable diseases will need a concerted effort from all quarters—including health economists and legal experts. From the onset, I must highlight, that strengthening the regions health capacity to address both communicable and non-communicable diseases will need a concerted effort from all quarters – including from health economists and legal experts.
It is well documented that Africa, carries the heaviest burden, accounting for 25% of the global disease load while facing major systemic and financial constraints.[1] Most of these diseases that affect the continent are termed ‘diseases of inequity,’ such as Tuberculosis and Cholera.
So, what are the immediate steps that the African Union should take?
Leadership and governance
If the region is to achieve its goal of strengthening its health system, it must acknowledge the need for dedicated leaders ready to implement evidence-based health policies. This will demand proper governance structures, ensuring accountability and transparency are not weakened. I am strongly of the opinion that leadership and governance are key ingredients in strengthening our health systems. Flour is to the making of cake as leadership and governance are to a successful system.
Health financing
As a region that accounts for approximately 25% of the global disease burden, one would expect African countries to spend more on healthcare. However, this has not been the case. At the 2023 Africa Dialogue Series High-Level Policy Dialogue, titled “Market and Scale: Unlocking Industrialisation through Intra-African Trade,” United Nations Secretary-General António Guterres remarked that Africa spends more on debt servicing than it does on healthcare. Health financing is therefore closely tied to health sovereignty.
The chronic underfunding of healthcare risks holding the continent back in its efforts to strengthen health systems. Several African countries need to develop clear frameworks and roadmaps for increasing investment in their respective health sectors. I also agree with policymakers who argue that health sovereignty is not only a national concern but a regional one. Agreements such as the African Continental Free Trade Area (AfCFTA) can help strengthen intra-African trade in health products and technologies.
Achieving sustainable health financing will also require country-driven policy reforms. These could include imposing taxes on harmful products, as South Africa has done with its tax on sugary drinks. This measure has contributed to lower consumption while generating additional government revenue that could support the health sector.
Official Development Assistance (ODA) has long played an important role in financing health objectives across the continent. However, this assistance has declined in recent years. Africa must therefore identify alternative sources of funding to help close the resulting fiscal gap.
Africa is rich in natural resources but has often failed to benefit fully from them, mainly because of illicit financial flows and weak tax systems. Addressing these challenges would enable African countries to collect and retain more revenue, some of which could be directed towards financing healthcare.
Research and Innovation
Research and innovation remain areas in which the region continues to lag. Africa needs to invest more in local manufacturing. During the COVID-19 pandemic, we witnessed vaccine hoarding in plain sight. As Gavi, the Vaccine Alliance, has noted, when COVID-19 struck and exporters restricted supplies, African hospitals ran out of critical treatments. This was a wake-up call, and the continent is now beginning to respond.
Such a situation must never be allowed to happen again. Building regional self-reliance would go a long way towards ensuring that vaccines and pharmaceutical products are available during times of crisis. Higher education institutions across the region must also expand cross-border collaboration and skills exchanges. This would make a significant contribution to the research and innovation the continent urgently needs.
These are only some of the solutions that require attention. There are, of course, many others, but space constraints make it impossible to discuss them all here.
The African Union Roadmap to 2030 and Beyond is an important blueprint for the continent. It cannot be neglected. It must be implemented, and doing so will require collective action and political will from every country in the region. Similarly, the Accra Declaration is not merely a piece of paper. It is a commitment against which future generations will judge us.
The African Union and its member states cannot afford to neglect Africa’s healthcare systems. The cost of doing so will be felt for many years, and neither the current generation nor those that follow can afford to bear the consequences.
Written by Dr Nthabiseng Makgana, CEO at Chris Hani Baragwanath Academic Hospitall, writing in her personal capacity