Securing Africa's health future: the road to 2027 and beyond

The reporting period was one of the most demanding in the Region’s recent history, but also one of its most productive. Member States, supported by the Secretariat, kept essential services running through the sharpest health-financing contraction in decades, brought several outbreaks under control, and recorded the largest cluster of verified disease-elimination milestones in a generation, while the Regional Office rebuilt itself to move even closer to the people it serves. The full record is set out in the preceding chapters; this section distils it, and outlines the gaps that still decide whether a mother or child lives.

The pattern beneath the results is as important as the results themselves. Where services shared a single primary health care platform, and where scarce resources were targeted on a district-by-district basis using routine data, coverage held. Conversely, where programmes stood alone, they were the most exposed to these shocks. The achievements are therefore not a list of separate victories but evidence of a system beginning to respond appropriately. Equally, the persisting challenges resolve into a small number of cross-cutting themes rather than a catalogue of programme shortfalls: a financing gap widening faster than domestic substitution can close it; coverage that has plateaued where inequity is greatest; system foundations – workforce, data, supply chains – that remain too weak to absorb shocks; and the recurring difficulty of converting political commitment into funded, delivered results. A synthesis of both sides of the ledger, organized by theme so the reader sees the pattern rather than the pieces, is set out in the Annex ( Table A1 ).

The message for ministers and partners is threefold. First, the Region delivered under conditions that would have reversed progress a decade ago – proof that the reforms of recent years are changing what the system can withstand. Second, the gains are real but not yet secured: they rest on financing that has not been replaced by other sources, on platforms that must be protected, and on commitments that must now be funded. Securing them is the work of the period this chapter focuses on. Third, Member States should be resolute and ensure the sustainability of these commitments and their translation into concrete actions.

The outlook for 2027 and beyond is best read through the social, technological, economic, environmental and political forces acting on health from outside the sector. Chapter 1 established the baseline for the reporting period; this section takes it forward and draws out, for each dimension, the manner in which these forces are shaping public health (3).

Political. Sovereignty is becoming the grammar of global health. The defining political shift of the period is the consolidation of an African health sovereignty doctrine. The Africa Health Sovereignty Summit in Accra (August 2025) and its outcome, launched as the Accra Reset at the 80th session of the United Nations General Assembly, moved the Region’s contribution from technical negotiation to political norm-setting: country ownership, domestic financing and fair partnership are now stated terms, not aspirations (4). They build on Africa’s New Public Health Order (African Union and Africa CDC, 2022) and are carried forward by the African High-level Ministerial Committee on Global Health Architecture Reform, which brings together ministers of finance in a standing mechanism (5). The implication for public health is structural: health financing, partnership and governance in the Region will increasingly be set by African institutions and instruments, and external support will be judged by how well it aligns with nationally led plans. Sovereignty is no longer a slogan; it is the framework within which ministers now negotiate.

Economic. If growth is coming, health must claim its share. Africa’s economies are projected to grow by 4.2% in 2026 and 4.4% in 2027, with 12 of the world’s 20 fastest-growing economies on the continent and several Member States – among them Ethiopia, Rwanda and Uganda – growing at or above 6% (6). Growth on this scale widens the fiscal space that could finance resilient health systems, but only if health claims it. More than two decades after the Abuja Declaration committed governments to allocate at least 15% of national budgets to health, that target remains largely unmet, and government health expenditure across the Region averages about half of it (7). This infers the need for a clear domestic financing path to translate growth into ring-fenced health budgets – through pro-health taxes, solidarity levies and insurance reform – and to treat spending on health not as a recurrent cost but as an investment that protects the very productivity on which growth depends (1).

Social. A younger, louder Africa is claiming the right to health. The Region’s population, more than 1.2 billion people across 47 Member States, is among the world’s youngest, with around 60% aged under 25 years; a rights-conscious generation that increasingly holds governments to account for the services they receive (8). At the same time, forced displacement reached record levels during the period – 12.7 million people were displaced or stateless in West and Central Africa alone, up by 48% since 2020, with women and children comprising about 80% of that number (9). The inference is twofold: a demographic dividend that makes the health sector one of the continent’s most credible engines of decent employment, and rising demand, equity and accountability pressures that health systems must manage or forfeit public trust.

The Region’s public health vision for 2027 and beyond can be stated in a single line a minister can repeat: an African Region that finances, governs and delivers its own health – where care is affordable, trusted and protected during shocks, and where health is treated as a foundational investment in stability, productivity and sovereignty (1). This vision is consistent with the WHO Fourteenth General Programme of Work, 2025–2028 (GPW 14) and with the Regional Director’s strategic direction, and it reframes the Region’s posture from implementing decisions taken elsewhere to co-authoring the rules of global health itself (2).

Four organizing priorities give the vision shape: universal health – the promise of affordable, quality health services for all, built on primary health care; resilience – health security and whole-system continuity that hold through emergencies; modernization – the digital, data, workforce and institutional capabilities that make delivery possible; and ownership and sovereignty – domestic financing, African medicine regulation and manufacture, and African data governance that together move the Region from dependency to leadership. These priorities are drawn from the sound architecture of the Region’s draft strategy, A new era of health for Africa: united action for Vision 2035, which is reviewed critically below; they replace and are deliberately clearer than earlier framings (8).

The policy orientation that follows from the outlook is a set of deliberate shifts in posture. The first shift is from donor alignment to fiscal stewardship – institutionalized health-finance-planning dialogues, ring-fenced domestic financing, and health treated as macroeconomic risk management. The second is from fragmented, disease-specific projects to regional public goods – pooled procurement, regulatory harmonization, local manufacture and shared digital platforms. The third is from response to whole-system resilience, with continuity of essential services embedded as a design requirement. The ultimate shift is morphing from an implementer to a steward: the Regional Office is redefining its own role from a technical body to a fiscal and policy steward and architect of African health sovereignty – a technical steward, implementation-support partner, convenor, systems integrator and accountability platform (1–2). In practice, this means prioritizing upstream normative, standard-setting and stewardship work while continuing to support downstream implementation where Member States most need it – the two together, not one at the expense of the other.

Africa is already co-authoring the rules of global health. The claim that the Region shapes global health rather than receives it is not aspirational; it is evidenced by the instruments of the reporting period. The WHO Pandemic Agreement, adopted in May 2025 with its Pathogen Access and Benefit-Sharing system, and the 2024 amendments to the International Health Regulations, in force since September 2025, carry equity provisions that the African Group negotiated and secured (12–13). The Lusaka Agenda’s principle of “one plan, one budget, one report” – an African-led reform of how global health initiatives operate – was embedded in binding WHO policy through a financing resolution led by the Region (5). Additionally, regulatory and manufacturing sovereignty is being built through the African Medicines Agency and the African Vaccine Regulatory Forum, and through the first serious investments in African manufacture of vaccines, medicines and diagnostics (14–15). These are the means by which the Region protects essential services, finances its own health and responds to shocks as external support recedes – and they are propelled by two complementary institutions whose division of labour is deliberate: the WHO Regional Office for Africa leading on normative standards, technical guidance, country support and accountability, and Africa CDC leading on continental political coordination and the interface with Heads of State and Government. It is the coherence of that relationship, more than any single declaration, that turns continental consensus into country-level result.

The vision is delivered through a medium-term framework organized over three time horizons – a near-term sprint to 2027, a medium term to around 2030, and a longer horizon to 2035 – and along seven delivery flagships. Ending Disease in Africa and the decade-long Transformation Agenda are the delivery spine that carries them (17–19). The framework is deliberately differentiated: it speaks to all 47 Member States by segmenting delivery for fragile and conflict-affected settings, for the many countries facing a dual burden of disease, and for those already advancing towards universal coverage – so that the pace of each reform reflects each country’s circumstances.

The seven flagships are the lines along which the vision becomes delivery: district-centred primary health care and community systems; preparedness and whole-system resilience; digital transformation; a fit-for-purpose workforce and leadership; institutional modernization; regional manufacturing and pooled procurement; and sustainable financing and partnerships. Each is grounded in results already reported and pointed forward to a measurable milestone.

The near-term sprint to 2027 – stabilize and reset. The immediate period is defined by two simultaneous pressures: ongoing health emergencies and a structural financing shock. The first task is to hold hard-won gains while resetting the operating model, bring active emergencies under control and convert the response into durable, country-owned detect-to-respond and cross-border capacity – beginning with a safe and complete close of the Bundibugyo Ebola public health emergency (20). Another near-term task is to cushion the financing shock by protecting essential services and accelerating domestic-financing measures tied to the Abuja commitment and the Lusaka Agenda, while protecting immunization and primary health care gains through the Gavi transition. Again, there is need to sustain the modernization capability – the regional data backbone, the workforce and the digital and governance foundations on which every priority rests – and secure political endorsement of the vision at the Regional Committee and within the African Union architecture, translating it into country compacts with shared milestones.

This is the Report’s closing request. It is specific, and it is addressed to the two audiences whose decisions will secure Africa’s health future.

To Member States: own it, finance it, deliver it

1. Finance health as the investment it is. Set an explicit national trajectory towards attaining the Abuja benchmark of devoting at least 15% of the national budget to health; ring-fence domestic financing through pro-health taxes, solidarity levies and insurance reform; and institutionalize health–finance–planning dialogues to ensure that growth translates into health budgets.

2. Commit to sovereignty and delivery. Endorse the vision and translate it into a costed country compact with shared milestones to 2030; sustain political and financial commitment to African medicines regulation, pooled procurement and local manufacture; and protect the primary health care, immunization, surveillance and workforce platforms that underpinned this year’s results. Honour the commitments already made by Member States in successive Regional Committee resolutions – on primary health care and universal health coverage, health security, domestic financing and local production of health commodities – and move them from resolution to implementation.

3. Reform to deliver. Convert political commitments – workforce posts, replenishment pledges, adopted protocols and legal instruments – into funded, staffed and operational reality, through joint planning by the ministries of health, finance, education and labour.

To partners, including donors: align and make support predictable