After Accra, Africa’s Health Sovereignty Needs Receipts
Africa has made its case for greater health sovereignty. What comes next will determine whether Accra becomes a defining turning point or another well-intentioned moment without sustained follow-through.
At the African Union’s Extraordinary Summit on Health in Accra, I found myself carrying two feelings at once.
The first was fatigue. Much of what was said was true, urgent, and painfully familiar. Africa must finance more of its own health systems. Primary health care must be stronger. Medicines and vaccines must be manufactured closer to home. External financing is becoming less predictable. Out-of-pocket payments are harming families. Pooled procurement, better regulation, and stronger accountability are overdue.
We have heard these things before.
The second feeling was discomfort edged with hope. President John Mahama cut through the ceremony when he said Africa’s health pledges must become “physical, not lyrical.” He also reminded leaders that the Abuja commitment to allocate 15% of national budgets to health is now “old enough to have children of its own.”
Finally, someone said it plainly.
Dr. Jean Kaseya, Director-General of Africa CDC, also brought the summit back to reality. Speaking as the continent faced an expanding Ebola threat, he warned that if Africa did not control the outbreak, “everything we are doing today won’t make sense.” That mattered. It suggested something more than rhetoric: Africa might actually be building the muscle to act.
But that is exactly why Accra must not be allowed to become another elegant declaration.
In an earlier Devex essay with Justice Nonvignon, I argued that Africa had made bold health commitments and now had to finance them. After Accra, the question is sharper. If African leaders now speak the language of health sovereignty, what proof should citizens demand?
Because Accra was not just another financing discussion. It was a sovereignty claim.
Health sovereignty should mean a functioning health system where people’s needs are met, predictably funded by African countries themselves. It means Africans setting the agenda and partners aligning behind it. But agenda-setting without budget releases is performance. Ownership without execution is theatre.
Country ownership must not become cost-shifting.
If a donor withdraws and a mother is asked to pay at the hospital gate, that is not sovereignty. If trained nurses remain unemployed years after qualification because the system cannot absorb them, that is not sovereignty. If families sell land, livestock, phones, or tools to settle hospital bills, that is not sovereignty. If patients die after being turned away because there is no bed, as Ghana’s painful “no-bed syndrome” cases have shown, that is not sovereignty either.
No one is coming to save Africa from the consequences of underfinanced health systems. Politicians should treat health financing as if their own lives depend on it, because they do. One uncomfortable question should follow every president and finance minister after Accra: if this were the only health system available to you and your family, what would you fix first?
The answer starts with receipts.
The first receipt is budget allocation. Which countries increased health allocations after Accra, and by how much?
The second is release. Money announced is not money available. A budget line that never reaches facilities is just a speech with numbers. World Bank analysis has shown that health budgets are often executed less fully than overall government budgets, with service-delivery spending especially vulnerable. Citizens should not only ask what was allocated. They should ask what was released, when, and to whom.
The third receipt is service protection. Did the money protect primary health care, immunisation, maternal and newborn health, emergency care, HIV, TB, malaria, noncommunicable diseases, commodities and the health workforce?
The fourth is household protection. WHO’s African Region has reported that out-of-pocket payments place a financial burden on more than 200 million people and push over 150 million people into or deeper into poverty. In my recent ONE essay on out-of-pocket health payments, I called this Africa’s cruelest health tax: one collected at the hospital gate, when people are most afraid. If sovereignty does not reduce that burden, citizens are simply paying for political failure in cash.
The fifth receipt is continental action. The African Pooled Procurement Mechanism should turn fragmented national demand into bargaining power. Local manufacturing will not survive on speeches; it needs predictable demand, quality regulation, long-term purchasing and countries willing to buy African-made products when they meet standards. The African Medicines Agency also needs more countries to move from endorsement to full ratification and implementation.
There are signs that this is possible.
The Accra convening shifted the conversation from ambition to action. The real test now is whether governments, partners and institutions can translate commitments into measurable investments, stronger health systems and lasting accountability.
– William Nii Ayetey menson
In Kenya, civil society pressure helped make vaccine financing a public political issue. HENNET and other advocates worked with parliamentarians, used media advocacy and helped keep attention on financing gaps that threatened vaccine supply. Kenya subsequently moved to protect vaccine financing, including additional resources reported in the national budget process. This was not magic. It was evidence, pressure, timing and persistence.
Ghana has also had to confront the reality of USAID funding disruption. President Mahama directed urgent action to bridge a $156 million gap, including health programmes at risk, and Ghana’s Ministry of Finance later pointed to increased health financing, NHIS reforms and preparation to fully finance vaccines and critical medicines as external support declines. Nigeria, too, has made commitments toward self-reliance, including a health partnership framework that links external support to increased domestic financing and a commitment to allocate at least 6% of executed federal and state budgets to health.
These examples are not perfect. That is the point. Sovereignty will not arrive as a clean slogan. It will be built through imperfect but measurable decisions: a release made, a vaccine paid for, a nurse employed, a procurement plan honoured, a family spared a catastrophic bill.
An Akan and Ewe proverb says, “Wisdom is like a baobab tree; no one individual can embrace it.” Accra did not lack wisdom. Presidents, ministers, technical agencies, civil society and partners all know enough to act. The harder question is whether that collective wisdom will now become budget releases, medicines on shelves, nurses employed, emergency care that works, and fewer families paying for public failure in cash.
The African Union Commission chairperson, Mahmoud Ali Youssouf, was right that “future generations will remember this Summit” by whether it changed Africa’s health trajectory. To make that possible, Accra needs follow-through.
Presidents should ask for an annual Accra Health Sovereignty Ledger. Finance ministers should be judged alongside health ministers. Parliaments should track allocations, releases and service results. Civil society should follow the money to facilities and communities. Africa CDC and the AU Commission should make continental commitments visible, comparable and politically uncomfortable to ignore. Donors and philanthropies should support transitions that build capacity, not dependency.
The time to act is now. We have talked enough.
Accra gave the continent words worthy of the moment. Now citizens need proof.
Future generations should judge this summit not by the words spoken or written, but by the difficult actions taken to protect our citizens.
Dr. William Nii Ayitey Menson is Director of Health Financing for Africa at The ONE Campaign (ONE). ONE drives the investments needed to create economic opportunities and healthier lives in Africa.
