Addis Ababa, Ethiopia. Rising debt-servicing costs are squeezing health spending in Africa’s poorest countries, while out-of-pocket medical expenses push an estimated 150 million people into poverty every year, the UN Economic Commission for Africa (ECA) has warned.
The warning was issued at the opening of the 76th Session of the WHO Regional Committee for Africa, held at the Adwa Museum in Addis Ababa under the theme, “Roots and Wings – Heritage Meets Digital Health.”
Speaking on behalf of ECA Executive Secretary Claver Gatete on August 25, 2026, the commission’s Chief of Staff, Aboubakri Diaw, told health ministers that Africa’s health sector faces not only a financing gap but also a crisis of confidence.
“Confidence, unlike capital, cannot be borrowed. It must be built,” Mr Diaw said.
The session was officially opened by Ethiopian President Taye Atske Selassie and attended by African Union Commission Chairperson Mahmoud Ali Youssouf, WHO Director-General Dr Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Dr Mohamed Yakub Janabi.
Mr Diaw illustrated the economic consequences of inadequate health financing through the story of “Amina”, a composite small-business owner who delays seeking medical care because she fears the cost. When she eventually receives treatment, the resulting bills force her to sell business equipment and reduce jobs.
“What began as one person’s illness has become a household financial crisis—and, when repeated across millions of families, a macroeconomic problem,” he said.
According to ECA, three pressures are converging to deepen the challenge. External health assistance has fallen by almost 30 per cent, while debt servicing now exceeds health spending in the median low-income country. Meanwhile, out-of-pocket payments account for an average of 35 per cent of health expenditure across the region, well above the WHO benchmark of 20 per cent.
ECA also pointed to national health strategies that remain uncosted and poorly sequenced, making it harder for governments to attract and coordinate financing.
To address the problem, Mr Diaw urged African governments to make three major shifts.
First, he called on health ministries to approach finance ministries with quantified investment cases that demonstrate how spending on health contributes to productivity and economic growth, rather than presenting health financing simply as a funding request.
Second, he urged countries to replace fragmented health plans with a single, politically endorsed national health-financing compact bringing together health, finance, planning, revenue, debt, insurance and private-sector stakeholders.
“Putting more money into a fragmented system can finance more fragmentation,” Mr Diaw said. “Putting money behind a credible national compact can finance transformation.”
Third, governments should select financing instruments that reflect their respective fiscal positions. ECA said early data from countries adopting its approach shows that health receives only 5 to 9 per cent of national budgets, while out-of-pocket payments can account for as much as 64 per cent of total health spending.
The work is being undertaken through ECA’s African Initiative on Transforming Health Financing, launched in Tangier in April 2026.
Mr Diaw also called for digital health to be treated as part of the continent’s financing infrastructure. He noted that fewer than one-third of health systems in low-income settings can track health spending digitally in real time.
He described the gap as one of the fastest opportunities for improving efficiency and called for systems that can enable treasuries to trace health funds from national budgets to individual patients.
He cited Ethiopia’s digital health drive under Prime Minister Abiy Ahmed as an example of how digital systems can improve financial tracking and accountability.
The objective, he said, should be to move digital health beyond individual projects and use it to transform how health financing is managed.
Mr Diaw said the ultimate measure of progress should not be the number of declarations made by governments, but whether people like Amina can access healthcare early without being forced to sacrifice their livelihoods.
“Health is not what we spend when Africa grows. Health is how Africa grows,” he said.
ECA said it was ready to work with African governments to translate the ambition into measurable and adequately financed action.