Reimagining Health Financing in Africa: Navigating the Aftermath of the U.S. WHO Withdrawal
Emeka Oguanuo and Tzar Oluigbo (Lead Writers)
The United States’ withdrawal from the World Health Organization (WHO) and 90-day pause in foreign aid programmes following President Donald Trump’s re-election have sparked a global health debate. While critics warn that this decision threatens Universal Health Coverage (UHC), the commitment to ‘leave no one behind’ others see an opportunity for Africa to accelerate its vision of a new public health order focused on self-sufficiency.
Could this geopolitical development catalyse a paradigm shift, with African health systems moving from donor-dependency towards self-reliance, thereby strengthening the region’s health security and contribution to global health?
Progress toward achieving UHC, a guarantee that populations have access to quality health services without financial hardship, has been disturbingly off track. The “Tracking Universal Health Coverage: 2023 Global Monitoring Report” paints a bleak picture: 4.5 billion people globally cannot access affordable, quality care when they need it. Even worse, 2 billion people face financial hardship, with 1.3 billion of them being pushed into poverty by out-of-pocket health expenses.
For developing countries with poorly funded healthcare systems and high dependency on foreign aid for critical health programmes –such as Tuberculosis, Malaria, maternal and child health, and HIV/AIDS– the funding cut or reduction from the United States could pose an even more pressing global health issue.
However, while it exposes vulnerabilities in donor-dependent systems, it also presents a timely opportunity to reimagine and strengthen health sovereignty aligned with the new public health order. This will require a whole-of-society approach, driven by strong political commitment and civil society participation.
2025 and the global health financing landscape
The U.S., the WHO’s largest funder, has driven life-saving global health initiatives, including the President’s Emergency Plan for AIDS Relief (PEPFAR), which saved 26 million lives and enabled 5.5 million HIV-free births. With over $640 billion spent in foreign aid from 2012 to 2022, its withdrawal threatens global health diplomacy and sparks opposition. Legal experts have argued that President Trump cannot unilaterally exit the WHO without congressional approval, as the U.S. joined through a 1948 joint resolution. Congress is now pursuing measures to block the move, underscoring the WHO’s indispensable role in global health security.
In response to the U.S. pause on foreign aid and retreat from the Paris Agreement, the WHO plans to reassess costs, urging the international community to pursue innovative financing. While philanthropic groups are pledging to address the funding gap, with emerging economies like BRICS nations potentially stepping up, their efforts must extend beyond financial support to include technical collaboration and knowledge sharing.
Time to focus on the African response?
This recent geopolitical shift exposes the vulnerabilities of Africa’s heavy reliance on foreign aid to realise its commitment to UHC, underscoring the urgent need to “not let this crisis go to waste” by strengthening health sovereignty.
Africa’s proactive response to COVID-19 demonstrated its capacity for regional coordination and innovation. Initiatives such as the African Vaccine Acquisition Task Team (AVATT) and the Africa Medical Supplies Platform (AMSP) highlighted the continent’s commitment to self-reliance. However, the pandemic also exposed deep vulnerabilities, including the overdependence on external sources for critical medical supplies, with less than 1% of vaccines manufactured locally.
In response, countries including Egypt, Kenya, Morocco, Senegal, South Africa, Uganda, and Rwanda initiated steps to boost local vaccine production, with Nigeria more recently, initiating policy measures to unlock its healthcare value chain. Speaking at the 2025 World Economic Forum, Kashim Shettima, Nigeria’s Vice President reiterated the need for Africa to move beyond foreign aid and embrace partnerships rooted in equality and self-reliance. Similarly, Dr. Jean Kaseya, Africa CDC Director General, emphasised the need for domestic resource mobilisation, in the wake of the geopolitical shift. He stated that “I’m glad to announce that our Heads of State will meet on the 14th of February in Addis Ababa to discuss domestic resources for Africa and how to provide appropriate funding to Africa CDC and African Medicine Agency.”
Africa’s new public health order, introduced in 2021, provides a framework to consolidate these gains, by focusing on institutional strengthening, local manufacturing, and increase in domestic financing for health. However, achieving health sovereignty goes beyond financial independence — it demands the capacity to design, implement, and sustain programmes tailored to Africa’s unique contexts.
Collaborative path forward: Role of civil society organisations
Civil Society Organisations (CSOs) are indispensable allies in advancing UHC goals, serving as watchdogs and bridges between underserved communities and policymakers. U.S.-funded CSOs, whose work directly impacts vulnerable populations, were abruptly told to halt operations, disrupting essential health interventions. In response, swift, and strategic advocacy efforts led to a life-saving waiver on emergency services from the U.S States Department, demonstrating that decision-makers recognised the potential harm of an outright freeze.
In Nigeria, the Federal Executive Council approved ₦4.8 billion for HIV/AIDS treatment and formed a multi-ministerial committee to sustain health programs impacted by U.S. policy shifts. This signals a move toward domestic health financing, creating a pivotal moment for CSOs to advocate for sustainable funding, transparency, and efficiency. Seizing this opportunity, the Nigeria UHC Forum — a coalition of indigenous CSOs — is moving to explore resilient financing pathways amid donor uncertainty, by convening a health financing policy dialogue this month.
CSOs in Nigeria have demonstrated their capacity to shape impactful health reforms. The Health Sector Reform Coalition, for instance, led the development of the Basic Health Care Provision Fund Accountability Framework, ensuring transparency in the allocation and use of ₦12.9 billion earmarked for the fund. Similarly, advocacy by CSOs like the Centre for Social Justice catalysed the 2022 passage of the National Health Insurance Act, marking a critical moment in expanding access to health insurance and reinforcing Nigeria’s commitment to leave no one behind.
In light of shifting global dynamics, CSOs must take on an even more transformative role to reimagine Africa’s health systems, holding leaders accountable for their pledge of allocating 15% of their total expenditure to health, while fostering accountability, driving innovation, and amplifying local voices.
