I attended a continental media workshop on health investment in Africa, organised by the United Nations Economic Commission for Africa (UNECA). The session aimed to explore the challenges confronting health systems across the continent, identify financing gaps, and discuss pathways toward sustainable solutions.
What surprised me most was reflecting on my own country’s long‑standing community‑based health insurance, a system I had come to regard as ordinary.
Conversations with participants from across Africa highlighted the persistent difficulty many face in obtaining affordable care without out‑of‑pocket payments. What is commonplace in one nation remains an aspiration in another, underscoring the uneven progress of health access on the continent.
Kenya is advancing health coverage through its Social Health Authority (SHA), established in October 2024 to replace the former National Hospital Insurance Fund. By May 2026 the programme had enrolled 30.7 million individuals, yet only around 4.7 million were active contributors—3.2 million from the formal sector and 1.5 million from the informal sector, according to the Daily Nation.
The gap between registration numbers and active contributions illustrates a key challenge: enrolling people does not guarantee they can sustain coverage or be shielded from costs when treatment is required.
A Sierra Leone case study revealed that pregnant women often struggle to obtain emergency transport to health facilities. Participants reported incidents where ambulance services were hampered by fuel shortages, forcing patients or families to supply fuel money for what should be rapid, potentially life‑saving assistance.
A 2025 Human Rights Watch report underscores Sierra Leone’s broader financing challenges, showing that over half of health expenditure in 2022 was paid out‑of‑pocket by patients.
The report documented informal payments and obstacles to essential maternity services, despite the government’s Free Health Care Initiative.
Tanzania has moved toward universal health coverage via its Universal Health Insurance Act of 2023, launching nationwide implementation on 26 January 2026. The new framework expands coverage through government‑supported contributions for vulnerable groups, illustrating the extensive institutional and financial effort required to turn policy commitments into effective protection against health costs.
These experiences raise questions about whether health financing truly extends beyond registration to the practical delivery of essential services.
The discussions prompted reflection on Rwanda’s experience.
For years Rwanda has operated Mutuelle de Santé, a community‑based health insurance scheme aimed at improving access to care for financially disadvantaged populations.
Contributions are structured by socioeconomic status, complemented by government subsidies and other financing, extending coverage beyond those who can afford private or employer‑based plans.
Rwanda’s National Institute of Statistics reported that health insurance coverage reached 85.3 % of the population in the 2023/2024 Integrated Household Living Conditions Survey, with community‑based insurance accounting for 93 % of the insured.
This represents a significant achievement, highlighting how financial barriers can deter medical seeking and offering a model for other African nations striving to broaden health access.
Constructing a health financing system demands more than policy announcements. Governments must create administrative structures, design contribution and payment mechanisms, build institutional capacity, mobilise resources and gain public trust. These efforts are time‑ and resource‑intensive, and implementation inevitably entails challenges, adjustments and errors.
What if countries could avoid reinventing the wheel by learning from each other’s experiences? While substantial investment remains essential, shared knowledge can help governments make better decisions, avoid preventable mistakes, and allocate scarce resources to proven approaches.
As development assistance for health becomes more precarious, the imperative for countries to learn from one another intensifies. External funding has historically underpinned essential services, ranging from HIV/AIDS care to maternal health and the fight against malaria and tuberculosis.
Recognizing the decreasing predictability of external aid, governments must strengthen domestic capacity to finance health systems and reduce reliance on outside funding.
This entails mobilising greater domestic resources, refining budget allocation, and developing sustainable financing mechanisms to maintain essential services. It does not diminish the role of development partners, but underscores the need for self‑sustaining systems that can endure when external support wanes.
Another key lesson from Nairobi is that improving health outcomes is not solely a function of how much governments spend on hospitals, equipment, or facilities.
Rispah Walumbe, Head of Strategy and Policy at Amref Health Africa, noted that health is shaped by how people live, move, and work. Consequently, governments must integrate health considerations into decisions across all sectors.
Schools can embed physical activity into daily curricula, workplaces can enhance nutrition options for staff, and urban planners can design environments that promote walking, exercise, and active lifestyles.
Preventing non‑communicable diseases (NCDs) demands that governments look beyond treatment to address underlying risk factors such as poor diet, inactivity, tobacco use, and harmful alcohol consumption.
Prevention should complement, not replace, investments in hospitals, medicines, health workers, and emergency services. Governments must balance addressing root causes with meeting the needs of those already ill.
Health cannot be the sole responsibility of health ministries; education, agriculture, trade, transport, urban planning, and environmental policies all have a direct impact on population wellbeing.
Decisions on food production, nutrition access, working conditions, public transport, and air quality can influence the overall burden on healthcare systems.
Given constrained public resources, African governments must focus not only on raising more funds for health care, but on spending existing resources more effectively.
The Nairobi discussions highlighted how much African countries could gain by sharing experiences, including the mistakes and challenges inherent in implementing ambitious health reforms.
Continental cooperation must extend beyond identifying financing gaps or seeking external aid; it should foster learning from policies and systems already developed across the continent.
As a Rwandan, I left the discussions with a deeper appreciation for the effort invested in building a community‑based health insurance system at home. Importantly, I was reminded that a nation’s progress should be shared so others can benefit.
Africa cannot afford to keep reinventing health systems while ignoring valuable experiences. The continent should share successful approaches, learn from failures, and invest not only in treatment but also in building societies that reduce the incidence of illness.
