Accelerating Sustainable Health Financing in Africa: The Africa Leaders Meeting (ALM) Declaration in Action
The 3rd International Conference on Public Health in Africa, held in Lusaka, Zambia, from November 27-30, 2023, proved to be a pivotal African-led platform. Leaders from across the continent converged to address critical global health challenges, encompassing various issues. Among these, sustainable health financing emerged as a prominent topic, showcased at a side event led by the Global Fund. This event drew attention to the transformative role of the Africa Leaders Meeting (ALM) Declaration in mobilizing domestic resources, offering a promising pathway towards sustainable healthcare solutions for Africa.
Africa has witnessed substantial increases in life expectancy with commendable success in programs mostly donor-driven targeting key health challenges like HIV, TB, malaria, and maternal and childhood conditions. However, progress has been hindered by persistent reliance on regressive health expenditure sources, such as out-of-pocket payments (OOP), and a significant gap in meeting the Abuja Declaration target.
Despite high-level commitments, few African countries have met the 2001 Abuja Declaration’s goal of allocating at least 15% of their budget to the health sector. The consequences of falling short of this target are discernible in the form of inefficient health expenditure. According to IMF inefficiency in health spending costs sub–Saharan Africa close to 10 years of life or 1% of GDP on average[1]. Common sources of inefficiency include corruption and fraud, slow absorption of funds, ghost workers, and poor-quality care.
The Africa Leaders Meeting (ALM) initiative emerged as a transformative force in response to the urgent need for sustainable health financing. This journey began with the landmark 2001 Abuja Declaration. Building on this foundation, the African Union Assembly adopted the Africa Scorecard on Domestic Financing for Health in 2016, providing a comprehensive framework to track progress toward the Abuja target. In 2019, solidifying a collective commitment, H.E. President Paul Kagame gathered all African Union Heads of State to ratify the ALM Declaration. This historic moment marked the official launch of the ALM initiative, aiming to secure “More money for health,” achieve “More health for the money,” ensure equity and improved financial protection, and promote country leadership and coordination.
ALM Implementation: A Collaborative Effort for Change
In 2020, an agreement was reached to establish Health Financing Hubs in Southern and Eastern Africa within Regional Economic Communities. Subsequently, in 2022 and 2023, National Health Financing Dialogues were held in Malawi, Zambia, Kenya, Mozambique, Mauritius, and Rwanda, bringing together key stakeholders to deliberate on strategies and mechanisms for sustainable health funding.
Generally, the pattern followed by countries is to convene pre-dialogue activities, encompassing stakeholder mapping, desk reviews, sensitization, and workshops, to establish a strategic foundation for inclusive discussions. The dialogue events, spanning technical discussions, partner alignment, private sector engagement, and commitments to priority reforms, act as a confluence of expertise and commitment. Post-dialogue measures ensure sustained momentum through follow-ups, ongoing technical support, and tracking using agreed tools and indicators. Notably, these dialogues offer a unique opportunity for in-country development partners to align and actively support the development and implementation of national health financing agendas. The collaborative approach, involving diverse stakeholders including CSO’s and development partners, positions the dialogues as a catalyst for transformative change, driving a resilient and sustainable healthcare ecosystem in Africa.
Regional Economic Communities (RECs) play a pivotal role as the regional implementors of the ALM agenda. Operating in direct collaboration with country Ministries of Health (MOH) and Ministries of Finance (MOF), RECs serve as vital intermediaries in the coordination and execution of the national health financing dialogues, ensuring a seamless alignment with national health financing priorities. In consultation with RECs, individual countries assume the ultimate responsibility for both convening and coordinating these dialogues, thereby creating a collaborative framework that leverages regional expertise and resources while allowing for tailored, country-specific approaches to sustainable health financing.
The Global Fund has stepped in to support the ALM agenda through grants from the Bill and Melinda Gates Foundation (BMGF). This funding, disbursed by the Global Fund, empowers Regional Economic Communities (RECS) to work directly with countries in implementing the ALM agenda, including National Health Financing Dialogues.
As Africa grapples with the challenges of health financing, the ALM initiative stands as a beacon of hope. Drawing from the successful experiences of Rwanda and Mauritius in increasing domestic resources for health, there was a resounding call to enhance the capacity of health ministries to craft compelling investment cases that resonate with finance ministries. This endeavor goes beyond a mere budgetary request; it is about effectively articulating the economic added value of health investments. By learning from the achievements of countries such as Rwanda and Mauritius, the ALM Initiative aims to build a foundation where health and finance ministries work hand in hand to ensure the sustainable growth of healthcare resources.
By fostering collaboration, political commitment, and efficient resource mobilization, the ALM is guiding African countries toward sustainable health financing, aiming for improved health outcomes for all. While the journey ahead presents undeniable challenges, especially in the face of macroeconomic issues, the ALM instils optimism, positioning Africa to achieve greater health equity and resilience. Continuous support from partners to Regional Economic Communities (RECs) remains crucial, empowering them to address the prerequisites for successful national dialogues. In the realm of the new public health order for Africa, this sustained support is pivotal for extending these vital dialogues to more African countries, ensuring a comprehensive and inclusive approach to advancing sustainable health financing across the continent.
[1] https://www.imf.org/en/Publications/WP/Issues/2022/03/04/Patterns-and-Drivers-of-Health-Spending-Efficiency-513694
Fassika Alemayehu
