Africa at a Crossroads: The urgent call for healthcare self-reliance
At a small health clinic in Kibera, one of Nairobi’s largest informal settlements, Beatrice Akinyi cradles her feverish son, Junior.
His tiny body burns with fever, and his breathing is laboured. “I have been here since dawn,” she says, her voice thick with worry. “They say there is no malaria medicine because the donors have stopped funding. What am I supposed to do? I don’t have money to buy drugs at the pharmacy.”
Across the border in Uganda, in a village on the outskirts of Kampala, Joseph Lwanga, an HIV-positive father of three, counts his remaining pills.
His antiretroviral therapy (ARV) medication, provided free under the USAID-funded PEPFAR program, has sustained him for a decade.
Now, with funding cuts, he’s unsure if he’ll get his next refill. “I feel like I’m waiting for death,” Joseph confesses, staring at the half-empty pill bottle. “If I miss my medication, my immune system will collapse. I have young children who will take care of them if I die?”
These are not isolated cases. From the urban slums of Nairobi to the rural villages of Uganda and the densely populated neighbourhoods of Lagos, millions of people across Africa are bearing the brunt of donor funding cuts, particularly from the United States.
The consequences are devastating shortages of essential medicines, overwhelmed hospitals, and an increase in preventable deaths.
For decades, foreign aid has been the backbone of Africa’s healthcare system. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID, the Global Fund, and other donors have provided free HIV treatment, malaria drugs, maternal healthcare, and childhood vaccines. But now, with donor commitments shrinking, the cracks in Africa’s healthcare infrastructure are painfully visible.
In western Kenya, at Bungoma County Referral Hospital, Dr. Samuel Masinde sees the reality firsthand. “Kenya alone has 1.4 million people on ARVs, and over 60% of that funding comes from donors,” he explains. “If this funding stops, we will see an explosion of AIDS-related deaths.” It’s not just HIV patients who are at risk.
In Nigeria, a resurgence of malaria cases has overwhelmed hospitals as USAID-funded malaria programs shut down. In Kenya, particularly in counties like Turkana, Garissa, and Kisumu, child immunization rates are plummeting due to vaccine shortages.
“We had almost eliminated measles, but now, due to vaccine shortages, we’re seeing new outbreaks,” warns Dr. Wanjiku Kamau, a pediatrician in Nakuru. “This is heartbreaking because we are losing children to preventable diseases.”
Kenya’s free maternal healthcare program, which was widely embraced in counties such as Kiambu, Machakos, and Mombasa, is also in jeopardy. Pregnant women who once received free prenatal care are now being turned away due to a lack of funding.
“I was told I have to pay for delivery,” says Faith Mwenda, an expectant mother from Machakos. “I don’t have the money. What do they expect me to do?”
Kenya, as East Africa’s economic powerhouse, cannot afford to continue depending on donors for basic healthcare. The government allocates only about 5% of its national budget to health far below the 15% commitment made in the Abuja Declaration.
“How is it that we have money for roads and big political events, but not for hospitals?” asks Dr. Amina Yusuf, a medical researcher in Nairobi. “It’s time we prioritize our own people.”
To break this cycle, Kenya must take decisive steps. Fully implementing the Social Health Authority (SHA) scheme would ensure every citizen contributes to a self-sustaining healthcare system.
Investing in local pharmaceutical manufacturing, particularly in Nairobi’s growing industrial sector, could reduce reliance on foreign medicine.
A dedicated healthcare levy similar to taxes on fuel and luxury goods could provide sustainable funding. Additionally, private sector partnerships in counties like Uasin Gishu and Kisii, which have emerging health investment opportunities, could enhance healthcare infrastructure.
Fighting corruption remains a critical step. Billions meant for medical supplies have been lost to mismanagement, with cases such as the COVID-19 procurement scandal exposing deep-seated rot in Kenya’s health sector. Without accountability, no funding model will succeed.
Beyond Kenya, the entire continent must rethink its approach to healthcare financing. In South Africa, one of Africa’s most developed economies, local pharmaceutical production is taking shape, setting an example for countries like Tanzania and Ghana.
However, reliance on donor-funded programs remains widespread. “It is embarrassing that a continent with over 1.4 billion people still depends on donors for basic healthcare,” says Prof. Njeri Kamau, a health economist at the University of Nairobi. “We must take responsibility for our survival.”
The African Union must lead the way in creating a continental health fund, ensuring that each nation contributes a fixed percentage of GDP.
Countries like Egypt, which have successfully developed universal healthcare models, can serve as a blueprint for others. Investment in local production of medicine, robust health infrastructure, and research must be prioritized.
Imagine an Africa where no child dies from malaria because every country produces its own medicine. Imagine a Kenya where no woman loses her life giving birth because maternity care is funded domestically. This is not a fantasy it is a necessity.
The USAID cuts are not just a financial setback; they are a wake-up call. If African governments do nothing, the consequences will be catastrophic rising mortality rates, preventable disease outbreaks, and a reversal of decades of progress.
For Beatrice Akinyi in Kibera, for Joseph Lwanga in Uganda, for millions of vulnerable people across Africa, the question is simple: Will we continue to beg for survival, or will we finally take control of our own healthcare?
