Unaffordable Health Costs? We’re Sick of It -Why UHC Must Be a 2025 Priority for Africa
Universal Health Coverage (UHC) Day 2025, marked on 12 December, lands at a critical moment for Africa’s health systems. This year’s campaign theme, “Unaffordable health costs? We’re sick of it,” speaks directly to a continent where too many people still pay cash at the clinic door and walk away poorer or never seek care at all. African governments have endorsed UHC in the Sustainable Development Goals and continental frameworks, yet gaps in primary health care, infrastructure, and financing mean millions remain unprotected when illness strikes.
Globally, at least 4.5 billion people still do not have full access to essential health services, and around 2 billion experience financial hardship when they seek care, with about 1.3 billion pushed into or deeper into poverty because of health expenses. Africa carries a disproportionate share of this burden: a WHO analysis shows that more than 200 million people in the region face heavy out‑of‑pocket payments, and over 150 million are pushed into or further into poverty due to health costs. On average, people in Africa spend less than 35 US dollars per year on healthcare yet this limited spending is often at the point of use, forcing families to cut back on food, school fees, or rent to pay for medicines and consultations. At the same time, less than half of Africa’s population can access essential health services, with coverage hovering around 48% and some large countries still below this average.
These realities show why unaffordable health costs are not just a personal crisis but a structural failure. Health financing systems that rely heavily on out‑of‑pocket payments are regressive and unjust, and they undermine both human rights and economic development. When people delay care, skip medicines, or fall into debt to pay medical bills, countries lose productivity, deepen inequality, and weaken trust in public institutions. By contrast, public investment in pooled, pre‑paid schemes through tax‑funded services, social health insurance, and community‑based models has been linked to lower levels of catastrophic spending and impoverishment in African countries that prioritize domestic health budgets.
Making this shift requires putting primary health care at the centre of UHC efforts. Evidence from across Africa shows that systems with stronger primary care, staffed clinics, reliable medicines, functioning laboratories, and connected community health workers are better able to deliver essential services close to where people live. Yet the continent faces a projected shortfall of around 6.1 million health workers by 2030, and under‑resourced clinics still struggle with stock‑outs and infrastructure gaps. Initiatives like the AUDA‑NEPAD Continental Primary Healthcare Programme, launched for 2025–2030, aim to close these gaps by investing in community health workers, digital tools, and resilient primary care infrastructure as the backbone of UHC.
Finance remains the toughest constraint. Analyses of primary health care financing in Africa point to a massive gap, estimated at tens of billions of dollars per year — that countries must close to deliver even a basic package of services. Many governments still spend well below the Abuja target of 15% of public expenditure on health, with some large economies allocating less than 5%, even as they face rising debt service costs and competing development priorities. In this context, 2025 must be a turning point: Ministries of Health and Finance need to work together to expand pooled financing, remove user fees for essential services, and target subsidies to the poorest households, while also pursuing debt relief, concessional finance, and innovative mechanisms that free fiscal space for health.
Innovation offers part of the answer. Across the continent, digital health tools, solar‑powered facilities, telemedicine, and data platforms are helping extend services to remote communities and improve the quality of care. However, the Health Policy Watch analysis of Africa’s health future warns that technology alone will not fix systemic underinvestment; digital innovations must be anchored in strong primary care systems, clear governance, and sustainable financing if they are to advance UHC rather than add new layers of fragmentation. That means investing in basic infrastructure — clinics, connectivity, cold chains, alongside electronic health records, decision‑support tools, and platforms that make it easier to plan, purchase, and monitor services.
Accountability and citizen voice are equally important. The 2025 UHC Day campaign calls for better data on who is left behind, how much households are paying out of pocket, and whether public resources are reaching rural areas, informal settlements, and marginalized groups. In Africa, communities have a long tradition of mutual support, and tapping into this through community scorecards, social audits, and participatory budgeting can help ensure that UHC reforms respond to real needs, not just national averages. Women, youth, people with disabilities, and informal workers must have a say in shaping benefit packages and monitoring service quality, since they are often the ones hardest hit by both service gaps and financial shocks.
Read the full story on Medium: https://medium.com/@info_EdgeSocialimpact/unaffordable-health-costs-were-sick-of-it-why-uhc-must-be-a-2025-priority-for-africa-22d767e0786f