Rising debt payments are crowding out health spending in Africa's poorest countries, and out-of-pocket medical costs push 150 million people into poverty every year, the UN Economic Commission for Africa (ECA) warned today at the opening of the 76th Session of the WHO Regional Committee for Africa, held at the Adwa Museum under the theme "Roots and Wings – Heritage Meets Digital Health."

Speaking on behalf of Executive Secretary Mr Claver Gatete, ECA Chief of Staff Mr Aboubakri Diaw told health ministers that Africa's health sector "does not only suffer from a financing gap. It also suffers from a confidence gap; and confidence, unlike capital, cannot be borrowed. It must be built." The session was opened by President Taye Atske Selassie of Ethiopia, joined by AU Commission Chairperson Mahmoud Ali Youssouf and WHO Director-General Dr Tedros Adhanom Ghebreyesus and Dr Mohamed Yakub Janabi, WHO Regional Director for Africa,

To make the stakes tangible, Mr Diaw described "Amina," a composite small-business owner who delays care for fear of its cost, then faces bills that force her to sell equipment and cut jobs. "What began as one person's illness has become a household financial crisis... and, when repeated across millions of families, a macroeconomic problem," he said, citing three converging pressures: external health assistance down almost 30 per cent while debt servicing now outpaces health spending in the median low-income country; out-of-pocket payments averaging 35 per cent of health expenditure regionally, above the WHO benchmark of 20 per cent; and national strategies that remain uncosted and unsequenced, making financing harder to attract.

To close that gap, ECA is asking ministers to make three shifts. First, health ministries should bring finance ministries a quantified investment case, not just a request, tied to productivity and growth. Second, countries should replace fragmented plans with one politically endorsed national health-financing compact spanning health, finance, planning, revenue, debt, insurance and private-sector actors, "putting more money into a fragmented system can finance more fragmentation," Mr Diaw said, whereas "putting money behind a credible national compact can finance transformation." Third, governments should match financing instruments to their own fiscal starting point; early data from ECA's adopter countries shows health receiving just 5 to 9 per cent of budgets while out-of-pocket costs can reach 64 per cent of health spending. This work sits under ECA's African Initiative on Transforming Health Financing, launched in Tangier in April 2026.

Mr Diaw also urged governments to treat digital health as financing infrastructure, noting that fewer than a third of health systems in low-income settings can track spending digitally in real time, a gap he called "among the fastest efficiency gains  that should be met and made available to any treasury." He cited Ethiopia's digital health drive under Prime Minister Abiy Ahmed, the AU's AI and Digital Health Champion, as a model for tracing every Birr or Franc from budget to patient, turning digital health, he said, from "a project" into "a financing revolution."

Mr Diaw said success would be measured not by declarations but by whether people like Amina can seek care early without losing their livelihoods. "Health is not what we spend when Africa grows. Health is how Africa grows." ECA said it stands ready to help turn this ambition into financed, measurable action.