Three leading African health advocacy organisations have declared that the continent can no longer rely on unpredictable external donor funding to meet its health needs, urging governments to prioritise domestic investment and health sovereignty.

The AIDS Healthcare Foundation (AHF) Africa, Africa Reach and WACI Health made the call ahead of the African Union Heads of State Summit scheduled for February 14 to 15, describing health sovereignty as essential to Africa’s survival and prosperity.

The declaration followed a webinar convened in advance of the summit, which the groups say will serve as a call to action and a manifesto to AU leaders. The coalition argued that Africa must shift from a dependence on development assistance to sustained health investment.

The appeal is grounded in funding realities across the continent. African countries currently spend an average of 17 dollars per person annually on health, far below the estimated minimum requirement of 60 dollars per person. With donor funding declining, the organisations called for urgent domestic financing reforms and strengthened local health manufacturing capacity.

AHF Africa, which convened the webinar in partnership with the other organisations, describes itself as the largest global AIDS organisation. It currently provides medical care and services to more than 2.8 million clients in 46 countries across the United States, Africa, Latin America and the Caribbean, the Asia-Pacific region and Europe.

The coalition’s manifesto, read by Tolessa Olana Daba of AHF Ethiopia, outlined three non-negotiable demands to AU leadership. It called for a unified African front to renegotiate what it described as odious debt terms to free up fiscal space for health spending, and for supply sovereignty through the urgent operationalisation of the African Medicines Agency to harmonise regulations and support the three per cent of local manufacturers currently operating on the continent.

The coalition also urged a shift from state sovereignty to people-centred sovereignty to ensure that communities facing climate-induced health shocks are not left behind.

During the webinar, which featured four speakers, the Executive Director of WACI Health, Rosemary Mburu, underscored the urgency of ensuring universal access to healthcare across the continent, describing that urgency as non-negotiable.

She stressed that health must be viewed beyond the narrow perception that it is merely a sector that consumes resources rather than contributing to economic growth.

"African leaders need to be sensitised to the notion that they need to push back on the inequities we see around the world when it comes to access to capital. We need to institutionalise or formalise how we engage communities and civil societies in policy processes, and we need to continue to seek domestic leadership by reducing wastage as a continent, better prioritisation of health and innovative financing," she said.

A Senior Health Officer in charge of Medicines and Food Safety at the East African Community Secretariat, Dr Julius Simon Otim, said access to medicines remained a major challenge in Africa due to high costs and weak distribution systems.

Citing the East African region, he said some countries lacked dedicated national medicines procurement agencies, resulting in heavy reliance on partners, donors and non-governmental organisations for the supply of medicines. He also pointed to the persistent challenge of counterfeit and substandard drugs.

"If you look at the national budget of some countries for medicines, you find that it’s so limited. Some countries within East Africa don't have national medicines procurement agencies, so there's basically no funding for procurement of medicines," he said.

Dr Otim urged African leaders to treat health investment as a strategic priority, noting that the COVID-19 pandemic had exposed the continent’s vulnerability.

He said the pandemic demonstrated the urgent need to strengthen local pharmaceutical manufacturing, recalling that Africa had to wait for other regions to secure supplies before accessing essential medicines.

"We need to address the gaps in manufacturing, capacity building and financing. We need to have supportive government policies for a conducive financing environment. We need to have policy coherence, strong regulatory systems, infrastructure, research and development, industrial production capacity and robust supply chain mechanisms. And we need to have a global mapping of actors, existing and planned programmes, and available resources in manufacturing technology," he said.

On the legal and policy framework guiding Africa’s pharmaceutical manufacturing agenda, Kemi Gbadamosi acknowledged progress in policy autonomy, noting that many of the continent’s frameworks reflect its specific needs.

However, she described the frameworks as fragmented and called for harmonised regulatory systems. She also urged the introduction of enforcement mechanisms to ensure policies deliver on their intended objectives, as well as alignment between procurement policies and local production initiatives.