Charting a Pathway for Sustainable Financing of Africa’s Resilience — Statement

On Wednesday, April 30, 2025, Resilience Action Network Africa (RANA), AIDS Healthcare Foundation (AHF) Kenya, and Pandemic Action Network (PAN) convened more than 50 leaders from across sectors and communities in Kenya to reimagine a new future toward sustainable financing for Africa’s resilience amid shifting global aid dynamics. The convening sparked bold, African-led priorities — from increasing domestic health investment to centering equity and community leadership — laying the groundwork for long-term, resilient systems driven by local ownership and shared action. The following outcome statement, signed by 30 civil society partners, was delivered to the press at the close of the convening. 

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Dear Members of the Press,

On behalf of Resilience Action Network Africa (RANA), AIDS Healthcare Foundation (AHF) Kenya, Pandemic Action Network (PAN), leaders and practitioners from civil society, research institutions, accountability networks, trade unions, climate and feminist movements, and development partners — thank you for joining us. Today’s press conference highlights the urgent need for Kenya and African nations to respond to shifting Official Development Assistance (ODA) dynamics and advance sustainable, inclusive development financing. This must include bold commitments to strengthen domestic resource mobilisation — through progressive taxation, budget transparency, and public investment in people-centered systems.

Africa stands at a critical crossroads as many governments grapple with what has been called a fiscal trilemma, namely: how to contain ballooning debt, increase spending on development, while at the same time managing citizen resistance to increased taxation. 

In 2025, the termination of thousands of USAID awards has sharply reduced funding for global health programs targeting Malaria, TB, and HIV and other primary services. While President Trump’s abrupt ‘Stop Work Orders’ drew global attention, fewer are aware that European governments are also steadily slashing foreign aid to low- and middle-income countries (LMICs) — including Kenya and others across Africa.

While aid has contributed to development, it is a misconception that foreign aid solely funds our national budgets and health systems. Available evidence shows that domestic resources finance nearly 40% of health services, while donors finance about 20%, and households cover the rest. However, sectors like Malaria, HIV, and TB remain overly donor-dependent, distorting priorities and limiting policy autonomy.

UNAIDS warns of life-threatening consequences from the recent dramatic reductions: up to one million people may soon face treatment disruptions. In Kenya alone, over 54,000 health workers have lost their jobs due to halted projects. This exposes the fragility of over-reliance on foreign aid.

Faced with a shrinking fiscal space, 34 out of 54 African countries now spend more on debt servicing than on healthcare. Coupled with corruption, inefficient spending, and low civic accountability, this is not just an economic crisis — it’s a governance and accountability crisis.

These challenges are personal. Margaret Wavinya, a TB survivor and community health volunteer is directly affected. When PEPFAR funds were halted, it was a matter of life or death. Margaret didn’t vote in the U.S.; she voted in Kenya, where the government bears a constitutional responsibility to uphold her right — and the right to health for all Kenyan citizens as outlined in Article 43 of the Constitution. That duty is non-transferable and cannot be outsourced to donors.

Today’s Nairobi Convening to Chart A Pathway for Sustainable Financing of Africa’s Resilience brought together civil society, community voices, experts, and leaders to reimagine sustainable models for human development and health systems across Africa. To break the cycle of dependency, we must build resilient, self-reliant economies by investing in our greatest asset, our people. That means prioritising our teachers, nurses, and students, and holding every budget, contract, and decision to the highest standard of transparency and accountability.

In the spirit of shared goals and differentiated responsibilities, participants at the Nairobi Convening make the following Key Asks:

For African Governments:

1. Enhance accountability, improve efficiency, build self-reliance. Corruption and inefficiency can no longer be business as usual. We must strengthen our institutions and enforce real accountability at every level of leadership. The sources and uses of funds should be made public with robust, intentional citizens’ involvement at all levels of decision making.
2. Put our money where our mouth is. Shifting ODA should push African governments to meet long-overdue commitments — starting with allocating at least 15% of national budgets to health, as pledged in the Abuja Declaration. Now is the time to close funding gaps, prioritise domestic resource mobilisation, and invest in people and systems for long-term resilience — not just one-off fixes.
3. Renegotiate debt and reduce the cost of capital. The global finance system is stacked against Africa. Governments must renegotiate debt and support South Africa’s G20 push for fairer interest rates.
   • Kenya’s ability to achieve Universal Health Coverage (UHC) is being undermined by a debt burden shaped by unfair global financing terms and shrinking external aid. Under Kenya’s Public Finance Management Act, debt must be sustainable and geared toward development goals. Yet today, the country spends more on debt servicing than on health. The government must urgently renegotiate debt terms and work with allies like South Africa, which have consistently advocated for financial justice in global forums such as the G20, to push for fairer interest rates and reclaim fiscal space for health investments that prioritise people over payments
4. Social sector spending is not an expense, it’s an investment. With Africa’s youthful population, we have a unique opportunity to unlock a demographic dividend. But this requires bold, smart investments in health and essential public services. To secure economic growth and climate resilience, Africa must urgently prioritise domestic financing for human development.
5. Prioritise climate and health financing. Africa faces a 63% rise in zoonotic outbreaks, which are tied to climate change, yet less than 0.5% of climate adaptation funds support health. This must rise to at least 15%. A health-centered approach saves lives, builds resilience, and delivers critical climate co-benefits.
6. Restructure international financing mechanisms as well as global health initiatives to work for Africa. We urge governments and civil society organisations to champion the redesign of international financing mechanisms and global health initiatives so they reflect Africa’s unique needs, leadership, and priorities — advancing locally driven equitable development, climate justice, and resilience.

For Citizens and Civil Society groups:

1. Unite and hold power accountable. Citizens and civil society groups must organise across sectors, such as climate, finance, food systems, gender, and health systems, and nature, to act collectively in pursuit of a new transformative resilience agenda. Silence only serves the now unsustainable status quo — while unity of purpose can drive lasting change. Let civil society and indeed all actors embrace “whole-of-society” approaches to build resilient systems.
2. Debunk the false capacity deficit narrative — center African leadership and households in health reform. Dependency has normalised a false deficit narrative. Achieving UHC requires rebuilding confidence in African governance and placing households at the center of health systems — not as passive recipients, but as active agents where water, energy, nutrition, and care converge. We must redesign health systems to prioritise health, not just healthcare.
3. Push for locally-driven global health governance. Global health initiatives, including Gavi and the Global Fund and others, must evolve to prioritise sustainability, national capacity, and African representation, in line with the Lusaka Agenda to transfer capacity and accountability locally.

For Africa’s Development Partners:

1. Partners must bolster local systems. Intervention-specific and disease-specific aid has weakened systems. We urge development partners and global health initiatives to prioritise investment and solutions that break silos and strengthen cross–cutting systems for health and development, while building local capacity for sustainability and ultimately resilience.
2. Leverage investment to drive local accountability and sustainability. Aid must reinforce, not replace, domestic accountability. We urge development partners and global health initiatives to structure systemic investments to bolster local capacity and drive accountability of local governments. True impact lies not in temporary gains but in providing time-bound support to enable governments to take full ownership of the provision of equitable, accessible, accountable, and sustainable services.

There’s always talk about Africa, but rarely a unified voice or collective role. We must focus on generating our resources by trading what we produce to strengthen our systems. At the same time, embracing peace is critical to reducing fragility and preventing constant emergencies.

Ladies and Gentlemen, we believe that now is the time for our governments to step up to meet the current and future needs of Africa’s people, for development partners to act in solidarity, and for civil society to hold our leaders and systems accountable. Together, we can break the cycle of dependency and build economies that are resilient and self-reliant.

Thank you.

Sincerely, 

1. African Population and Health Research Center (APHRC)
2. AIDS Healthcare Foundation (AHF) Kenya
3. Amref Health Africa
4. AYARHEP KENYA
5. Community Initiative Action Group Kenya
6. ESCR-NET
7. Global Strategic Communications Council (GSCC)
8. Haki Jamii
9. Health NGOs Network (HENNET)
10. Health Rights Advocacy Forum
11. Institute for Economic Affairs (IEA)
12. Kenya Medical Practitioners Pharmacists and Dentists Union
13. Kibra-Kenya
14. Kuza Trust
15. Médecins Sans Frontières France (MSF)
16. Nairobi County TB Champions
17. ONE
18. Pandemic Action Network (PAN)
19. Peoples Health Movement Kenya
20. Resilience Action Network Africa (RANA)
21. SDG2 Advocacy Hub
22. Sharing Strategies
23. Social Justice Centers 
24. Stop TB partnership – Kenya
25. The Eastern Africa National Networks of AIDS and Health Service Organizations (EANNASO)
26. Transform Health Coalition
27. Umande Trust
28. WACI Health
29. Women Voices
30. Wote Youth Development