Around the world, the model for health financing is changing. Between 2024 and 2025, global health funding fell by more than 20%, leaving many organizations scrambling to continue vital work. A recent study from The Lancet Global Health, with support by The Rockefeller Foundation, found that a major drop in global aid could lead to 22.6 million additional deaths by 2030, including 5.4 million children under the age of five. Of nations facing the greatest risk, nearly half are in Africa.
But great change can bring great opportunity. What if the old, donor-centric model was replaced by a new model that is led by and centered on the people it serves? The ONE Campaign, which has worked for more than two decades to support a healthier and more economically secure future for Africa, believes it can be done. In the spring of 2025, ONE brought 20 leaders and changemakers together at the Bellagio Center to discuss how to adapt to these changes, expand the resources available for public health in Africa, and incentivize spending on African health systems.
One critical output was “A New Vision for Health Financing in Africa,” which outlines an African-led, blended-financing model for public health. Using innovative, sustainable approaches, it aims to ensure African governments can meet basic health needs, prioritize health as a tool to drive economic growth, and address key social determinants of health, such as clean water, sanitation, nutrition, and health care.
In the year since the convening, the plan is already beginning to bear fruit. African leaders are advancing its proposals through national, global, and regional institutions. ONE shared their plan at the 80th session of the U.N. General Assembly, and pilot programs in Sierra Leone and Senegal are in motion.
We spoke to ONE Campaign leaders Serah Makka, Executive Director for Africa, and William Menson, Director of Health Financing for Africa, about how global health funding changes are impacting African health, how their model differs from donor-driven health financing, and what others looking to reimagine global development can learn from their experience.
The COVID-19 funding and supply crises demonstrated that if Africa did not bring elements of its health financing, manufacturing, and production to the continent, we would be at the back of the line when the next challenge came along.
Serah MakkaExecutive Director for Africa, The ONE Campaig
How has the realignment of global health financing affected health efforts in Africa?
Serah
The COVID-19 funding and supply crises demonstrated that if Africa did not bring elements of its health financing, manufacturing, and production to the continent, we would be at the back of the line when the next challenge came along. So in 2024, we began exploring what it would look like if Africans and African governments had more agency and sovereignty in our healthcare. While we were taking that journey, USAID withdrew from many countries.
The loss of donor funding has impacted countries across the continent. More than half of Malawi’s health budget is donor funded, for example. Even in nations with a lower percentage of donor funding, donor agendas still drive healthcare. If a donor is focused on malaria, the country’s entire health system tilts toward that one disease, because that’s where the incentives are. But the larger health infrastructure still isn’t being built.
William
Countries’ domestic resources are already overstretched. We released a report last year showing that nearly 30 African countries spend more on debt than on health. So how do we find more money in a system where donor funding is at an all-time low and falling? Our Bellagio Center convening was an attempt to answer these questions. We brought together a group of experts—Africans and bright minds from around the globe—to tackle where funding is going to come from.
Tell us about the model developed at the Bellagio Center convening.
Serah
Our model is based on three principles: Centering Africa in the work, viewing health as an economic driver, and designing for the most vulnerable using an ecosystem approach.
First, we want countries looking for domestic resources to start with their current budgets. Implementing technology and budgeting and allocating more effectively can help free up funding for health.
Next, we want countries to think of health as driving revenues, rather than costs. Around the world, many nations’ populations are aging and will need more health workers to care for them. Africa, on the other hand, has a very young population, with 800 million residents entering the workforce by 2050. How do we ensure African health workers who migrate to other countries still create revenue for African health? The remittances sent by the diaspora eclipse the entire budgets of some countries. How can countries harness this economic power to fund healthcare? We’ve partnered with the Insurance Development Forum to create a program called HealthBridge to help us reach that goal.
Along with these steps, we need to reform how global health institutions work, so you don’t have a situation where one organization buys five trucks for a district and then another buys 10 more for the same place.
William
Our north star is for African countries to be able to fund their own healthcare. To get there, we work with countries, international institutions, and global health initiatives to raise more money for their health systems.
Our solutions are demand driven. If a country is open to launching new taxes to fund healthcare or expanding vaccine manufacturing, we can work with partners to support those efforts. If servicing debt is an obstacle, we can help countries explore debt swaps, where they agree with creditors to put funds that would normally go to debt repayment towards healthcare and services.
What makes this model a breakthrough, compared to the old donor-centric approach?
Serah
This model is a true expression of Africa’s agency. It is also empathetic. We’re not asking African leaders to do the impossible. We’re walking in their shoes and looking for ways to bring in new resources for health.
William
There’s also growing alignment on where we are and where we need to be. People see that this is an emergency, a genuine financing cliff, and there are broader political mandates for reform. Health financing as a tool of sovereignty and security, not just an expense. The health needs of countries are changing, requiring new interventions. And we have better implementation tools, like the World Health Organization’s health financing progress matrix. All these things underscore the need for innovative financing, increased resources, and domestic resource mobilization. And we’re seeing those ideas being embraced by countries and international institutions.
Serah
Ghana started us off last year with the Accra Reset, which is reimagining development in Africa with a focus on sovereignty and sustainable, local systems. Health is a big part of that. At the upcoming health meeting of the Economic Community of West African States (ECOWAS), financing is at the top of the agenda. Rwanda has taken great initiative in expanding their health insurance coverage, while Ethiopia has developed exemplary community health worker systems to ensure that everybody who needs healthcare gets it. Back home in Nigeria, the Minister of Health, Dr. Muhammad Ali Pate, is driving the country forward in terms of health. While there is more they can still do, they’re taking things in the right direction.
William
We’re also seeing new incentives from the donor community, with more and more looking to support domestic resource mobilization. Many see the writing on the wall and are urging players to be more creative about resourcing for the system. In terms of global health initiatives, Gavi is anchoring all their work in the Gavi Leap, which centers the countries they serve, giving them a greater say on what money will be used for, with fewer dictates from Geneva. U.N. agencies are also looking to relocate a lot of their work into the continent. I believe that these things really will lead to actual change.
What can others in global development learn from your experience over the past year?
Serah
You have to keep the right people in the center. When conversations about Africa are taking place, it can’t just be two of us from Africa representing a continent of 1.4 billion people. Our convening didn’t isolate the conversation just to Africans, but they made up a large proportion of the people who took part, centering on African needs and how Africa can drive efforts to address them.
It’s also important to bring people in early and get buy-in. There’s no way we could have done this without the partnerships and commitment of the people who co-designed. Collaborative design is the nature of humanity. We all want to put our fingerprints on something and have ownership of it.
William
There’s a saying that became quite popular in the days of COVID: Until all of us are safe, no one is. No one can do this work alone. That’s why it’s so important that we find and communicate what’s in it for everyone. Activists in Europe and Africa need to be working hand-in-hand for our joint future, because the world needs us to band together.
At its core, Serah sees this approach as being rooted in a longstanding African concept. “We need to find a place for Ubuntu – where my future is interlinked with your future and we have all stake in what the new world looks like,” she said. “Europe can see its existential crisis, just as Africa and Asia can. Let’s band together and create something more beautiful.”
Learn More:
- Watch a a conversation with ONE Campaign CEO Ndidi Nwuneli on reimagining African health financing.
- Read a deep dive into the data on how global financing changes are affecting health systems in Africa.
- Watch a conversation with Serah Makka and other global health leaders on reforming global health financing from the 2025 World Heaktg Summit.
The opinions expressed in this article are those of the authors. The Rockefeller Foundation is not responsible for and does not endorse its content.