By Dr. Ahmed Ogwell, CEO, VillageReach
In July, the U.S. government officially dissolved the U.S. Agency for International Development (USAID). Weeks later, a U.S. court cleared the way for the Trump Administration to continue blocking billions in foreign aid. For Africa and other regions that have long relied on donor contributions to health and development, these events mark more than a funding freeze; they signal the end of an era.
What replaces that model will define the future of health for the millions of people who still wait too long, travel too far or miss out entirely on the health services they need. In Africa, where health needs are rising and donor support is increasingly uncertain, governments are being forced to navigate an entirely new reality. The key question now is not how much we spend, but how well we spend.
Efficiency over Austerity
Across the continent, health budgets are under immense strain from rising debt, shrinking donor support, competing development needs and the ever-present threat of the next pandemic. Traditional donor-driven models—often fragmented, rigid and externally dictated—are failing communities, especially the most under-reached.
Cutting back is not the answer. Slashing support would leave millions more without appropriate care and reduce productivity among the same populations that are needed to drive economic growth.
The alternative isn’t austerity—it’s efficiency. By prioritizing investments in efficient and responsive primary health care systems—systems that are available when needed, adapt to demand changes and better absorb shocks, and that respond to the needs and preferences of under-reached communities—we can safeguard the health gains secured over decades of progress and mitigate the impacts of funding cuts.
This is not just a moral imperative; it is smart economics. In this context, efficiency is not about spending less; it’s about redesigning systems to maximize impact and get more value for every investment.
This means integrating services to reduce duplication and promote efficient use of resources; embracing blended financing models to unlock sustainable funding from public, private and philanthropic sources; leveraging data to inform allocation of resources based on needs and institutionalizing strong governance and accountability mechanisms to eliminate wastage of resources and rebuild trust in public health systems.
With the right policies, partner alignment and innovative, evidence-based actions, even modest investments can achieve outsized results.
Proof in Practice: Where Innovation Meets Impact
Across Africa, there are already powerful examples of what smart systems can look like, with cost-effective innovations being implemented to strengthen health systems in limited-resource settings. For instance, by optimizing existing transport infrastructure and leveraging digital tools to collect and analyze data and track laboratory samples in real time, my team at VillageReach is helping modernize laboratory sample transport in key countries, strengthening disease surveillance, speeding up outbreak response and minimizing waste.
More countries are also turning to digital health solutions, including those powered by artificial intelligence (AI), to connect more people to care. Solutions such as AlôVida, a telephone hotline developed in partnership with the Mozambique Ministry of Health, provide timely and relevant health information and reduce the need for in-person consultations, which are often expensive and time-consuming. Other countries are digitizing their immunization records, helping health workers track who has received which vaccines, thereby cutting down on missed opportunities, preventing unnecessary repeat doses and enabling better forecasting for future stock needs. These technologies are not only bridging access gaps, but they also make entire systems more responsive, efficient and equitable.
The Real Opportunity: Strategic Investments, Smarter Partnerships, Stronger Systems
There is no denying that Africa remains in urgent need of accelerated funding for health and will require continued support to plug gaps in the near term. However, the real opportunity goes beyond securing more aid, to positioning the health sector as a viable investment—similar to manufacturing, tourism or technology—building smarter partnerships and laying the foundation for stronger health systems. This calls for visionary African leadership that sets the agenda and follows through on commitments, private sector collaboration to bring new tools and models to the table and ensure accountability for greater returns on investment and bold partnerships with investors rooted in equity, mutual respect and shared priorities.
Cross-sectoral partnerships are already making a difference in countries like Kenya, where the Community Health Units for Universal Health Coverage (CHU4UHC) initiative is supporting the government to strengthen supply chains and build capacity among health workers at community level, expanding access to quality care in rural communities. This is just one example of what’s possible when collaboration is prioritized and strategic investments are made through innovative, fit-for-purpose models.
The old model of foreign-led development is fading. In its place, we must build a new one, focused not on inputs, but on outcomes and efficiency.
The road ahead will not be easy. The funding that once powered much of global health will not return to the same form or scale. But this moment also presents an opportunity to rethink what’s possible. Rather than viewing efficiency as a constraint, we can choose to consider it an invitation to break down silos across sectors, align around shared goals and embrace innovative new approaches.
That is how we protect past gains and build a healthier, more self-reliant future for Africa, ensuring our health systems deliver better for everyone, everywhere.
