Health financing, an imperative to accelerate action towards universal health coverage

Cotonou, July 10-12, 2025, the West African Federation of the Private Health Sector (FOASPS), in partnership with Benin’s Private Health Sector Platform (PSSP), has initiated it’s first high-level conference on health financing, with the support of key partners: the West African Health Organization (WAHO), the World Health Organization (WHO), PSI/ABMS and Speak Up Africa.

Under the theme “Building resilient health systems: public-private partnerships for sustainable health financing”, the two-day conference at the Palais des Congrès brought together over 200 political decision-makers, representatives of regional and international institutions, parliamentarians, public administration executives, representatives of consular and employers’ chambers, health and non-health private sector leaders, civil society actors and researchers from all over the region, for exciting discussions, engaging debates, enriching thematic panels and remarkable exhibitions.

Rethinking health financing, a quarter century after the Abuja Declaration.

Only 5% of African countries are meeting the Abuja commitment to devote 15% of the budget to health, according to World Health Organization data, while 44% of households contribute to financing their own healthcare.

Dr Hugues Tchibozo, Representative of the Director General of the West African Health Organization (WAHO), warns of the decline in external funding. “We need to strengthen local governance, rethink financing models and adapt regulatory frameworks to current challenges,” he stressed.

Dr Joseph Boguifo, President of the West African Federation of the Private Health Sector (FOASPS), recalled that in several countries, the private health sector provides up to 60% of care and invests massively in innovation, training and pharmaceuticals, and contributes strongly through taxation to the overall financing of public spending. “The private sector is not a competitor to the State, but a partner rooted in the regions, close to the real needs of the population”, he insisted.

The private sector, engine of change

The highlight of the debates was a panel devoted to the fight against malaria, under the evocative theme: “Innovative financing and public-private partnerships, essential pillars for achieving malaria elimination”.

Moderated by Franz Okey, Regional Advisor at Speak Up Africa, the panel opened with a worrying observation: « Every minute, a child dies of malaria. And every year, 4.3 billion working days and more than 1.5 billion school days are lost », he recalled. These figures have serious consequences for African economies. According to the WHO, $42 billion could be saved by 2030 if the fight against malaria were fully funded.

But this ambition is undermined by a context of declining funding. “The gradual withdrawal of certain donors, such as USAID, and the adjustment of Global Fund spending in several countries in the region are warning signs”, warned Franz Okey. As we approach the next replenishment of the Global Fund, with a target of $18 billion, uncertainties loom.

Hon Constant Nahum, Coordinator of the Parliamentary Caucus for the Elimination of Malaria, highlighted a number of major achievements. ‘’The creation of the parliamentary caucus, with its three-year plan 2025-2028 and its procedural rules, marks a new stage, » he said. The aim is to mobilize more domestic resources following the significant budget increases recorded over the past three years. The caucus will initiate bilateral partnerships, notably with China, and integrate the fight against malaria into national budgetary policies and laws on a long-term basis, he added.

For her part, Dr Annabelle Ekué, Director of Pharmacie Camp Guézo and champion of the fight against malaria, focused on the impact of malaria on business productivity. ‘’Each affected employee is absent for an average of 15 days a year, representing a direct loss of productivity estimated at $12 billion a year ». In addition to being the leading cause of hospital consultations, it is also the leading cause of absence from work. “The burden of malaria is heavy”, she insisted.

The coordinator of the National Malaria Control Program (NMCP), Dr Codjo Dandonougbo, agreed with his co-panelists. Among children under 5, malaria still accounts for 33% of admissions, 31% of hospitalizations and 21% of deaths. “This is equivalent to one child dying every four hours in Benin,” he says. Nonetheless, he notes that there has been notable progress in the fight against this disease in Benin. He mentioned the introduction of the malaria vaccine, which puts Benin in a stronger position. We realize that the number of countries with high malaria rates is growing all the time, » he said. The RTS’S vaccine is a major step forward, according to this health professional.

Panelists hailed the creation of the Zero Malaria Fund, supported by the Ministry of Health, as an innovative and inclusive financing platform. They made intelligent recommendations to accelerate the march towards eliminating the disease, highlighting the importance of mobilizing the private sector in rural areas, technological innovations, and better data sharing between stakeholders.

A new regional pact for resilient health systems

The Cotonou conference was a powerful catalyst for collective reflection on the critical issue of health financing in Africa. It brought together committed actors to confront persistent challenges, notably the consequences of budget cuts and the gradual withdrawal of donors such as USAID. Together, they explored concrete solutions and shared inspiring practices to strengthen resilience in the face of financial shocks. Discussions highlighted essential levers such as social taxation, the health tax, the use of bank loans, the development of medical group practice, the adoption of a specific law on public-private partnerships in healthcare, and the establishment of a dedicated investment fund. The importance of an intersectoral and multi-sectoral approach was also stressed as essential to building sustainable and equitable healthcare financing on the continent.

At the close of proceedings, Dr Latif Mousse, Chairman of the PSSP, expressed his satisfaction in achieving this “dream” long held by private sector actors. “We have laid the foundations for recognizing the private healthcare sector as a highly social and more or less commercial sector,” he asserted. “It’s not just a question of financing the private sector, but of making this pillar an essential lever for achieving universal health coverage,” he added.

Dr. Lamidhi Salami, President of the National Primary Health Care Council and representing the Minister of Health, assured the audience that the Ministry of Health would play its full part in implementing the commitments contained in the Cotonou Declaration, adopted at the end of the proceedings. This declaration marks a strategic turning point for the financing and governance of the healthcare system in Benin and Africa.

The commitments made are based on resilience, co-construction and social justice. The challenge is now to transform the strong words of Cotonou into concrete actions for mothers, children and the whole of Benin’s  population.

The first edition of the “High-Level Conference on Health Financing in Africa” marked a strategic turning point. A strong consensus emerged: to make public-private dialogue an institutionalized and sustainable framework, to ensure real equity in access to healthcare, and to reposition healthcare financing as an essential lever for human development.

The message is clear: healthcare is not a burden, but a structural investment in the continent’s future. As such, the private sector is no longer on the sidelines – it is becoming a key partner in the co-construction of solid, inclusive and resilient healthcare systems.