African Governments Urged to Fully Finance Primary Health Care through Taxation and Build Trust with Progressive Benefit Packages

Public health Experts have advised African governments that for Sustainable PHC financing in Africa to be realized it must be anchored in domestic tax-based systems with context-aware benefit packages, and meaningful community participation.

The experts warned that without political commitment and consistent investment, PHC risks remaining a rhetorical goal rather than a practical tool for universal health coverage and equitable development.

Public health experts also called on the African governments to gradually implement a well-defined PHC benefit packages that respond to people’s needs. This, they argue, will foster public trust and transform PHC from a political aspiration into a practical and sustainable reality.

Speaking during a high-level panel discussion titled ‘Sustainable Financing for Primary Healthcare: Strategies and Innovations’ at the concluded Evidence for Development Conference (Evi4Dev)—co-hosted by the African Union Development Agency (AUDA-NEPAD), Science for Africa Foundation (SFA Foundation), and African Institute for Development Policy (AFIDEP)—experts emphasized that PHC must be viewed as a public good and core national investment.

“Core investment in people should include health, security, education, and food security—all of which should be exclusively funded by government,” said Dr. Andrew Dabalen, Chief Economist at the World Bank.

“Health is the most core investment that every responsible government can offer its people,” he added, warning against relying on health insurance driven by market forces which can lead to high costs and poor outcomes.

Dr. Dabalen argued that outsourcing health funding to donors has left African health systems vulnerable to foreign political and economic fluctuations. Instead, he advocated for innovative domestic solutions such as advance market commitments for vaccines, debt swaps, and pooled procurement platforms to reduce costs and boost access.

Dr. Georgina Bonet, Health Financing Officer at the World Health Organization (WHO), emphasized that PHC financing must be broad and inclusive.

“Primary health care is not just about accessing services at health facilities—it must include community engagement, disease surveillance, and public health response systems,” she said.

“Countries that have prioritized public financing and population-wide coverage before prioritizing difficult and high level spending programs have seen better outcomes.”

Bonet pointed to successful financing models such as Ghana’s VAT levy dedicated to health, sin taxes on tobacco and alcohol in Botswana and Senegal, and integrating PHC into social protection schemes in Ethiopia. These approaches, she said, provide critical lessons for scaling up equitable and sustainable PHC financing.

“It’s not just about spending more, but spending better. Harmonized payments, frontline funding, and long-term political commitment are key,” Bonet emphasized.

Dr. Mike Mulongo, a health financing specialist, stressed the importance of designing benefit packages that are context-specific, equity-driven, and responsive to community needs.

“Kenya and Uganda are neighbors, but their socio-political and economic contexts differ greatly. A one-size-fits-all approach won’t work,” he noted.

“Designing PHC without including marginalized groups—women, refugees, the elderly, and the poor—will only deepen inequalities.”

Mulongo warned against overly ambitious benefit packages not grounded in fiscal realities, noting that such packages can erode public trust when they are not delivered.

“Progressive realization means starting small, building trust, and expanding benefit packages as resources allow,” he said.

“We need to clearly link entitlements to robust financing mechanisms—otherwise, we risk creating political wish lists that never materialize.”

Melissa Wanda, Public Health Specialist at PATH, highlighted Kenya’s policy reforms aimed at revitalizing PHC. She praised the enactment of four key laws in 2023: the Social Health Insurance Law, Digital Health Law, Facility Improvement Act, and the Primary Healthcare Act.

Primary Healthcare Act reforms marked a shift from curative to preventive healthcare, with the Facility Improvement Finance (FIF) Law allowing facilities to retain and manage funds to fill gaps in staffing and supplies when government disbursements delay.

“Kenya has robust policies in place, but there’s a feeling that community voices were left behind in designing benefit packages,” Wanda said adding that, “Fragmentation of service delivery remains a major barrier. Integration must be done from policy down to the facility level.”

Wanda also highlighted the potential of interoperability of health systems—enabled by the Digital Health Law—that aims at creating functional smart primary care networks that are digitally coordinated, interconnected and data-driven.