Africa must strengthen health systems through innovation and collaboration to achieve universal health coverage, write Mengistu Asnake, Rispah Walumbe.

The economic case for investing in health systems has never been more compelling, yet the path to Universal Health Coverage (UHC) remains frustratingly complex.

A global UHC monitoring report published by the World Health Organization (WHO) last year confirms the enormity of the crisis: more than half of humanity—4.5 billion people—still lack access to essential health services. Two billion people are facing devastating financial hardship from healthcare costs.

Every year, according to the report, 1.3 billion people are pushed into poverty—or further into poverty—due to out-of-pocket health expenses.

With climate change and emerging pandemic threats adding to the pressure, it’s clear we need a fresh approach to strengthening health systems.

Despite these huge challenges across Africa, we’re seeing some positive interventions.

In Ethiopia’s rural communities, health workers demonstrate extraordinary resilience and commitment to community health.

They have been instrumental in implementing high-impact health interventions, such as maternal and child health services, despite lacking some essential skills, facing systemic design flaws in the programme, physical exhaustion and very limited resources.

In Kenya, stipends are being offered to Community Health Promoters, creating crucial bridges between formal health systems and local communities.

These grassroots efforts demonstrate the potential for change, even within fragmented healthcare landscapes.

The stakes couldn’t be higher. A recent Lancet analysis suggests a greater than 20 per cent chance of another pandemic causing at least 25 million deaths in the next decade.

The life expectancy gap between Africa and higher-income regions, such as Western Europe, remains a staggering 22 years—an indication of entrenched inequalities and missed opportunities for strategic investment.

The work of Pathfinder and Amref across the continent demonstrates that effective health system transformation is possible.

Ethiopia’s Transform Primary Health Care project has improved service delivery and health-seeking behaviours, training over 110,000 health workers who serve 57 million people.

In Kenya, Amref Health Africa’s Primary Care Networks show how strategic resource distribution between primary and higher-level facilities can improve care quality.

Digitisation efforts in these networks underscore how technology can boost efficiency and care delivery.

Countries could potentially reduce the risk of premature death by 50 per cent over the next 25 years through focused health system investments.

While this goal might seem ambitious—especially given we’re likely to miss many of the 2030 health targets set out in the Sustainable Development Goals—meaningful progress is within reach.

The key lies in building people-centered primary healthcare systems that address communities’ most pressing health needs.

This means ensuring essential medicines are available and affordable and supporting health workers with necessary skills and resources.

We must also embrace multisectoral approaches that view the health system through the lens of collaboration.

We must develop health systems resilient enough to maintain essential services during crises, invest in emergency preparedness, strengthen supply chains, and develop flexible service delivery models.

We must leverage digital technologies thoughtfully and equitably. While technology alone cannot solve health system challenges, strategic digital investments can enhance service delivery, improve data use, and extend healthcare reach.

“Health: It’s on the government!” is the theme of this year’s Universal Health Coverage Day (12 December), underscoring governmental responsibility.

Yet success demands broader engagement.

While 93 per cent of African countries include UHC in health sector policies, only 37 per cent have formal political commitments beyond healthcare, according to a report of the Africa Health Agenda International Conference.

This gap highlights the need for a whole-of-society approach, with civil society organisations playing a crucial role in maintaining accountability.

Effective leadership drives transformation, as seen in the primary health care project in Ethiopia, where strong national and regional coordination has enabled widespread health system improvements.

When local voices shape health services and community needs guide implementation, we witness the emergence of healthcare systems that truly serve their populations.

The private sector’s expertise in supply chain management and digital innovation, when thoughtfully applied, can further strengthen these systems while maintaining accessibility.

Achieving universal health coverage is more than an aspiration—it’s an imperative.

Through focused investment, strategic partnerships, and an unwavering commitment to equity, we can build health systems that leave no one behind.

The challenges are significant, but the path forward is clear: strengthen primary healthcare and embrace innovation to truly serve everyone.

Mengistu Asnake is the senior country director at Pathfinder International, Ethiopia. Rispah Walumbe is a policy advisor at Amref Health Africa. They both serve on the Civil Society Engagement Mechanism for the UHC2030 Advisory Group.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.