Ebere Okereke, an independent global health expert, has urged African governments to treat health spending as a strategic economic investment rather than a social cost or burden.

Ms Okereke, who is also an associate fellow of Chatham House, said on Sunday that governments must rethink how health financing is presented during national budgets and policy discussions.

According to her, health is often framed primarily in humanitarian or social terms, making it more vulnerable to cuts when governments face competing fiscal pressures.

“Governments need to change how they make the case for health in budget and policy discussions. Instead of presenting health mainly in terms of need, they should present it in terms of economic return, labour productivity, resilience, and the cost of inaction,” Ms Okereke said.

She said underinvestment in primary care, prevention and health system preparedness often leads to greater long-term costs through disease outbreaks, loss of workforce productivity, household impoverishment and expensive emergency responses.

She noted that reframing health financing as part of economic policy could make it easier for governments to prioritise the sector even during periods of fiscal constraint.

The expert also mentioned that health financing discussions must extend beyond ministries of health. She explained that ministries of finance, planning, and labour, as well as heads of government, must recognise the strong link between health systems and national economic performance.

“When health is linked to workforce participation, human capital, fiscal risk and social stability, it becomes easier to defend in tight budgets and harder to treat as a discretionary social cost,” Ms Okereke said.

Despite decades of commitments to strengthen health systems across Africa, Ms Okereke said the core challenge often lies not in resource availability but in governance and implementation.

“The first reform is to move from allocation to execution. In many countries, money is approved for health but is not spent well, or sometimes not spent at all,” she said.

She said improving budget execution, strengthening procurement transparency and reinforcing public financial management systems were essential for translating allocations into real improvements in health services.

According to her, accountability mechanisms must also involve institutions beyond the executive arm of government.

“This is not only a technical problem. It is also a political one. The issue is often not knowledge but weak incentives and limited accountability. That is why parliaments, audit institutions, civil society and the private sector also matter,” Ms Okereke said.

With global development assistance for health becoming increasingly uncertain, she said African governments should prioritise domestic financing mechanisms that are already known and feasible.

She identified health levies, excise taxes on tobacco, alcohol and sugary drinks, as well as insurance pooling arrangements, as potential sources of sustainable funding for health systems.

“Health levies, excise taxes, insurance pooling arrangements and other ring-fenced instruments can all play a role,” added Ms Okereke.

She added that debt-for-health swaps could also be useful in certain contexts, although their complexity makes them less likely to serve as a broad financing solution across the continent.

“The issue is not a lack of financing ideas. Proven mechanisms already exist, but they are unevenly governed, inconsistently scaled and insufficiently embedded in national systems,” Ms Okereke explained.

She noted that strong governance structures were essential for these financing instruments to succeed.

“These instruments work only when they have a clear legal basis, transparent reporting, independent oversight and protection against diversion and inflation erosion,” Ms Okereke said.

She further noted that improving the use of funds already approved in national budgets could provide one of the fastest ways to strengthen health financing.

“In the current context of tight fiscal space, high debt servicing and declining external assistance, improving budget execution may be one of the fastest and most practical ways to strengthen health financing,” Ms Okereke said.

On the role of data in policy decisions, Ms Okereke said governments must ensure that evidence is not only generated but also used effectively in budgeting and planning processes.

“Governments need to make evidence usable, not just available,” Ms Okereke said.

She recommended that countries begin by realistically costing a defined package of essential health services and using that information to guide budget decisions. Ms Okereke also called for stronger integration between routine health data, National Health Accounts, private-sector service data and fiscal planning.

“Reforms become more credible when they are based on country-owned evidence, realistic assumptions and clear priorities rather than aspirational plans or external preferences,” said Ms Okereke.

(NAN)