The African Union Commission convened global and regional health leaders, National Heads of States and Governments in Addis Ababa on the 9th February 2019 for the African Leadership Meeting (ALM)- Investing in Health.

A crucial outcome of the meeting was the “Addis Ababa Commitment toward Shared Responsibility and Global Solidarity for Increased Health Financing Declaration”. The Declaration, otherwise known as the ALM Declaration, is an initiative geared towards increasing domestic resources for health and reorienting health systems in Africa.

  • Overview
  • Milestones
  • Key Facts & Figures
  • Key Messages


The endorsement of the ALM Declaration by Heads of State and Government of African Union (AU) Member States serves as recognition for the need to improve the health financing status quo in Africa, by investing increased domestic funds for health in a more effective and efficient way.

The Declaration specifically calls for Increased Domestic Resource Mobilization for Health; and in tackling existing inefficiencies in health budgets towards financing more effective and efficient health systems. The declaration also calls for better collaboration between multi-sectoral actors - regionally and globally - to strengthen existing health systems in AU Member States. It further invites the private sector to explore and seize existing opportunities for investing in the health sector.

High-impact, multi-sector partnerships will go a long way in strengthening the concrete asks of the ALM Declaration which include:

  • Establishing a number of regional health financing hubs to support countries implement evidence-based health reforms, processes and policies. These hubs will also support advising countries on enhancing the impact of both domestic funds and development assistance for health;
  • Developing a domestic health financing tracker that will enable AU Member States to track step-by-step progress of resource allocation and key reforms towards increased domestic financing;
  • Digitizing the Africa Scorecard on Domestic Financing for Health and the domestic health financing tracker to allow greater comparability, transparency and enhanced communication of existing health financing data. The scorecard will also allow countries to monitor and interpret historic trends and progress on health financing, and to improve learning and accountability;
  • Building an accountability framework to define roles and responsibilities of different stakeholders to enhance collaborative implementation;
  • Setting up a Technical Working Group, and number of sub-committees to encourage diverse solutions from a vast pool of technical experts across both public and private sectors to make sure no health financing dimension is left uncovered;
  • Convening a biennial consultation meeting with Ministers of Health and Finance to enhance collaboration for increased domestic resources for health and improved health expenditure efficiency;

All of these concrete asks, form the basis of a programme of work for the African Union Leader for Domestic Health Financing, His Excellency Paul Kagame, President of the Republic of Rwanda


The 2001 Abuja Declaration was a historic milestone for Africa. The AU Member States met and pledged to set a target of allocating at least 15% of their annual budget to improve the health sector. Over the years, health expenditure in Africa has increased significantly, but domestically financed government spending has stalled.

According to the 2019 Africa Scorecard on Domestic Financing for Health: only two AU Member States dedicate 15% of the government budget to health; five dedicate 12%; twelve dedicate 10%; twenty dedicate 8% of GDP on health; and 29 spend less than 7%.  Moreover, out-of-pocket spending on health exceeds 20% in 41 AU Member States.

Development partner spending on health constitutes more than 50% of total health spending in three AU Member States; more than 40% of total health spending in 10 Member States; 25% in 20 Member States; and 10% in 17 Member States.

Africa is home to 16% of the world’s population. The continent accounts for 26% of the world’s disease burden yet receives just 1% of global health spending. As a result, 11 million Africans are falling into poverty every year due to high out-of-pocket health spending.

This must change. The future of Africa depends on its people. To make progress on the path of sustainability requires that Member States make substantial incremental increases in domestic investment in health every year. The Declaration, if implemented with sustained political commitment and accountable leadership will deliver Africa to the desired change.

July 11-12, 2019
The Pan African Parliament Summit: Brazzaville, Republic of Congo Parliamentarians in attendance signed a communiqué where they pledged to support the ALM Declaration through various ways, importantly, by passing policies aiming at increasing domestic health financing and enhancing accountability during implementation of the Declaration;

July 29 - 2 August, 2019
Third Ordinary Session of the Specialized Technical Committee on Health, Population and Drug Control (STC-HPDC 2019): Cairo, Arab Republic of Egypt The Department tabled several suggestions to Ministers of Health from African Union (AU) Member States regarding domestication of the ALM Declaration and respective implementation mechanisms and strategies. Following in-depth discussion, they endorsed establishment of: Regional health financing hubs; A domestic health financing tracker; An Accountability Framework; and Technical Working Groups. They also endorsed digitization of the Africa Scorecard on Domestic Financing for Health and the tracker;

August 2019
The Commission sent out letters to AU Member States calling upon their commitment towards health financing with specific reference to participating in the Replenishment Cycles and Conference in Lyon. 24 AU Member States responded to this call and leading to a cumulative pledge of US$ 75.2 million from Africa. This, in fact, is a 90% increase in Africa’s pledges from the 2017-2019 Replenishment cycle, which is a commendable indication of growing commitment from our leaders to improving health financing in Africa;

November 12, 2019
ALM Declaration Technical Working Group Meeting Kigali, Republic of Rwanda The Department organised and executed the first ALM TWG. The conceptual frameworks guiding formation of the tracker, the regional health financing hubs and accountability framework were presented to the vast pool of health financing experts across both public and private sectors present at the meeting. The experts offered their recommendations which were used to improve the concept notes. They were also briefed on the outcome of the July STC-HPDC 2019 regarding the same.

November 13 – 14, 2019
AIDS Watch Africa (AWA) Experts Consultative Meeting: Kigali, Republic of Rwanda Health experts from AU Member States working in the field of AIDS, TB and malaria were convened to prepare a report with key advocacy, resource mobilisation and accountability issues posed by the three diseases for the consideration of the AWA Heads of State and Government Action Committee. The progress of implementation of the ALM Declaration was presented to the experts who were well-pleased with the initiative and pledged their support. The meeting was attended by health experts from 21 AU Member States, AUDA-NEPAD, 4 Regional Economic Communities (RECs) and 24 partner organisations.

November 15 2019
African Union - Regional Economic Communities (RECs) Coordination Meeting: Kigali, Republic of Rwanda A working meeting with representatives from RECs was conducted to discuss hosting the regional health financing hubs within RECs. Representatives from Southern African Development Community (SADC), West African Health Organisation (WAHO), the East African Community (EAC), and Intergovernmental Authority on Development (IGAD) presented on their ongoing efforts towards strengthening health financing in Africa. The information was used to determine the RECs assessment mission schedule for 2020.

January – February 2020
The formation of technical working groups and subcommittees is currently ongoing. The members will shape and lead the strategic direction in which implementation of the ALM Declaration heads.

February 10, 2020
African Union Summit: Addis Ababa, Ethiopia His Excellency Paul Kagame, President of the Republic of Rwanda and AU Leader for domestic health financing briefed the AU Assembly on the progress of implementation of the ALM Declaration. His report was complemented by briefing from His Excellency Cyril Ramaphosa, the President of the Republic of South Africa and Chairperson of the African Union (AU) and AIDS Watch Africa (AWA) about the progress attained by AWA in 2019.

February 20, 2020
Regional Economic Communities (RECs) Assessment Mission: Arusha, Tanzania The Commission conducted its first RECs assessment mission in February to evaluate the capacity of the East Africa Community to host a regional health financing hub.

View scorecard here:


Health is a key aspect of human and economic development in Africa.
  • Recognizing this, countries are increasing investment in actions and reforms to strengthen health systems and thus improve health outcomes.
  • The health system consists of all organisations, people and actions whose primary intent is to promote, restore, or maintain health.
  • The primary goal of a health system is to improve health — both overall health and health equity — and to do so in ways that are responsive, financially fair, and make the best, or most efficient, use of available resources.
Ensuring Sustainable Financing for Health is a cornerstone for building stronger health systems.
  • Reducing financial barriers to access depends on coordinated intervention on regulation of user fee schemes, scaling-up health equity fund (HEF) arrangements in a sustainable manner and expansion of as an intermediate measure before an effective implementation of compulsory health insurance.
  • We also need to ensure alignment of public funding with the priorities of the health sector.
  • Unfortunately, global resources are limited, so we must make the best use of available resources even as we continue to generate additional resources for health.
  • Innovative resource mobilization instruments and prioritization of government spending on health will bridge the funding gap to a great extent.
Better collaboration towards establishing resilient and sustainable health systems that nurtures preventive care and health for all remains a critical issue.
  • External funds also remain critical and more is being done to ensure their effective use through improved predictability alignment with national priorities and mechanisms.
  • Different international development partners need to collaborate toward establishing resilient and sustainable health systems that nurtures preventive care and health for all.
Every human being has the right to health and governments have the responsibility of ensuring access to those things that safeguard health.
  • Because health is central to sustainable development, inadequate funding for health impacts not just health, but other aspects of social and economic development as well.
  • The poorest and most vulnerable people in society are often most dependent on the public health system, and are therefore most likely to be affected by how public resources are allocated.
  • Governments show their commitment to health largely by allocating public funds to health-related activities and initiatives.
  • Governments have an obligation to govern in the best interests of their citizens, ensuring that health budget formulation begins at the community level.
Gathering and presenting evidence in support of key arguments and positions will be critical for success.
  • Even if a government allocates funds to disadvantaged groups, weak financial management – and a lack of political ‘voice’ on the part of those groups – can mean that money does not always reach them.
  • Efficient accountability mechanisms will ensure that resources are being spent as they were intended to be.
Attainment of sustainable health financing in Africa is within reach.
  • However, it will require sustained political leadership and a clear strategic vision.
  • The path to attain healthy and well-nourished citizens - as mandated by the African Union Agenda 2063 - is through accountable leadership, joint effort, and dedication to protecting Africa against the impoverishing effect of catastrophic health payments.