Financing, ownership and partnership
A health improvement only lasts for the population that achieved it if it can be sustained financially in subsequent years. As detailed in Chapter 1, the reporting period started in the most adverse health-financing environment of recent memory.
Against this backdrop, the Region mobilized a historic regional bloc of sovereign pledges to the first-ever WHO Investment Round. It boosted the amount of voluntary contributions through a regional surge emergency resource mobilization plan and increased assessed contributions and expanded its private-sector and foundation share to 24%. Furthermore, the Region supported Member States in accelerating health financing reform and domestic resource mobilization under the Lusaka Agenda, revamped collaborations with regional economic communities and deepened the WHO–African Union strategic partnership at the heads-of-state level. This chapter sets out the resources mobilized, the sources of financing, national strategies for domestic health system financing, and the future trajectory of the global partnership architecture.
01The first-ever WHO Investment Round: a historic regional bloc of sovereign pledges
Predictable financing is the difference between a programme that runs to the end of the year and one that runs to the end of the disease. During the reporting period, 22 Member States, iii representing 47% of the 47 Member States of WHO African Region, pledged to the WHO Investment Round. Overall, the Investment Round mobilized US$ 3.8 billion globally from 71 contributors, reaching 53% of the target of US$ 7.1 billion. These pledges include a deliberate mix of low-, lower-middle- and upper-middle-income economies acting in solidarity, validating Africa’s leadership in the wider effort to secure predictable, flexible and resilient core financing for WHO.
Over the past year, 48% of these pledges were converted into liquid funds, up from 12% in July 2025. These commitments underpin the sustained delivery of essential services for the populations served by the pledging ministers. Three operational moves drove this outcome: the Regional Committee for Africa was used as an innovative resource-mobilisation platform for the first time in the WHO system, with the Seventy-fourth session of the WHO Regional Committee for Africa held in Brazzaville in August 2024 hosting the first Investment Round event ever held during a Regional Committee meeting and the Seventy-fifth session of the Regional Committee for Africa, held in Lusaka in August 2025, anchoring the next wave of pledges. In addition, more than 10 high-level briefings were prepared for the participation of African Member States in global pledging events.
Country spotlights
United Republic of Tanzania
securing health-security financing in the same year in which an outbreak tested it. In the same year that the Region responded to a Marburg virus outbreak in the United Republic of Tanzania, the country secured a US$ 25 million grant from the Pandemic Fund to boost health security and pandemic preparedness, pledged to the WHO Investment Round and hosted a high-profile partnership with the Coalition for Epidemic Preparedness Innovations through the African Vaccine Regulatory Forum. The sequence (domestic resource mobilisation, sovereign pledging and outbreak response in the same 12 months) is the operational form that the partnership architecture is meant to take.
Madagascar
a foundation partnership tied to lymphatic filariasis elimination. The partnership for lymphatic filariasis elimination in Madagascar demonstrates how a contribution by a foundation can be linked to a defined elimination end-point, rather than to an open-ended programme line. The model, in which foundation capital, ministerial leadership and WHO technical assistance are all measured against a single elimination target, is one of the clearest country-level translations of the call for strategic coherence among global health initiatives contained in the Lusaka Agenda.
Zambia
private-sector capital solving the electricity problem that holds back primary health care. Reliable electricity is not a luxury in healthcare: it is essential. A health facility that cannot keep a vaccine cold cannot deliver the immunization gains that the rest of the system pays for. The solar electrification of health facilities in Zambia is one of the most practical demonstrations during the reporting period that, when channelled through an effective partnership with WHO and aligned with the stated priorities of the ministry of health, private-sector capital can solve a binding infrastructure constraint at the primary care level. By leveraging an existing multilateral programme, this initiative demonstrates how private sector co-financing can expand health infrastructure efficiently, without creating parallel systems. As development assistance declines, such models offer a practical pathway for sustaining essential health services in resource-constrained settings. Importantly, such models are also replicable across the Region's energy-poor health facility networks.
02Outstanding challenges
The work is not yet done. The Region will face four unresolved challenges in the next biennium.
Firstly, the residual financing gap for base programmes. Reforms and mobilisation reflect part, but not all, of the WHO 2026–2027 funding picture. The Region’s base programmes carry a residual funding gap of US$ 662 million, set against a WHO-wide funding gap of approximately US$ 1.1 billion for the same biennium. Closing the Region’s share requires both expanded sovereign pledging, with a focus on the 25 African Member States that have not yet pledged contributions to the Investment Round and continued private-sector and foundation engagement.
Secondly, the conversion of pledges into disbursements. Pledges are far from actual disbursements. The most consistent failure mode across comparable Gavi and Global Fund replenishment cycles is the slippage between political commitment and budgetary execution. The Region will establish a quarterly tracker for the 22 Investment Round pledges by African Member States and report quarterly to the Regional Director on disbursements compared to pledges. Engagement with ministries of finance, alongside ministries of health, should deepen for that conversion to occur.
Thirdly, the exposure to G7 aid reductions. Almost all G7 nations have announced reductions in development assistance, with material implications for the Region’s mobilisation potential in 2026–2027. The Regional office will build a defensive risk register to monitor exposure to the top 10 sovereign donors and a corresponding mitigation plan, drawing on the call for stronger domestic resource mobilisation as the complementary strategy contained in the Lusaka Agenda. Domestic financing is no longer just an option for the future; it is the central plank of the next biennium. Out-of-pocket spending on health accounts for at least one quarter of current health expenditure in 35 Member States, increasing the risk of financial hardship and limiting financial protection. The contraction of and official development assistance has reduced the fiscal space for health systems strengthening investment in at least 14 highly dependent countries.
Fourthly, the digital stewardship infrastructure required to scale. Sustaining stewardship of the WHO African Region Partnerships Network without proportionate staffing growth requires a region-wide partner-relationship management platform and a digital stewardship architecture. Investment in both is required in 2026–2027.
03Priorities going forward
The Region’s priorities for partnerships and financing over the next biennium are anchored in three specific political moments and one operational shift. The political moments are the Seventy-sixth session of the WHO Regional Committee for Africa in 2026, at which the Regional Committee is expected to endorse the Strategy for the Future of Health Financing in the WHO African Region 2026–2035; the Seventy-seventh session of the WHO Regional Committee for Africa in 2027, at which the Regional Committee will assess implementation of the Lusaka Agenda Continental Roadmap; and the Africa Health Financing Forum in 2026, at which Member States will commit to updated national health financing strategies and costed PHC investment cases. The operational shift is fivefold: converting pledges to disbursements and reporting on conversion evert quarter; expanding Investment Round engagement to the remaining 25 African Member States, with a target of full regional participation by the end of 2027; targeting a 30% private-sector and foundation share of mobilised resources by the end of 2027; operationalizing the WHO–Africa CDC Joint Action Plan with quantified deliverables; and deploying a region-wide partner-relationship management platform underpinning the Partnerships Network. The single most consequential step toward replacing external grants with domestically owned and financed health systems is to operationalize the 2026–2035 health financing strategy, with at least 25 countries publishing updated national health financing strategies and costed PHC investment plans by 2028. Progress will be reported in relation to the Seventy-seventh session of the WHO Regional Committee for Africa in 2027.
04The secretariat calls on Member States to
The secretariat calls on Member States to
• Continue supporting WHO with flexible and predictable funding by:
• honouring their assessed contributions and continue the increase in line with the investment case 2025-2028;
• continuing the momentum for growth in voluntary contributions realised over the past year through domestic resource mobilization and increased health investment; and
• Innovatively expanding their donor base, including by engaging with non-state actors in the private sector.