As world leaders convene in New York for the 80th United Nations General Assembly (UNGA), African policymakers eye an opportunity to redefine the continent’s relationship with donors in health financing.

Obinna Ebirim, senior technical advisor on youth health and policy research to Nigeria’s Minister of Youth Development, says Africa must use UNGA to press for fairer partnerships — and hold its own leaders accountable on funding commitments.

While international aid has provided vital support in tackling diseases such as malaria and HIV, an overreliance on donor funding has left many African countries dangerously exposed, Ebirim warns.

In Nigeria, for instance, he says overseas partners fund significant parts of vaccination campaigns, disease surveillance, and health worker incentives, yet when funding shifts or dries up, programmes struggle to survive.

As UNGA prepares for a week of high-level meetings on critical global issues as well as a series of health-focused side events, Ebirim talks to SciDev.Net about why Africa must take ownership of its health financing and what leaders should be prioritising in New York.

Donors have supported African health systems for decades. What is the main risk of Africa’s heavy reliance on donor support for health?

Donors have been essential and we must acknowledge their contribution. But dependency creates vulnerability. The moment donor funding is withdrawn, systems collapse. We have seen disruptions in HIV, TB, malaria, and nutrition programmes, with commodity shortages, some hospitals scaling back some services and some donor-supported health workers facing job losses.

It’s not about rejecting donor support. The issue is sustainability. A strong health system must be financed and sustained by its own government. If donors remain the backbone, the system is always at risk of collapse.

What happens to people on the ground when donor support falls away?

When programmes are donor-funded and the money runs out, patients arrive at clinics and there are no medicines, no vaccines or vaccine stock outs, sometimes not even staff. Our primary healthcare centres in Nigeria have many donor-funded ad hoc staff (sometimes called volunteer health workers) bridging the health human resources gap.

Health workers also leave because their salaries were tied to donor projects. That’s devastating, because our workforce is already stretched thin. Beyond these practical challenges, there is a deeper consequence: people lose confidence in a system that keeps breaking down. Trust, once lost, is very hard to rebuild.

Nigeria — Africa’s most populous country — was a signatory to the Abuja Declaration, committing 15 per cent of its budget to health. How close has the country come to this goal?

Frankly, not close at all. Nigeria has never reached the 15 per cent target. In recent years, health has received between four and six per cent of the national budget. That gap is where donors step in, but it reflects a lack of political will to prioritise health.

Health should not be seen as a cost but as an investment. A healthy population is the foundation for education, productivity, and economic growth. Without investing in health, every other development effort is undermined.

Beyond financing, what else must governments address to strengthen their systems?

Human resources are at the heart of everything. Doctors, nurses, midwives, community health workers — they keep the system running. But Africa is losing them. Many are migrating abroad in search of better pay and working conditions. Those who remain are often underpaid and overworked.

We need deliberate strategies to train, retain, and motivate health workers. Otherwise, even with better financing, the system will collapse for lack of staff.

Infrastructure is another weak link. Many hospitals lack reliable electricity, running water, or basic supplies. During an outbreak, that becomes catastrophic. So the investment has to go into the fundamentals, not just high-level programmes.

What policies are needed to integrate the continent’s growing youth population into the health workforce, not just as doctors and nurses, but across supply chains, digital health, and research?

Africa’s large youth population presents an opportunity to bridge the human resources gap caused by donor exit disruptions. They can also form a critical mass required for more domestic health financing advocacy.

To do this, countries need deliberate youth-focused workforce policies that expand beyond traditional clinical roles. A good example in Nigeria is the National Health Fellows Programme, under the Health Sector Renewal Investment Initiative. This programme recruited 774 young people, one per local government area nationwide, who were automatically employed after their fellowship to serve across health-related fields. It creates a pipeline of skilled youth who can grow into various roles in the health sector.

How is the issue of African health finance being discussed at UNGA this year?

Some meetings at UNGA80 are directly addressing health financing and regional collaboration in Africa. An example is VitalTalks Live at UNGA with the theme, The Future of Health Financing in Africa (23 September). It will spotlight how governments can strengthen health taxes to reduce non-communicable diseases, generate domestic revenue, and resist industry pushback.

Another is Foreign Policy’s Health Forum (24 September) … It brings together policymakers, multilateral leaders, and private sector innovators to explore new investment strategies, global health governance, and ways to strengthen health systems under financial pressures.

Finally, there is the UNITAID side event on advancing women’s health, focused on innovative financing and partnerships to accelerate progress despite shrinking donor funds.

What should African leaders bring to the table in New York?

They must make health financing the number one priority. Leaders should be clear: we are ready to invest in our own systems. Donors are partners, but they cannot carry the responsibility for African health.

They also need to highlight the human resources crisis. Without a workforce, there can be no service delivery. And they must emphasise the importance of regional collaboration.

Finally, they must make the link between health and development. Health is not a side issue; it underpins economic growth, education, and stability. If Africa wants to prosper, it must invest in health.

Donors are partners, be we must understand that sustainability cannot be built from outside. Their role should be to support African governments in building systems that last beyond aid. That means investing in capacity, not just funding short-term projects.

It also means allowing African governments to set priorities. Too often, donors dictate what gets funded, leaving other critical needs unmet. Effective partnerships complement government efforts rather than replace them.

If you could give policymakers one clear message, what would it be?

Accountability. Governments must own the responsibility for financing health. Without that, every outbreak or donor withdrawal will push us back to zero. The time to change course is now.

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