Redesigning Africa’s health agenda: Immunization financing and MNCH targets at AHAIC 2025

In early March 2025, Africa’s thought leaders, policymakers, and the larger health sector convened in Kigali, Rwanda, for the Africa Health Agenda International Conference (AHAIC). This year’s conference brought together more than 1,500 participants for key discussions on the changing geopolitical landscape, the shrinking health funding pot, and the need to reshape Africa’s health agenda.

A wide range of critical health issues, from climate-resilient health care to disease burdens and immunization, were central to the conference theme. However, the crucial issue of health financing dominated discussions, catalyzing urgent deliberations on alternative funding models and intensified calls for African governments to prioritize health in their national budgets.

Drawing on our expensive experience in advocacy in the region, our team steered conversations on immunization financing in Africa and shared insights across different sessions with key stakeholders and health partners in the region. In this article, we share insights and takeaways from PATH’s engagement at the AHAIC 2025.

PATH convened a high-level session with government officials, financing experts, civil society leaders, and development partners to explore practical solutions and commitments to advancing health equity through sustainable and inclusive immunization financing.

While opening this session, Dr. Samukeliso Dube, Executive Director of FP2030, underscored every child’s fundamental right to vaccines, stressing the collective responsibility of all stakeholders to reshape Africa’s financing architecture to achieve health equity for all Africans.

This session highlighted the critical need for sustainable immunization funding in Africa, emphasized the negative impacts of underfunding, and advocated for diversified strategies, stronger primary health care, and public-private partnerships.

Sustainable health financing is necessary for strong health systems. Yet, Africa still faces gaps in health funding. A recently published report by WACI Health, PATH, and the Gavi CSO Constituency on immunization financing, presented during the session, provided key evidence on the critical need for increased investment in immunization across ten African countries. The report highlighted significant challenges characterized by low public funding, high out-of-pocket payments, and substantial donor reliance, with key findings indicating that inadequate investments in health and immunization led to vaccine equity gaps, vaccine wastage due to infrastructure loopholes, low immunization coverage with a notable increase in zero-dose and under-immunized children, and higher incidences of vaccine-preventable diseases and vaccine hesitancy.

Countries must adopt innovative approaches to achieve adequate funding for their health programs, including immunization. Dr. Emily Chirwa, Deputy Director of Planning and Policy, Ministry of Health Malawi, shared how Malawi is tackling health care funding shortfalls by diversifying its revenue streams, acknowledging that while taxation is optimal, fiscal constraints limit government contributions to the health care budget. To supplement this, the Malawi Ministry of Health is exploring innovative funding approaches such as expanding optional paid services in district hospitals, actively engaging the private sector through business investments and mandatory corporate social responsibility for health-impacting industries, and exploring innovative solutions like motorcycle taxi registration fees directed toward a health care fund. This multipronged approach, sustained taxation, and a strong political commitment aim to improve health care access for all Malawians.

Melissa Wanda, PATH’s Kenya Advocacy and Policy Manager, shared opportunities for increasing access to immunization, reflecting on Kenya’s progress in strengthening primary health care systems. She highlighted the importance of community-based strategies, leveraging community health promoters to reach zero-dose children; defaulter tracing and provision of immunization services at the household level; enhancement of health facility access through mobile clinics and extended clinic hours; implementation of data-driven approaches through the use of geospatial mapping to identify and target areas with low immunization coverage; and collaboration through public-private partnerships to enhance access to immunization.

Emily Katarikawe, Executive Director of InPact Uganda, stressed that current immunization funding is not enough, and that further cuts would disrupt immunization services, causing childhood illnesses to resurge and under-immunization to rise. Additionally, reduced funding would result in a shortage of community health promoters, hinder vaccine supply to remote areas, disrupt data management, and weaken government accountability. Finally, Chioma Nwachukwu, Head of Public Policy Engagement at Gavi, further reiterated the importance of immunization and the return on investment realized from immunization financing, emphasizing the role of primary health in increasing equitable and sustainable use of vaccines to save lives and protect people’s health, particularly in low-income countries. She called for universal support—from governments, the private sector, and communities—for the Gavi 6.0 replenishment cycle over the next five years, ensuring equitable vaccine access for 500 million children, 80 percent of whom live in Africa.

Zero to one hundred: Back to the basics—eliminating zero-dose children in Africa

In a complementary conversation, Rachel Ndirangu, PATH’s Regional Director of Advocacy and Policy, joined Save the Children UK and GlaxoSmithKline (GSK), Africa Centres for Disease Control and Prevention, the World Health Organization African Region (WHO AFRO), and Ethiopia’s Ministry of Health for a side session to explore political commitment, innovative delivery approaches, and the role of data in reaching zero-dose children.

Drawing from PATH’s work in several countries in the region and partnership with local organizations, governments, regional and continental agencies, and other health partners, Rachel shared progress made on the Addis Declaration on Immunization. She highlighted remarkable achievements that contributed to 50 million lives saved across Africa through the Expanded Programme on Immunization (EPI) initiatives, including significant progress in polio eradication and notable improvement in immunization coverage for specific antigens. She also acknowledged the role of political will and high-level African leadership in driving progress, as recently exemplified by HE Julius Maada Bio, President of Sierra Leone, at the 38th African Union Summit as he called for bold leadership, emphasizing that a strong immunization system is fundamental for national security, and that Africa cannot depend indefinitely on external funding.

While acknowledging progress, Rachel underscored the persistent and critical gaps that require urgent attention. Millions of children remain underserved or entirely missed by routine vaccination programs. Nigeria and Ethiopia, the two countries with the largest number of zero-dose children on the continent, together have more than 3.3 million unimmunized children. Progress in securing adequate domestic financing has been slow, with only a few countries managing over 90 percent self-funding of their immunization programs. Rachel proposed the development of institutionalized accountability mechanisms to ensure governments meet their domestic financing commitments for immunization. She shared the Democratic Republic of the Congo’s Mashako Plan—which provides a clear roadmap for government and partners to deliver on commitments at national and subnational levels for improving immunization coverage—and the African Leaders Malaria Alliance scorecard as practical examples.

Across the panelists, the link between political (commitments, policy, and accountability), technical (programmatic innovations and partnerships), and analytical (data) dimensions was emphasized, as these critical levers are necessary for reaching zero-dose children and other underserved communities.

Accelerating RMNCH interventions and innovations to improve women’s lives

Melissa Wanda, PATH’s Kenya Advocacy and Policy Manager, joined the Gates Foundation for a session on accelerating reproductive, maternal, newborn, and child health (RMNCH) interventions and innovations to improve women’s and children’s lives in sub-Saharan Africa.

Melissa highlighted how the Every Woman Every Newborn Everywhere (EWENE) initiative helps countries accelerate progress toward global maternal and newborn targets through a global strategy that consolidates advocacy efforts to enhance leadership, investments, and accountability for maternal and newborn survival and well-being.

She highlighted PATH’s efforts in promoting EWENE through strategies such as ensuring accountability for global maternal, newborn, and child health (MNCH) commitments, supporting the implementation of the global maternal and newborn health (MNH) strategy, translating evidence and data into actionable insights, and strengthening civil society’s coordination and capacity to contribute to advocacy and accountability.

Melissa outlined the critical need for robust domestic resource mobilization to ensure sustainable health financing, urging countries to strive toward the Abuja Declaration’s 15 percent health allocation target while enhancing resource efficiency and scaling up proven cost-effective interventions. She advocated for innovative and collaborative approaches, highlighting the importance of public-private partnerships, decentralized funding models, and targeted efforts to address disparities. Finally, she stressed the imperative of leveraging data to optimize financing strategies.

Conclusion

The 2025 Africa Health Agenda International Conference served as a timely platform to address the challenges facing Africa’s health sector. It underscored the power of advocacy to drive change through accountability, community empowerment, and sustainable funding.

PATH’s Center for Advocacy and Policy partners with governments, civil society organizations, and advocates to advance health equity by informing evidence-based policymaking and funding decisions. We leverage technical expertise and deep relationships from country to global levels to design and shape impactful policies, ensure effective implementation, and strengthen capacity along the way.