True independence is paying for our health

As Kenya celebrates Jamhuri Day today, we also mark Universal Health Coverage (UHC) Day. This coincidence of dates is not only symbolic, it is instructive. True sovereignty is not just about a flag or a national anthem, it is about the ability of a nation to keep its people alive and healthy without relying entirely on the benevolence of others.

Africa faces a persistent gap in health financing and repeated shocks from climate disasters and epidemics. While we have made strides, such as the Kenyan government’s commendable rollout of community health promoters (CHPs), our health systems remain vulnerable.

Why? Because for too long, we have relied on a fragmented system where donors and global health initiatives hold the purse strings. 

When external funding cycles change, or when geopolitical shifts occur in capitals thousands of miles away, lifesaving programmes in an African village can suddenly stop. We saw this vulnerability during the Covid-19 pandemic, and we see it now as global development assistance budgets shrink.

Make UHC a reality

We cannot achieve UHC if we are renting our health systems. We must own them. This brings us to the “Lusaka Agenda”. 

While the name might sound like diplomatic jargon, its proposition is necessary for Africa’s future. Launched one year ago, the Lusaka Agenda is a roadmap for shifting power back to African governments. It demands that donors align with our national priorities, rather than creating parallel systems that weaken ministries of health. However, implementation of the Lusaka Agenda has been too slow. 

To make UHC a reality, we need two fundamental shifts: financing sovereignty and community power.

First, on financing: Strong health systems start with strong primary health care. This is where prevention meets people. At VillageReach, we have seen that when you invest in the “last mile”, the results are immediate. In Kenya, our collaboration with the Ministry of Health to support CHPs with kits is increasing access to care in remote areas. In the Democratic Republic of Congo, partnering with the government to streamline supply chains drastically increased vaccine access.

But this work cannot be sustained by donors forever. The Lusaka Agenda challenges African governments to increase domestic financing. If we want the right to determine our health policies, we must prioritise health in our national budgets.

Health priorities

Second, we must pivot to community-centred decision-making. Even well-meaning initiatives fail when they are designed by technocrats in boardrooms rather than by the communities they serve.

Money flows through governments, but services are consumed by people. If the mama mboga or village elder is not involved in defining health priorities, the financing will not be responsive. In Mozambique, for instance, our Let’s Talk About Vaccines project succeeded because it incorporated feedback from local leaders and caregivers.

As we transition to new health insurance models and seek to strengthen our primary care networks, Kenya has an opportunity to lead. We must demand that our partners, including donors, align with our systems. But we must also demand political courage from our own leaders to fund these systems sustainably. The Lusaka Agenda is a declaration of intent; it asserts that African health systems should be resilient, locally led, and universally accessible.

This Jamhuri Day, as we celebrate our freedom, let us commit to the final frontier of independence: a health system that is funded by us, designed by us, and works for all of us.

Dr Ouma is the CEO and president of VillageReach, and former acting deputy director-general of Africa CDC