Health Systems, Global Health Architecture and the Lusaka Agenda, with a focus on LMICs.

Pete Baker and I independently arrived at a similar conclusion about one of the most important shifts needed in the future of global health financing: a much greater role for the World Bank in financing health at country level. In my September 2025 article, Rethinking the Global Health Financing Architecture: Principles and a Proposed Model , I proposed that the World Bank, alongside an expanded Global Financing Facility (GFF), should become a principal platform for financing holistic health development. I argued that the Bank was particularly well suited to this role because of its capacity to support country-led priority-setting, use national public financial management systems, provide concessional financing for health-system strengthening, operate through established country platforms, and finance health in a broader, integrated and multisectoral manner rather than through disease-specific silos. Pete subsequently developed a closely related proposition through his work at the Cent...

Africa is the biggest financier of its own health care — but in the most painful way possible. In 2022, 77% of Africa’s health expenditure was domestic and 23% was external. Out-of-pocket ( OOP) spending accounted for about 64 % of domestic health expenditure. This creates a troubling paradox. On the one hand, Africa is less dependent on aid and is funding more of its health needs domestically. On the other, this “self-financing” is being carried largely by households at the point of care, exposing millions of families to catastrophic health expenditures and pushing many into poverty each year. Financing health this way is neither equitable nor sustainable, and it undermines the very notion of health security and sovereignty. The question, therefore, is not whether Africa has the potential to finance its health. The evidence shows that it does. The real question is whether Africa can harness this potential without households continuing to bear the brunt of the cost of illness. Doing...