Rising debt repayments are crowding out health budgets across Africa’s poorest nations, and out-of-pocket medical bills push 150 million people into poverty each year, the United Nations Economic Commission for Africa (ECA) said on Tuesday.

The warning came as the World Health Organization’s Regional Committee for Africa opened its 76th session in Addis Ababa, under the theme “Roots and Wings – Heritage Meets Digital Health.”

Ethiopian President Taye Atske Selassie opened the meeting, held at the Adwa Museum, alongside African Union Commission Chairperson Mahmoud Ali Youssouf, WHO Director-General Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Mohamed Yakub Janabi.

Speaking on behalf of ECA Executive Secretary Claver Gatete, the commission’s chief of staff, Aboubakri Diaw, told health ministers that Africa’s health financing problem was not only about money.

“It does not only suffer from a financing gap. It also suffers from a confidence gap; and confidence, unlike capital, cannot be borrowed. It must be built,” Diaw said.

Diaw cited three pressures squeezing health budgets across the continent. External health assistance has fallen by almost 30%, he said, while debt servicing now outpaces health spending in the median low-income African country.

Out-of-pocket payments average 35% of health expenditure regionally, he said, above the WHO benchmark of 20%. He added that most national health strategies remain uncosted and unsequenced, making it harder for countries to attract financing.

To illustrate the human cost, Diaw described “Amina,” a composite small-business owner who delays seeking medical care over cost concerns and later faces bills that force her to sell equipment and cut jobs.

“What began as one person’s illness has become a household financial crisis… and, when repeated across millions of families, a macroeconomic problem,” Diaw said.

Diaw said ECA was asking health ministers to make three changes to close Africa’s health financing gap.

First, he said health ministries should present finance ministries with a quantified investment case tied to productivity and economic growth, rather than a simple funding request.

Second, he called for countries to replace fragmented health plans with a single, politically endorsed national health-financing compact spanning health, finance, planning, revenue, debt, insurance and private-sector actors.

“Putting more money into a fragmented system can finance more fragmentation,” Diaw said, adding that “putting money behind a credible national compact can finance transformation.”

Third, Diaw said governments should match financing instruments to their own fiscal circumstances. He cited early data from countries that have adopted ECA’s approach showing health receiving just 5% to 9% of national budgets, while out-of-pocket costs can reach 64% of total health spending in some cases.

The recommendations fall under ECA’s African Initiative on Transforming Health Financing, which launched in Tangier, Morocco, in April 2026.

Diaw also urged African governments to treat digital health systems as financing infrastructure rather than standalone technology projects.

He said fewer than a third of health systems in low-income settings can track spending digitally in real time, calling this gap “among the fastest efficiency gains that should be met and made available to any treasury.”

Diaw pointed to Ethiopia’s digital health initiative, led under Prime Minister Abiy Ahmed, the African Union’s AI and Digital Health Champion, as a model for tracking public funds from national budgets to individual patients.

Digital health, he said, should shift from being viewed as “a project” to being seen as “a financing revolution.”

Diaw said the success of the initiative would be judged not by declarations made at the conference but by concrete outcomes, including whether people such as Amina can seek medical care early without losing their livelihoods.

“Health is not what we spend when Africa grows. Health is how Africa grows,” he said.

ECA said it was ready to support African governments in turning the financing proposals into measurable action.

The WHO Regional Committee for Africa session continues in Addis Ababa this week, bringing together health ministers from across the continent to discuss regional health priorities, including digital health integration and financing reform.