Africa Health and WaSH Futures: Thematic Futures

This document provides conclusions and strategic recommendations for improving health and Water, Sanitation, and Hygiene (WaSH) systems across Africa. It emphasizes the need for a shift from donor dependency toward domestic investment, innovative financing, and regional self-reliance to transform health outcomes into macroeconomic drivers of growth.

• Health systems in Africa are characterized by chronic underfunding, high out-of-pocket costs, and a heavy reliance on external donors. While external assistance is vital for low-income countries, it often focuses on disease-specific vertical programs for tuberculosis, malaria, and HIV/AIDS, which can lead to fragmented service delivery and a lack of investment in core system-building.
• To achieve sustainable health and WaSH systems, the report recommends three primary financing shifts: increasing domestic investment, utilizing strategic pooled donor support, and adopting innovative mechanisms such as public-private partnerships, sin taxes, and diaspora bonds.
• Africa is pursuing 'health sovereignty' to reduce reliance on external actors, led by the Africa CDC, which has expanded its role in public health workforce development, emergency response coordination, laboratory networks, and epidemic surveillance since 2017. The African Union has specifically targeted the local production of 60% of the continent's vaccines by 2040, with investments occurring in Egypt, Rwanda, Senegal, and South Africa.
• The report advocates for decentralized and community-based solutions to improve access. This includes professionalizing community health systems for disease surveillance and child immunisation, as well as deploying off-grid WaSH innovations like nature-based sanitation, off-grid filtration, and solar-powered boreholes; over 1,000 solar water-pumping systems have already been installed across Africa.
• Progress toward universal health coverage (UHC) remains uneven across the continent, with only a few countries, specifically Kenya, Ghana, and Rwanda, having made meaningful progress through community-based or public schemes.

APA

Cilliers, J. (2026). Africa Health and WaSH Futures: Thematic Futures. Institute for Security Studies. https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=07-conclusion

Chicago

Cilliers, Jakkie. Africa Health and WaSH Futures: Thematic Futures. Institute for Security Studies, 2026. https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=07-conclusion.

Wikipedia

{{cite report |last1=Cilliers |first1=Jakkie |title=Africa Health and WaSH Futures: Thematic Futures |publisher=Institute for Security Studies |date=29 March 2026 |url=https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=07-conclusion |access-date=17 August 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{cilliers2026africa, author = {Cilliers, Jakkie}, title = {{Africa Health and WaSH Futures: Thematic Futures}}, institution = {Institute for Security Studies}, year = {2026}, month = mar, url = {https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=07-conclusion}, urldate = {2026-08-17}, note = {Indexed by Climate Insights Directory} }