Africa Health and WaSH Futures: Thematic Futures

Africa's health and WaSH systems are characterized by severe underinvestment, urban-rural disparities, and a precarious dependence on external aid, exemplified by the projected millions of additional deaths following the 2025 closure of USAID. As of 2023, over a billion people lack safely managed sanitation, and nearly a billion lack safely managed water, driving high rates of communicable diseases and hindering educational and economic development. These systems are currently not on track to meet 2030 SDG targets and face increasing pressure from climate-induced water stress and flooding.

• African health systems face four primary constraints: low per capita spending below WHO and Abuja Declaration thresholds, severe shortfalls in staffing and infrastructure (including hospital beds and clinical facilities), significant urban-rural disparities in service delivery, and a heavy reliance on external donor funding for critical services like immunisation and HIV treatment.
• The closure of USAID in 2025, previously the largest external health aid provider to Africa, has created significant vulnerabilities. According to The Lancet, this defunding is projected to result in approximately 1.8 to 2.5 million additional deaths annually between 2025 and 2030.
• WaSH infrastructure remains a major bottleneck, with 959 million people lacking safely managed water and over one billion lacking safely managed sanitation as of 2023. These gaps, particularly in rural areas and informal urban settlements, contribute to high rates of cholera, parasitic infections, and diarrhoeal diseases, especially in children under five.
• Inadequate hygiene infrastructure in healthcare and school settings negatively impacts infection control and learning outcomes. Specifically, it hinders the ability of girls and women to manage menstrual hygiene, which leads to school dropouts and absenteeism.
• Current health and WaSH systems are not on track to meet the 2030 Sustainable Development Goals (SDGs). The resilience of these systems is increasingly critical as climate change intensifies flooding and water stress.

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=01-introduction

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=01-introduction.

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=01-introduction |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=01-introduction}, urldate = {2026-08-17}, note = {Indexed by Climate Insights Directory} }