WE, the Heads of State and Government of the African Union, meeting at the 32nd Ordinary Session of the Assembly of the Union in Addis Ababa, Ethiopia, from 10 to 11 February 2019, reviewed the progress, challenges and next steps needed for increased financing to strengthen health systems and achieve Universal Health Coverage (UHC);

Taking Note of the key outcomes of the Africa Leadership Meeting – Investing in Health, we recommitted to increased domestic investments and urged the private sector and global health financing mechanisms to increase investments to address Africa’s health priorities;

Recalling Agenda 2063’ Africa’s blueprint for socio-economic transformation that calls for increased domestic investments to strengthen health systems as a foundation for solid inclusive growth, prosperity, peace and structural transformation, the ‘Africa Health Strategy (2016-2030)’ that seeks to strengthen health systems and achieve universal health coverage, the ‘Catalytic Framework to end AIDS, TB and Malaria in Africa by 2030’, the ‘Maputo Plan of Action (2016-2030) for Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa’, all endorsed by the Assembly in 2016, and the Declaration on ‘Universal Access to Immunization as a Cornerstone for Health and Development in Africa’, adopted by African Ministers of Health in 2016;

Recognizing the broader health and development agenda of ‘Agenda 2030’ and the continued efforts to advocate for, and prioritise health as central to sustainable development;

Also Recognizing that Sustainable Development Goal 3, on the achievement of universal health coverage, can only be achieved with country leadership and the support of multi-lateral and bi-lateral partners, other strategic partners and the private sector;

Noting that the Africa Scorecard on Domestic Financing for Health of 2018 demonstrates that 36 of 55 AU Member States (65.5%) have increased the percentage of GDP invested in health over the previous financial year;

Noting with Concern that, despite this increased investment in health, the level of investment means that only 2 (3.6%) of 55 AU Member States meet the target of dedicating at least 5% of the government budget to health and for this level of investment to exceed $86.30 USD per capita;

Also Noting with Concern that very few developed countries meet the commitment to allocate 0.7% of Gross National Product (GNP) to Official Development Assistance;

Bearing in Mind that the achievements of the last eighteen (18) years towards achieving Universal Health Coverage depended largely on the political will and commitment by Africa’s top leadership as well as strategic partnerships at all levels;

Expressing Concern on increased public health threats on the continent that require more concerted efforts to strengthen health systems and significant increase in investments to meet continental targets to end priority diseases by 2030;

Affirming that sustainable and diversified health financing is a shared responsibility which cannot be achieved without global solidarity and collective effort and cognizant of the importance of health and education in developing the human capital needed to drive economic growth, stability, peace and security;

Taking Note of the upcoming Replenishments of the Global Fund to Fight AIDS, TB and Malaria, Gavi, the Vaccine Alliance and the African Development Bank (AfDB) and of the importance of the recent Global Financing Facility (GFF) Replenishment meeting and requests African Union Member States to actively support those Replenishments;

DO HEREBY SOLEMNLY:

1. COMMEND the continued global, continental, regional and national efforts to keep health financing high on the political agenda;

2. ALSO COMMEND the support of international development partners and Global Health Financing Mechanisms to increase investments in health in the context of competing development priorities;

3. REAFFIRM our commitment to increase domestic health resources mobilisation and progressive taxation;

4. CALL UPON the private sector to support and invest in expanding access to quality health care services and achieving UHC;

5. ALSO CALL UPON Member States and partners to fully implement the Pharmaceutical Manufacturing Plan for Africa Business Plan and Regulatory Harmonisation for increased access to affordable and quality-assured medicines, vaccines and new health technologies, including generics, as well as negotiating for affordable prices for vaccines and medicines for priority diseases;

6. To this end, WE UNDERTAKE to:

i) increase domestic investments in health and improve health financing systems in a context-appropriate manner so that each country can pursue its own path to achieving and sustaining Universal Health Coverage and that the people of the African continent can receive qualitative, accessible and affordable prevention, diagnosis, treatment and care services they need without suffering financial hardships;

ii) mobilise sufficient and sustainable financing to strengthen health systems and achieve Universal Health Coverage;

iii) foster cooperation between public and private sectors to create synergies and deliver health for all;

iv) request the Commission and partners to ensure that strategies are in place for diversified, balanced and sustainable financing for health through the development of strategic health investment plans and strategies, including from the private sector;

v) also request the Commission to work with partners to create regional platforms to support relevant ministries, including finance and health, to catalyse, capture and scale innovations, best practices and gaps and requests multilateral, bilateral and private sector partners to support the platforms and to use them to align their efforts to those of Member States to increase domestic financing, including through improved taxation and health insurance efforts;

vi) further request the Commission to organise a biennial meeting of Ministers of Health and Finance to review the work of the platforms and to monitor progress;

vii) request the Commission to work with partners to improve the monitoring of health financing through greater annual implementation of National Health Accounts and wider dissemination; and

viii) redouble efforts to promote national health insurance systems, including greater coordination with and access to resources of the Global Fund to Fight AIDS, TB and Malaria, Gavi, the Vaccine Alliance and the AfDB;

7. REQUEST the Commission to monitor the implementation of the recommendations of the Africa Leadership Meeting-Investing in Health and report to the Assembly regularly;

8. ALSO REQUEST the Commission and partners to support the implementation of the commitments on health financing and to develop an accountability framework to monitor implementation of this Declaration;

9. EXPRESS our gratitude to H.E. President Paul Kagame of the Republic of Rwanda for hosting the Africa Leadership Meeting-Investing in Health;

10. APPOINT His Excellency President Paul Kagame as Leader for Domestic Health Financing.