Consultant to analyze PHC and immunization spending in Africa in reference to regional commitments, NYHQ, Programme Group, Immunization/Health Req# 584125

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Consultancy Title: Consultant to analyze PHC and immunization spending in Africa in reference to regional commitments.

Division/Duty Station: Programme Group, Immunization/Health

Duration: 20 September 2025 – 31 December 2025

Home/ Office Based: Remote

BACKGROUND

Purpose of Activity/ Assignment:

The primary objective is to provide technical and analytical expertise to support the development of evidence-based recommendations with a particular focus on sustainable financing for primary healthcare and immunization programs.

Background

The Abuja Declaration on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases, adopted by African Union Heads of State and Government in April 2001, marked Africa's most significant health financing commitment of the modern era. The declaration's call for countries to allocate at least 15% of their annual budgets to improve the health sector arose from the urgent need to combat the devastating effects of communicable diseases, especially the HIV/AIDS pandemic that was taking millions of lives across the continent.

The declaration was groundbreaking for several reasons:

• Political leadership: It represented the highest level of political commitment to health financing in Africa's post-independence history.
• Continental Scope: Unlike fragmented, country-specific initiatives, it established a unified framework for all AU member states.
• Quantitative Target: The 15% benchmark offers a clear, measurable goal that can promote accountability and track progress.
• Crisis Response: It demonstrated Africa's ability to coordinate policy responses to health emergencies.

Twenty-three years after its adoption, the Abuja Declaration remains the primary reference for health financing commitments across Africa. However, healthcare has undergone considerable evolution since 2001. New challenges include emerging infectious diseases, the rising burden of non-communicable diseases, climate-related health impacts, demographic changes, and the need for universal health coverage through stronger primary healthcare systems. Most importantly, the external financing environment that existed in 2001 has degraded, forcing countries to adapt to very different resource realities.

 

The Numbers reveal a stark reality: Recent analysis indicates that fewer than 12 AU member states have consistently met the 15% Abuja target. At the same time, over 30 countries spend less than 10% of their budgets on health. Even more concerning, this performance gap is widening as countries face rising fiscal pressures and competing priorities.

 

Immunization programs under threat: 23 African countries are currently in or approaching Gavi transition, affecting immunization programs that reach over 300 million children across the continent. Countries are now facing immediate decisions about sustaining vaccine procurement and delivery systems without adequate preparation or transition support.

Primary Healthcare Financing in Crisis: Although universal agreement exists that PHC is the foundation of effective health systems, current financing methods remain fragmented, inefficient, and unsustainable. The COVID-19 pandemic revealed the disastrous effects of weak PHC systems, yet recovery efforts after the pandemic have failed to produce sustainable financing solutions. Countries are struggling to meet immediate health needs while also attempting to strengthen their health systems for the long term, amid unprecedented budget constraints

Donor landscape transformation: Traditional health sector donors have reduced their commitments by an estimated 30-50% since 2019, while shifting priorities toward climate change, conflict response, and domestic concerns. The bilateral aid architecture that supported Africa's health gains over the past two decades is undergoing fundamental changes, leaving countries with financing gaps that they are not prepared