Four Ways to Improve Country Ownership in Africa

PATH has outlined four strategic shifts to increase “country ownership” of health systems across Africa, aiming to transfer decision-making power from international donors to national governments. According to the global health organization, this transition is necessary to build sustainable health infrastructure and reduce the systemic reliance on external aid for basic medical services.

The framework focuses on moving away from top-down, donor-driven models that often prioritize the goals of funding agencies over the specific needs of the recipient nation. PATH argues that for health interventions to last, they must be integrated into national budgets and led by local health officials.

How can African nations improve health system ownership?

PATH identifies four primary methods to ensure health initiatives are locally led and globally connected. These strategies aim to bridge the gap between international funding and national execution.

• Investing in the local health workforce to ensure leadership roles are held by national experts rather than international consultants.
• Aligning donor funding with existing national health strategies to prevent the creation of fragmented, “siloed” programs.
• Expanding local manufacturing of vaccines, diagnostics, and essential medicines to reduce import dependency.
• Strengthening national data systems so governments can make health decisions based on real-time, local evidence.

The organization suggests that when donors align their funding with a country’s own health plan, the result is a more cohesive system. This prevents the common issue where multiple donors fund overlapping projects, which PATH notes can strain the administrative capacity of local ministries of health.

Why is the shift from donor-led to locally-led health systems necessary?

The push for country ownership follows years of criticism regarding the “decolonization” of global health. Many African health leaders have argued that the traditional model of aid creates a cycle of dependency where the priorities of the Global North dictate the health agenda of the Global South.

The COVID-19 pandemic highlighted these vulnerabilities. During the crisis, many African nations faced severe shortages of vaccines and personal protective equipment because they relied on global supply chains and donor distributions. This experience accelerated the demand for what the Africa Centres for Disease Control and Prevention (Africa CDC) calls the “New Public Health Order.”

While PATH’s framework focuses on the operational shift in ownership, the Africa CDC’s New Public Health Order specifically emphasizes the need for strengthened institutional leadership and domestic financing. Both approaches agree that the current donor-centric model is insufficient for long-term pandemic preparedness.

What role does local manufacturing play in health security?

Local production of medical countermeasures is a central pillar of the PATH strategy. By establishing manufacturing hubs within Africa, countries can ensure a more reliable supply of life-saving tools without waiting for international shipments.

This shift involves more than just building factories. It requires the development of local regulatory bodies to ensure the safety and quality of produced medicines. According to PATH, supporting these regulatory frameworks is just as critical as the manufacturing process itself.

The goal is to move from a model of donation to a model of production. This transition allows African nations to control the pricing, distribution, and timing of medical interventions.

What barriers remain for national health ownership?

Despite the framework, significant hurdles remain. Many international grants come with strict “earmarks,” meaning the money can only be spent on specific diseases or targets defined by the donor. This limits the ability of national governments to pivot funds toward more urgent, local health priorities.

There is also the challenge of “brain drain,” where highly trained local health professionals move to higher-paying roles in international NGOs or emigrate to wealthier nations. PATH suggests that increasing ownership requires creating sustainable, competitive career paths within national health systems.

The success of these four strategies depends on a fundamental change in how global health partners operate. It requires donors to accept less control over the minutiae of program implementation in exchange for more resilient and independent health systems.