2025年2月，美国政府撤销了对非健康援助，导致肯尼亚公共卫生外部资金骤降。在此之前，美国承担了肯尼亚60%以上的公共卫生外部资金。援助削减使数十万抗艾滋病和避孕药物断供。一年多后，刚果东部和乌干达爆发了2018年以来最严重的埃博拉疫情。这迫使面临预算危机的肯尼亚等国政府将稀缺资源转向病毒监测。然而，这也催生了“健康主权”运动，各国开始寻求减少对外部支持的依赖。

自2022年以来，非洲获得的外部卫生资金下降了60%。作为回应，加纳取消了针对其医保机构的消费税上限，使预算增加了60%，而尼日利亚、卢旺达和埃塞俄比亚正考虑对烟酒糖征税。同时，各国也在寻求私营部门资金，如推广非营利组织主导的性健康开发影响债券。此外，莫桑比克在泰特省整合了疟疾和家庭计划等基层医疗服务，将NGO的碎片化项目合并，提高了医疗效率。目前，该模式正向全国推广。

非洲急需扩大医药本土生产，目前其70%至100%的制药及99%的疫苗依赖进口。非洲疾控中心的目标是到2040年实现60%的疫苗和诊断试剂本土化生产。南非和尼日利亚等国正致力于LENACAPAVIR等药物的本土制造。然而，地区合作仍面临阻碍，南非至今拒绝加入2021年成立的非洲医学局。此外，债务压力巨大，2024年有28个非洲国家的债务支出超过了医疗支出，肯尼亚的债务占GDP比率每上升1个百分点，其长期医疗支出就会下降1.2%。

In February 2025, the U.S. administration abruptly cut health funding for Africa. Prior to this, America provided over 60% of external public health funding in Kenya. The aid cuts caused layoffs and shortages of contraceptives and HIV drugs. More than a year later, the worst Ebola outbreak since 2018 is active in eastern Congo and Uganda. This forces cash-strapped governments to divert scarce resources to viral testing and surveillance. However, these crises have accelerated a drive toward "health sovereignty" and self-reliance.

Since 2022, foreign health funding to Africa has declined by 60%. In response, Ghana lifted a cap on excise taxes for its health-insurance agency, boosting its budget by 60%, while Nigeria, Rwanda, and Ethiopia are considering taxes on alcohol, sugar, and tobacco. Governments are also seeking private capital, piloting development-impact bonds for sexual health. Furthermore, countries are addressing inefficiencies; Mozambique successfully integrated primary care services in Tete province, pooling resources from multiple NGOs, a model now being scaled nationwide.

Africa must expand medical manufacturing, as it currently imports 70-100% of finished pharmaceuticals and 99% of vaccines. Africa CDC aims to produce 60% of vaccines and diagnostics locally by 2040. While South Africa and Nigeria are boosting local manufacturing of advanced medicines, regional regulatory cooperation remains stalled by South Africa's refusal to join the African Medicines Agency. Debt remains the biggest hurdle: in 2024, 28 African nations spent more on debt servicing than on health, with Kenya's health spending dropping 1.2% for every percentage point increase in its debt-to-GDP ratio.

Source: Ebola has put Africa’s fragile health systems in the spotlight

Subtitle: Emergencies and aid cuts are accelerating a push for self-reliance

Dateline: 6月 25, 2026 03:43 上午 | Nairobi