By Dr. Sylvia Vito
Families across East Africa face difficult decisions every day. When illness strikes, many families are forced to choose between seeking health care and spending money on other essentials like food and education.
Over 200 million people in the WHO Africa Region pay high out-of-pocket costs for healthcare, 150 million of whom are pushed into or deeper into poverty by the financial burden of costly consultations and treatment. The attainment of Universal Health Coverage (UHC) promises to change this by ensuring that everyone can access the care they need without facing financial ruin.
But despite efforts by African countries to make health affordable and accessible to all, high health care costs and constrained funding for health programs continue to derail progress. According to Africa CDC, funding for health in Africa dropped by about 70% between 2021 and 2025, creating a major financing crisis for essential programs.
These cuts have hit low-income countries especially hard, threatening maternal and child health, infectious disease control, and primary care services. Vulnerable groups such as women, children, youth, rural populations and informal workers bear the brunt of these losses.
Women, who often manage household finances and care responsibilities, feel this pressure most acutely, as a single clinic visit could mean loss of valuable time and earnings or deplete family savings. Such financial hardship slows economic growth and worsens inequality, putting the future of entire communities at risk.
UHC offers a solution to this challenge. It is a framework that is not only good for individual and community health, but also for the economy.
Scalable examples exist across the continent, even in resource-constrained settings. For instance, Rwanda’s Community-Based Health Insurance provides cover to 83.5 percent of the population and accounts for majority of insured individuals (90 percent). Annual fees are low and based on income, with the poorest 25% exempt.
In Kenya, digital systems are increasing efficiency, hastening the health insurance claims process and reducing fraud. In addition, flexible payment options like Lipa SHA Pole Pole allow workers in the informal sector, who make up 85 percent of the country’s workforce, to contribute to the national health insurance scheme by paying in installments. This reimagined approach to the delivery of public health care by combining subsidies, technology, community involvement, and strategic partnerships is helping to strengthen the health system.
Additionally, in Tanzania, the Improved Community Health Fund (iCHF) Is expanding access to affordable care, especially in rural areas, by enabling communities to contribute to basic health coverage. Ongoing digitalization and strengthened community health worker programs are improving service delivery. Still, gender gaps in decision making and access persist, underscoring the need for gender-responsive leadership to advance UHC.
Attaining UHC is both a social and economic imperative for African countries. However, for millions across the continent, UHC remains a dream—and it will remain so for as long as we continue to ignore the gendered nature of health policy- and decision-making.
To truly make health care accessible, countries must ensure that services are within reach of communities and grounded in a rights-based approach that recognizes health as a fundamental human right, as envisioned in the Universal Declaration on Human Rights. This means being deliberate about removing physical, financial, and social barriers that disproportionately affect vulnerable populations and prevent them from accessing health care when, where and how they need it.
As African countries seek new approaches to unlock sustainable funding to build resilient health systems that can deliver quality, accessible and affordable care to all, health leaders must also hold governments to account and advocate for gendered solutions that recognize the complexities of health care access for women and other vulnerable populations.
With studies indicating that women use more health care services than men, it stands to reason that women leaders in health have a more nuanced understanding of both the barriers and solutions to improving health outcomes through UHC. By making space for more inclusive leadership that increases the representation of women at decision
making tables and considers the lived experiences of women in all their complexity and gendered roles, we can create and implement policies that respond to community needs.
Representation must also be augmented by systemic changes that address gaps in gender-inclusive policymaking and implementation, resourcing for health and delivery of health care. By involving women at all levels of health policy and program design, we can tap into a rich pool of knowledge borne of experience that would address gaps such as cost and access. In this way, we could, for example, ensure that no household forfeits meals, education, a day’s wages or savings to access health, a fundamental human right.
Male allies play a big role too. They can leverage their power and influence to champion fair budgets, break old boys’ networks, challenge stereotypes and support women in leadership roles. Together, women leaders, alongside male allies, can build resilient health systems and advance progress toward health for all.
At a time when global health is under threat and progress in Africa at risk of reversal, African governments must act now to protect everyone, everywhere.
As countries examine the impact of reduced foreign aid one year after widespread cuts to funding sparked a resourcing crisis within global health, this is not the time to pause. Rather, it is time to boldly act to transform leadership and double down on a gendered approach to health care, which is key to unlocking better health outcomes for all.
Dr. Sylvia Vito is the Regional Director, East Africa, WomenLift Health,