An overlooked way to close Africa's health gaps

WASHINGTON, DC: Every year, millions of Africans fall into poverty simply because they got sick. A complicated pregnancy, a malaria infection, or an unexpected surgery can push a household to the brink, because many African countries suffer from a health-financing deficit.

The reasons for these gaps are well known: chronic under-investment, limited fiscal space, fragmented insurance markets, and an international development system geared more toward reacting to crises than to preventing them. Although global leaders have made repeated commitments to universal health coverage, too many African families still must pay for healthcare out of pocket, often falling into hardship or debt simply for seeking medical care.

But there is another story that deserves greater attention. Africans already fund a sizable share of the continent’s social protection, not through public budgets or donor funds, but through extraordinary commitments from the diaspora. In recent years, Africans abroad have sent home more than $100 billion in remittances, exceeding the sums from foreign direct investment and official development assistance combined. These transfers are not just acts of love and social responsibility. They are an underappreciated economic engine and an essential lifeline for millions of households.

Nonetheless, reliance on remittances underscores the failures of Africa’s formal institutions. Despite improvements in health outcomes over the past two decades, out-of-pocket payments still account for up to 40% of total health spending in many African countries. At the same time, remittances have grown steadily and consistently and, unlike aid, they go directly to households, bypassing bureaucracy and political volatility. Yet, these flows’ full potential remains untapped. They usually arrive only after a medical emergency has forced a family into crisis – when a bill has ballooned beyond control, or a loved one is already fighting for his or her life – rather than being pooled or structured in ways that would build sustainable health systems.

The solution is to devise a way to convert today’s emergency transfers into a more enduring health-financing tool. To that end, a working group comprising leading experts in health financing, insurance innovation, diaspora engagement, and global advocacy came together as part of the 17 Rooms Initiative to develop what we are calling HealthBridge.

HealthBridge reimagines Africa’s remittances, not as emergency transfers, but as a foundation for financing proactive healthcare. The idea is straightforward: build a mechanism that allows diaspora communities voluntarily to channel a small portion of their remittances into a pooled fund that will finance essential health services for their families and communities back home. Rather than scramble to send money after a health crisis, those across the diaspora can ensure that families are covered before disaster strikes.

The HealthBridge model has four core components. The first is pooled remittance contributions. Diaspora members can choose to contribute a modest amount regularly – say, $10-20 per month – into a regional solidarity fund, which could in turn be matched by employers, philanthropic organisations, or governments.

The second component is prepaid access. Named beneficiaries in Africa (often relatives) would be entitled to a package of essential health services, particularly for urgent or emergency care, with delivery either through public systems, accredited private providers, or regional networks.

The third component is cross-border portability. Since health threats do not observe national borders, HealthBridge would ensure regional coverage that follows the person, not the passport. This condition is especially important for families living in border regions, migrants, and communities affected by conflict.

The final element is transparency and accountability. A new digital platform would allow contributors to track payments, delivery, and outcomes, thus building trust and ensuring that this model strengthens rather than fragments existing health systems.

Our proposal builds on successful innovations such as Rwanda’s community-based health insurance model and Kenya’s M-TIBA health wallet. It also reflects a simple truth: diaspora Africans are already paying for healthcare, but in ways that do not strengthen health systems, ensure accountability, or generate long-term resilience.

The costs of doing nothing are enormous. With millions of African households pushed into poverty by medical expenses every year, governments too often find themselves reacting to crises without the pre-positioned resources needed to respond effectively. HealthBridge could help reverse these dynamics by offering a practical way for diaspora communities to co-invest in health systems. Doing so could reduce catastrophic health expenditures; expand predictable, pre-paid health financing; strengthen demand for high-quality, accountable health services; connect informal support systems with formal health financing mechanisms; and demonstrate a new model of citizen-led development finance.

But turning this vision into reality will require new and stronger partnerships. Governments must provide the policy frameworks to enable pooled financing and portable coverage. Central banks and regulators need to facilitate cross-border contributions with minimal friction. The private sector, especially fintech and health providers, must help design user-friendly platforms. And development partners may need to de-risk the early stages with funding and technical support. Most importantly, diaspora Africans must be at the centre of the process – not as passive donors, but as co-designers of a system that reflects their aspirations.

HealthBridge would not be a silver bullet. But it would offer a compelling new way to unlock the power of remittances, not just for survival, but for systemic change. It asks us to imagine a future where emergency calls for help don’t lead to spiralling catastrophes. Millions will no longer have to fear seeking care. They will have been told: “We’ve got you covered.”

Africans are already leading, innovating, and investing in their own development. What they need most are systems designed to amplify their agency.

This commentary draws on insights generated through the 17 Rooms Initiative, convened by the Center for Sustainable Development at Brookings and The Rockefeller Foundation. The views expressed here are the authors’ own and do not necessarily reflect those of 17 Rooms, its organisers, or funders.

Copyright: Project Syndicate, 2026.
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