Funding That Defines Health Sovereignty Must Be Preceded by Democratic Governance

This evening, I read the opening remarks by Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, at the Africa Health Sovereignty Summit held today in Accra, Ghana. The summit seeks to redefine African health governance and health systems sustainability leadership. While reading, I found myself deeply moved by both the urgency and clarity of his message. His words resonate profoundly, especially at a time when sharp aid cuts are becoming the common denominator across international development and humanitarian sectors. For fragile nations like South Sudan, the implications are far-reaching.

In his address, Dr. Tedros made several bold but necessary assertions, ones that offer a practical blueprint for African health systems to stand on their own feet. Among his key points, four struck me with particular force:

1. The responsibility for financing strong, resilient health systems rests with governments.
2. The most efficient and equitable source of health financing is the national budget.
3. More money alone is not enough. What matters is how effectively that money is used.
4. In many low- and middle-income countries, health budgets go unspent due to weak public financial management systems.

As a South Sudanese professional engaged in global health leadership and advocacy, I welcome these calls. They are not only timely but essential. And yet, I must add, with the same urgency, that none of these shifts are achievable without a corresponding transformation in governance.

Sovereignty Cannot Exist Without Accountability

There is no health sovereignty where citizens are unable to question how their taxes are spent, where decisions about resource allocation are made in darkness, or where data is not reliably available to guide policy. If governments are to finance their own health systems, as they must, then transparency, accountability, and civic participation are non-negotiable.

Sovereignty, in the truest sense, must be people-centred, and that includes the right of citizens to engage in policymaking, to demand value for money, and to insist that health spending reaches those who need it most. Without this, sovereignty becomes a hollow term, a banner under which inefficiency, exclusion, and elite capture are allowed to thrive.

Financing Without Good Governance Is Futile

Many meetings have long discussed domestic resource mobilisation and country ownership in development discourse. These are noble goals. But in many fragile and conflict-affected settings, health budgets remain underspent not due to lack of funds, but due to the absence of systems that are capable, responsive, and accountable. Weak procurement systems, delayed disbursements, political interference, and poor coordination continue to sabotage even the most well-intentioned efforts. This is what defines the weak public finance systems mentioned by Dr. Tedros.

In South Sudan, for instance, we have witnessed how donor dependency distorts national priorities and delays urgent reforms. Yet we have also seen how fragile the prospect of local ownership becomes when governance systems are not equipped to manage or absorb funds efficiently. Health workers go unpaid, medical supplies are mismanaged, and communities lose faith. More disturbing is that lives are lost.

This is not simply a health sector issue. It is a governance issue.

Seismic Shifts in Political Will Are Surely Needed

If Africa is to realise the health sovereignty that Dr. Tedros so eloquently advocates for, it must be matched with a seismic shift in political will, one that opens up civic space, strengthens institutions, and ensures governments are accountable to their people.

We cannot make promises at high level summits about strengthening health systems while stifling dissent. We cannot preach efficiency while ignoring corruption. And we cannot champion inclusion while excluding local actors and communities from decision-making.

Health sovereignty is not just about money. It is about who holds the power to decide how health systems are built, maintained, and sustained, and whether that power is exercised in the public interest.

As we respond to these calls for national investment and local ownership, let us not overlook the indispensable role of democratic governance. We must advocate not only for more domestic financing, but also for the political conditions that allow those resources to be used effectively, equitably, and accountably. This is the indisputable prerequisite for health sovereignty.

Only then will the vision of health sovereignty become a lived reality across Africa. Only then will the response to global aid cuts be a dignified one.