By Ekhosuehi Iyahen, Secretary General of the Insurance Development Forum and Pedro Pinheiro, Coordinator of IDF Inclusive Insurance Working Group (IIWG) & Sovereign and Humanitarian Solutions Working Group (SHS).
As the global community marks World Health Day 2026 under the theme “Together for health. Stand with science.”, we propose a collaborative solution to a fundamental question: how can Africa move from reactive, fragmented health financing towards a more reliable, robust approach?
It is a lesson well known to anyone who has lived or worked at the lower end of the wealth pyramid: long before insurance appears as a formal instrument, people, families, and communities manage risks with the tools they already have. When the state falls short, the safety net is woven by kin, by neighbours, or by religious or social institutions and networks.
Not so long ago, a large brood of children meant both the labour needed to work the land and the promise of support in old age. As societies urbanised, the eldest would leave the countryside for the city ahead of their parents, carrying with them an implicit obligation: to earn, to send money back, and, when possible, to bring the younger siblings and eventually the parents along.
At a broader scale, and in a globalised world, this movement extends beyond national borders. Migration stretches these informal systems of solidarity across continents. The money sent home by the diaspora in wealthier countries often sustains daily life and becomes all the more vital when an unexpected misfortune strikes.
In 2024, Sub-Saharan African countries received over $60 billion in annual remittances — around 3.3% of the continent’s gross domestic product (GDP), according to World Bank Data. A share of these transfers already finances households’ ad-hoc health costs: medical expenses, transport to health facilities, income replacement during illness and even funeral expenses.
Limited resources
However, these arrangements function with limited resources and without the structural advantages of formal health insurance. They can usually cope with everyday needs, but when something bigger hits, or when many people are affected at the same time, they quickly run out of capacity.
Formal insurance, by contrast, allows risks to be pooled at scale and over time, smoothing volatility and extending coverage beyond immediate social networks. It operates within a regulated framework that introduces consumer protection, contract certainty, and oversight on pricing and claims practices. In addition, insurance enables standardisation of health benefits, stronger links to quality-assured service providers, and the use of data to price risk and improve product design.
Beyond the household level, health insurance also plays a systemic role in strengthening national health systems. By pooling funds in advance and directing them more deliberately, and by purchasing health services and implementing them in a more structured way, health insurance helps align financing with policy priorities. The predictability of flows allows for more efficient allocation of resources. Overall, a health insurance system that covers more people and reduces reliance on out-of-pocket spending will also reinforce the availability and quality of health services.
Broader health financing context
The importance of the contribution of health insurance becomes even clearer against the broader health financing context in Africa. The continent faces an estimated annual health financing gap of around USD 66 billion, at a time when external support — while still significant — is declining. Official Development Assistance (ODA), long a backbone of public health programmes, has fallen sharply. At the same time, most countries still allocate less than 10% of national budgets to health, well short of the 15% Abuja Declaration benchmark.
Meanwhile, health needs are intensifying, and systems already under strain must respond to increasingly more frequent, severe and overlapping shocks. This includes recurrent outbreaks of infectious diseases, food insecurity, rising mental health burdens, climate-related risks, and protracted humanitarian crises. At its core, the health financing challenge faced by households mirrors that faced by governments: both are managing uncertainty with insufficient, reactive resources.
Diaspora bonds: bringing focus
The idea of tapping into diaspora finance flows seeks to organise the informal systems of solidarity through structured financial instruments, in order to amplify its impact. This is not without precedent: diaspora bonds have been used by countries such as Ethiopia and Nigeria to raise low-cost capital for infrastructure projects.
The same principle could be applied to health protection. In this context, the Insurance Development Forum (IDF), in collaboration with The ONE Campaign, is exploring how to translate this potential into effective protection, as outlined in a policy briefing published by the Brookings Institution, and is actively seeking partners to help bring remittance-linked insurance to scale.
On this World Health Day, the challenge, and opportunity, are clear: to move from informal, reactive solidarity towards structured, pre-arranged systems that can deliver health protection at scale. By combining the strengths of communities, markets and public institutions, there is a pathway to more resilient, inclusive health systems; and ultimately, to ensuring that no one is left to face health shocks alone.
