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At the bottom of the food chain: How the Ebola outbreak is highlighting Africa’s need for independent health systems

6 July 2026

The latest Ebola outbreak in the eastern provinces of the Democratic Republic of the Congo (DRC) as well as Uganda is the third largest on record and the 17th outbreak in 50 years. From the delayed detection of the outbreak to the ongoing spread of the deadly disease, the unfolding epidemic is revealing persistent gaps in Africa health systems – but it also points to opportunity. If Africa is to be better prepared for the next pandemic and to progress the inclusive health agenda, it needs to learn the right lessons once and for all and prioritise becoming more self-reliant.

A rare strain and lack of funding reveal glaring gaps

The latest Ebola outbreak was caused by a rare strain of the virus called Bundibugyo, for which there is no licenced vaccine or rapid test. Since May more than 1 400 people have contracted the strain in the DRC and at least 438 have died. A clinical trial has now begun for possible treatments for this strain. Most previous outbreaks of the disease in the region were caused by the Ebola Zaire variant.

The absence of a test combined with shortages in health workers and resources due to international funding cuts meant that the first cases likely started long before an outbreak was officially declared on 15 May. In addition, ongoing conflict in the eastern DRC, with armed rebel groups controlling key provinces, has meant that humanitarian supplies often cannot reach the intended recipients. As of 29 June, there are almost 1 300 confirmed cases, including more than 300 deaths, making this the worst Ebola emergency since at least 2018.

The situation has revealed persistent gaps in Africa’s health systems that can only truly be understood and solved by looking through an inclusive health management lens. “Inclusive health management recognises that health challenges are closely intertwined with various other determinants of health and therefore cannot be addressed in isolation,” said Prof Munya Saruchera, director of the Africa Centre for Inclusive Health Management at Stellenbosch University. “In the case of the Ebola outbreak, historical overreliance on foreign funding, insufficient local pharmaceutical development and political instability all play a role.” All these factors must be considered and addressed to build the resilience of Africa’s health systems – and that is where the opportunity lies.

The opportunity: A more self-reliant African health sector

The Ebola outbreak comes just over a year after the dissolution of USAID and the drastic reduction in public health funding from the US laid bare Africa’s extensive dependence on foreign support. The impact of fewer health workers, restricted access to medication and service cuts have been severe. Nevertheless, many African countries have started taking matters into their own hands, with good results – and the Ebola emergency provides further impetus to the pursuit of so-called health sovereignty.

It is about more than meeting immediate needs. Saruchera emphasises that sovereignty also plays a critical role in advancing inclusive health management and pursuing Africa’s goal of universal health coverage. “Inclusive health and universal health coverage are about ensuring everyone can access the health services they need and that service delivery is efficient, underpinned by the principles of social justice,” explained Saruchera. If Africa has more control over the provision and cost of health services, staff and supplies, it can actively push the inclusive health agenda, taking into consideration the continent’s unique socioeconomic, political and geographic challenges.

Becoming more self-reliant will involve various aspects of public health. The three most important elements are funding, pharmaceutical manufacturing and political will.

Funding

Money is crucial to Africa’s sovereignty efforts, but it is also the biggest challenge. In 2024, half of African countries spent more on servicing external debt than on health. Substantial decreases in foreign funding in 2025 widened financial gaps. Yet several African governments have found ways to boost health funding. Some tackle efficiencies in health programmes: Health officials in Mozambique’s Tete province have started integrating several primary services (e.g. immunisation, malaria and family planning), pooling resources to reach more people in less time. Others apply fiscal reforms. Ghana, for example, lifted the cap on excise taxes earmarked for its national health insurance programme, thereby increasing the health budget by 60%. Many countries are also increasingly relying on pro-health taxes like excises on tobacco, alcohol and sugar.

Pharmaceutical manufacturing

Currently Africa imports between 70% and 100% of finished pharmaceutical products and 99% of vaccines. Increasing local production will go a long way in ensuring more reliable, cost-effective, timely treatment, but it will require expanding research and development capacity. There has been progress (South Africa and Nigeria are both promising manufacturing hubs), but regional cooperation will be vital to success, since not every African country will be able to contribute to production.

Political will

Encouragingly, heads of state are instigating efforts to increase self-reliance. Ghana’s president, John Mahama, is leading an initiative called the Accra Reset – a global framework for re-engineering development architecture, financing and partnerships to shift the Global South from foreign aid dependency to sovereignty, with health as the focal point. The initiative is meant to increase local health resources and manufacturing.

Sovereign, inclusive health systems requires collaboration and coordination

With a long history of dependence on foreign support, Africa’s road to self-reliance won’t be easy. Yet perseverance is critical if the continent is to be better prepared for future pandemics and to establish inclusive health management as the norm. Key to this will be regional collaboration and coordination.