The three-body problem of Africa’s health sovereignty agenda

Physicists have a term for systems that look simple but behave badly: the three-body problem. With two bodies in space, gravity is predictable. Add a third, and the system turns chaotic. Tiny changes cause big swings. Stability becomes rare and fragile.

That is exactly where Africa’s health sovereignty agenda sits today.

The  African  Union  Strategic  Plan  2023–2027  and  Africa  CDC’s  vision  are unapologetically ambitious: build strong public health institutions, expand laboratories (Labs), manufacture vaccines locally, and stop being last in line when the next pandemic hits. Meanwhile, Financing Africa’s Health Security and Sovereignty document delivers a blunt message: Africa is not mainly short of money – it is leaking value and misusing what it already has.

These two agenda are not aligned. They are pulling against each other in unstable orbit, creating what can only be described as the 3-Body Problem of Africa Health Sovereignty:

1.   Expansion vs efficiency-first reform

2.   Coordinating donor money vs escaping donor dependency

3.   Africa CDC-led continental ambition vs country-led ownership

But there is a deeper problem hiding in plain sight. Africa is debating sovereignty as if it were poor. It is not.

The Fourth Force Everyone Avoids Talking About: Africa’s Resources

Africa holds 30–40 per cent of the world’s critical minerals, vast oil and gas reserves, forests, biodiversity, and strategic agricultural land. These resources power global supply chains, fuel green transitions, and generate enormous external value.

Yet Africa’s health systems remain financed as if none of this exists. That omission  is not accidental. It is political.

As long as health is funded mainly through donors, sovereignty remains conditional. As long as mineral wealth is exported raw whilst health budgets beg for aid, the system stays dependent no matter how many strategies are written.

Health sovereignty not powered by Africa’s natural resources is an illusion.

This missing fourth force: Africa’s natural and mineral wealth is what could stabilise the entire system if used deliberately.

Body One: Expansion without fixing the leaks (or capturing value)

Africa CDC’s Strategic Plan 2023–2027 sets six priorities: integrated health systems, surveillance and early warning, laboratory networks, emergency preparedness, stronger public health institutes, and health product innovation including local manufacturing. The baseline is weak: as of mid-2023, only about 20 of 55 Member States had National Public Health Institutes; fewer than 5% of laboratories meet international standards for priority diseases; and Africa produces under 1% of the vaccines it uses, despite a 60% self-sufficiency target by 2040.

Building  this  infrastructure  is  urgent  but  here  is  the  uncomfortable  truth:  Africa  is  trying  to scale health systems whilst losing billions through inefficiency and value extraction elsewhere.

Many systems operate at roughly 70% efficiency, meaning around 30% of spending is lost to misallocation, duplication, weak management, leakage, and fraud. Total health expenditure is projected  to  rise  from  about  $110  billion in  2023 to  about  $260  billion  by  2050.  Efficiency reforms, pooled procurement, integrated service delivery, stronger public financial management and smarter purchasing could generate roughly $15 per capita in fiscal space by 2026, rising to about $40 per capita by 2050. That is real money: around $15 billion in 2026 and about $35 billion in 2050.

Yet at  the same time, trillions of dollars’ worth of minerals  leave the  continent with limited local value addition and almost no systematic link to health financing.

The provocation is simple: Why is Africa expanding health systems with donor money whilst exporting the very resources that could pay for them?

Efficiency reforms matter but they will never be enough on their own. Real expansion needs new, sovereign revenue streams, not just better accounting.

Mining royalties, resource rents, carbon credits, biodiversity finance, and strategic extraction levies are not abstract ideas. They are underused tools that could anchor long-term health financing without begging donors.

If expansion is funded only by aid and efficiency savings, it will always be fragile.

Body Two: “We want less aid” whilst designing systems that still need it

The second force is equally paradoxical. Donor dependency undermines sovereignty: external actors shape priorities, impose conditionalities, fragment planning, and can withdraw abruptly. The United States cut health assistance to Africa by roughly 65 per cent from  around $10 billion a year to far less. The intended response is to mobilise more domestic resources, improve tax compliance, use innovative financing (levies, bonds, debt-for-health swaps), and shift the mix so external sources fall below about 20 per cent of total health expenditure within five years. Yet aid remains indispensable in the short to medium term. The gap is large, and out-of-pocket spending exceeding about 70 per cent of total health expenditure in Nigeria must fall as prepayment and risk-pooling expand.

This is the contradiction donors understand and quietly exploit. Aid is shrinking. Geopolitics has moved on. But Africa keeps treating aid as a financing pillar rather than a temporary bridge.

The harder truth is this: Africa cannot exit aid dependency without replacing it with domestic, politically protected revenue. Efficiency alone will not do that. Neither will coordination meetings. This is where natural resources matter again.

If even a small share of extractive revenues were ring-fenced for health security outbreak preparedness, manufacturing infrastructure, workforce protection – donor exits would stop being crises.

The provocation donors rarely hear: Aid should help Africa unlock its own wealth, not replace it.

Until health financing is structurally linked to Africa’s resource base, “less aid” will remain a slogan, not a strategy.

Body Three: Continental ambition vs national control – Who owns the wealth?

The third force is structural. Africa CDC, established in 2017 and made autonomous in 2022, coordinates continental health security by setting standards and mobilising resources. During

COVID-19 it helped secure vaccines through the African Vaccine Acquisition Trust,

launched Saving Lives and Livelihoods, and coordinated mpox research showing the value of centralised leadership.

But health systems are national (and often sub-national). Ministries, regulators, and district teams allocate budgets, procure, hire, and deliver services and answer to national institutions, not Addis Ababa. When Africa CDC sets ambitious targets such as 60% vaccine self- sufficiency and common laboratory standards it depends on Member States translating them into roadmaps, budgets, and operational plans.

Here is the risk no one states clearly: If countries do not own both the health agenda and the revenue behind it, continental strategies will always outpace national reality.

Resource governance is national. Mining contracts, royalties, taxation, and land rights sit with governments. If those revenues are not deliberately connected to health financing at country level, continental ambition floats above fiscal reality.

The solution is not Africa CDC delivering health systems. It is Africa CDC setting standards and expectations for how national wealth supports health security and making underinvestment politically visible. Health sovereignty cannot be coordinated if it is not funded domestically.

How to stabilise the system: Use Africa’s wealth on purpose

Three-body systems stabilise when forces are intentionally balanced, not when they are ignored.

For Africa’s health agenda, that means:

First, sequence reforms that enable expansion. Early efficiency gains, pooled procurement, integrated service delivery, strategic purchasing, and stronger public financial management

create fiscal space and credibility. Without budget discipline and expenditure tracking, neither efficiency reforms nor expansion investments will deliver.

Second, replace aid with wealth, not hope. Mineral rents, extraction levies, and environmental finance must become health financing tools, not abstract macroeconomic concepts. Pandemic preparedness, labs, and manufacturing should be financed like strategic infrastructure the same way roads and power plants are.

Third, redefine roles between continental and national actors. Africa CDC should set standards, convene, negotiate pooled mechanisms, and monitor progress; Member States should implement, finance, adapt to context, and report. This is functional specialisation with mutual accountability.

Fourth, re-engineer aid coordination to support sovereignty, not substitute for it. Donors should commit to pooled, multi-year funding aligned with nationally defined priorities under One Plan, One Budget, One Report. Blended finance can accelerate manufacturing and digital infrastructure without deepening dependency. Results-based financing should reward system strengthening, whilst transitional tools (e.g., debt-for-health swaps and earmarked levies) bridge the gap as domestic mobilisation scales.

Fifth, politicise health financing – intentionally. Sovereignty is not technical. It is about who controls revenue and who decides how it is spent.

Final Provocation: Africa is not poor—It is misaligned

The three-body problem teaches one brutal lesson: systems fail when forces pull in different directions at the same time.

Africa’s health sovereignty agenda is being pulled by ambition, aid dependency, and governance confusion whilst sitting on untapped wealth that could stabilise the entire system.

Health sovereignty will not come from better coordination alone. It will not come from donors behaving better. And it will not come from strategies that ignore Africa’s own resources.

Until Africa uses its minerals, land, and natural capital to underwrite its health security, sovereignty will remain conditional and fragile.

The system does not need another plan. It needs alignment and the courage to fund health with Africa’s own wealth.

Author: Dr Selorm Avumegah, UK. Email: Selorm.Avumegah1@outlook.com

LinkedIn: https://www.linkedin.com/in/michael-selorm-avumegah-phd- 06227842

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