Public-Private Partnerships in African Health Financing
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Public-private partnership models for health financing, service delivery and pharmaceutical manufacturing across Mauritius, Cameroon, Kenya and South Africa.
Across Africa, public budgets alone cannot meet the scale of need in health — especially where countries are managing debt pressure, rising NCD costs and shocks like COVID-19. The ALM framework treats public-private partnerships as a cross-cutting enabler, and several countries piloted or scaled PPP models between 2019 and 2026. In 2025, AUDA-NEPAD launched the Programme for Investment and Financing in Africa's Health Sector (PIFAH), officially launched by H.E. President William Ruto of Kenya and H.E. Mrs Nardos Bekele-Thomas, to provide a continental platform for structuring and coordinating health-sector investment under the ALM agenda. Four models are examined. Mauritius runs an investment-led PPP: the Economic Development Board's Health PPP Framework unlocked USD 150 million in domestic corporate investment between 2023 and 2025 for hospital modernisation and digital health. Cameroon runs a service-delivery PPP: the April 2023 UHC Phase 1 contract with SUCAM, a private entity managing UHC implementation in selected regions, is unique on the continent. Kenya runs a provider-contracting PPP, where SHA contracts both public and private facilities at SHA-determined rates and the Facility Improvement Financing Act lets public facilities retain and reinvest SHA revenues. South Africa's Biovac Institute is a manufacturing PPP established in 2003, whose April 2026 R1.47 billion EIB/EC/IFC investment is the continental benchmark for blended finance anchored by public-offtake commitments through AVMA.
Policy Recommendations
No one-size-fits-all. PPP models must be tailored to national context — investment-led for small island developing states, service delivery for fragile systems, provider contracting for emerging insurance markets, and manufacturing for industrially capable states.
Regulation before contracting. Egypt's three-authority model — UHIA, EHA and GAHAR — demonstrates that institutional separation of purchaser, provider and regulator is a prerequisite for effective PPP governance in health.
PIFAH gives the ALM agenda its missing investment-structuring arm. Countries with bankable health-sector projects can now access a coordinated platform for blended finance, closing the gap the 2019 ALM Declaration left between political commitment and operational execution.
Continental manufacturing works as a platform PPP. The PAVM, AVMA and APPM architecture provides a continental template for pharmaceutical-manufacturing partnerships that can be adapted for health service delivery.
Transparency is non-negotiable. Governance concerns around Cameroon's SUCAM contract, and implementation uncertainty around South Africa's NHI, underscore that PPP legitimacy depends on transparent pricing, publicly disclosed contracts and accessible dispute resolution.
Key Numbers
Distinct PPP models compared across African health systems
USD private capital mobilised by Mauritius's PPP framework
Rand invested in Biovac's multi-vaccine facility in 2026
Of the PPP literature that relies on case studies, not evaluations
Africa – Mauritius, Cameroon, Kenya, South Africa
Key Findings
Mauritius's Health PPP Framework unlocked USD 150 million in domestic corporate investment between 2023 and 2025, with three new manufacturing facilities established by late 2025.
Cameroon's SUCAM contract is the boldest service-delivery PPP on the continent, but the 2024 second-year evaluation found it functional while flagging governance and transparency concerns.
Kenya's provider contracting is the most scalable of the four models, but the 2025 provider-payment crisis shows the downside risk when the purchaser side underperforms on reimbursement.
The evidence base for health PPPs in Africa remains thin — more than half of the literature relies on case studies rather than rigorous evaluations.
AUDA-NEPAD's PIFAH, endorsed at the 38th AU Assembly in 2025 under Decision Assembly/AU/Dec.922(XXXVIII), addresses this gap through four workstreams covering resource mobilisation, investment structuring, capacity building, and political steering and accountability.