From personal stories to policy action: Advocacy at the 16th NEAPACOH meeting

Dar es Salaam, Tanzania—The room fell silent as Esther Nasikye, PATH's Global Maternal, Newborn, and Child Health (MNCH) and Immunization Advocacy Lead, shared a story of two lives separated by circumstance but united by diagnosis. Her sister Rhoda, the first college graduate in their family, died of AIDS in 1992 in Uganda, just a year after diagnosis. That same year, the US NBA star Magic Johnson announced his HIV diagnosis and received cutting-edge treatment. He is now a billionaire businessman.

"This is where our conversation starts," Nasikye told the parliamentarians gathered for the pre-NEAPACOH meeting on March 5. "Because you have a critical role in slicing the cake, in terms of what goes to the health sector or what doesn't."

This powerful opening to PATH's pre-meeting session on "Sustaining Health Gains: Strengthening MNCH and Immunization Financing for Resilient PHC [Primary Health Care] Systems" set the tone for what would become a landmark gathering of African health legislators.

The 16th Network of African Parliamentary Committees of Health (NEAPACOH) meeting, held March 6–7, 2025, brought together 186 delegates and members of parliamentary committees responsible for health and budget from 23 African countries. The gathering, held under the theme “Re-positioning the Role of Parliamentarians for Implementation of the Unfinished ICPD [International Conference on Population and Development] Agenda and Attainment of Universal Health Coverage (UHC): South to South Sharing of Lessons and Good Practices,” concluded with the adoption of the comprehensive Dar es Salaam Call to Action.

"The meeting provided a platform for Africa Parliamentarians to get acquainted with the status of implementation of the ICPD Programme of Action and attainment of UHC in the Africa region," noted the official communiqué.

The communiqué described that participants "deliberated on transformative actions for the health and well-being of millions of the African people" and "discussed challenges incumbering the achievement of UHC, such as inadequate domestic financing for health, structural inefficiencies and resource leakages."

In her opening remarks to the gathering, Dr. Betty Mirembe, PATH Uganda Country Director, presented sobering statistics that underscored the urgency of the moment.

"Today, approximately 5 million children die each year before their fifth birthday. Nearly half of these deaths occur in sub-Saharan Africa," Dr. Mirembe stated. "We lose a woman every two minutes due to pregnancy or childbirth, 70 percent of which are in sub-Saharan Africa. Nearly all of these deaths could be prevented with access to the package of innovations and interventions."

The scale of the challenge is daunting. Currently, 59 countries are expected to miss the 2030 United Nations Sustainable Development Goal (SDG) target for reducing under-five mortality to 25 per 1,000 live births. Only nine African countries have reached the SDG targets for reducing under-five and neonatal mortality rates—and no other African countries are projected to meet these targets by 2030 without accelerated efforts.

"To meet the 2030 targets, maternal mortality must accelerate nine times faster, stillbirth rates need a threefold acceleration, neonatal mortality requires a fourfold acceleration, and under-five mortality also requires a fourfold acceleration," Dr. Mirembe emphasized.

Dr. Caleb Mike Mulongo, a health financing specialist, gave a detailed presentation on health financing, supported by PATH's research across ten African countries. In it, he revealed the precarious state of immunization funding on the continent. Governments currently fund only 25 percent of their immunization needs, with development partners contributing the remaining 75 percent—creating what Dr. Mulongo called "a significant point of vulnerability."

His analysis went beyond immunization to examine the broader health financing landscape. Most countries allocate less than 2 percent of their gross domestic product (GDP) to health, with even less going to routine immunization. Government spending on immunization services accounts for less than 5 percent of all health sector spending and less than 10 percent of government health spending.

The research identified key structural barriers to sustainable health financing:

• Low tax revenues (below 15 percent of GDP) that limit domestic resource mobilization.
• High debt levels (exceeding 50 percent of GDP) that constrain fiscal space.
• High out-of-pocket payments (more than 40 percent of total health expenditures).
• Weak health systems, with UHC service indices ranging from just 34 to 53 percent.

"If countries cannot mobilize enough taxes, if countries are highly indebted, then they have limited fiscal space," Dr. Mulongo explained. "It simply means the cake is small, so health will get a smaller piece."

The final Dar es Salaam Call to Action, adopted on March 7, directly incorporated PATH's key recommendations on health financing and maternal and child health. The parliamentarians committed to a comprehensive set of actions that closely align with PATH's advocacy priorities:

1. Increasing domestic health financing. Parliamentarians pledged to "advocate for increased domestic investment in health" and "support and champion laws and policies that support sustainable financing mechanisms, including innovative domestic resource mobilization and national health insurance schemes."
2. Addressing donor funding gaps. Recognizing the shifting global landscape that PATH highlighted, they committed to "align budget and planning frameworks of our countries to cater for the financing gaps for essential health services created by the changing donor funding environment."
3. Prioritizing maternal and child health. Directly addressing PATH's call for protecting maternal and newborn health investments, the Call to Action includes a commitment to "advocate for increased national budget allocations to Primary Health Care (PHC), Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH), HIV/AIDS and TB, Immunization and Non-communicable Diseases."
4. Strengthening accountability. Parliamentarians pledged to "provide oversight and accountability by strengthening scrutiny and tracking of health budgets to reduce the leakages & inefficiencies in health budget spending"—a key area that Dr. Mulongo's research identified as essential.
5. Investing in regional vaccine manufacturing. Echoing PATH's emphasis on sustainable immunization systems, they committed to "advocate for increased partnerships and investment in Africa's vaccine manufacturing capacity to ensure sustainable, timely, and equitable access to life-saving vaccines for our populations."

These commitments reflect PATH's call for an urgent rethinking of health financing models in the face of changing global aid dynamics.

Tanzania’s experience offered a promising example of parliamentary action. Hon. Elibariki Kingu, a Tanzanian member of parliament and Chair of the Tanzania Parliamentary Committee on Health and HIV/AIDS Issues, highlighted how Tanzania has extended health insurance coverage to university students up to age 22, with plans to cover 24 million people in the next five years.

"Tanzania is doing this because of the serious commitment of the parliamentary committee, which provides oversight for the health sector in the country," he noted. "The government is extending to us the necessary cooperation to ensure these things happen.”

Hon. Dr. Christopher Kalila, a member of parliament from Zambia, was equally direct about the challenge: "We know the problems, and we also know the solutions. But how many are actually embracing those solutions and taking the step to do it?”

With the adoption of the Dar es Salaam Call to Action, the critical work of implementation begins. As Patrick Mugirwa, Acting Regional Director of Partners in Population and Development Africa Regional Office (PPD-ARO), stated during the opening session, “It should no longer be business as usual.”

The 16 commitments in the Call to Action represent a significant step forward. Still, their success will depend on parliamentarians returning to their respective countries and translating these promises into concrete legislative and budgetary changes during these unprecedented times of shifting global financial priorities.

The document itself acknowledges that previous commitments, including the Maseru Call to Action from 2024, remain "an important blueprint for accelerating the attainment of UHC in the region but whose full implementation remains unfinished business.” Breaking this cycle of commitments without sufficient action will require parliamentarians to exercise their full constitutional powers of legislation, representation, appropriation, and oversight.

As Dr. Mirembe emphasized, “This is an opportunity to define the way forward—to ensure that every woman and every newborn has access to quality, lifesaving health care.”

The African continent must step up to fulfill its own promises and responsibilities to ensure UHC for its people. As Amos Mugisha, PATH Tanzania Country Director, noted, “Without strong and predictable domestic financing, our efforts to improve health outcomes will remain vulnerable to disruptions, and our long-term progress will be at risk.”

The Dar es Salaam Call to Action represents a critical opportunity for Africa to take ownership of its health future.

The actual test will be whether the powerful words and commitments from the NEAPACOH meeting translate into action that transforms the lives of women, children, and all Africans in need of quality health care.