Francophone Africa Strengthens Health Financing Through Public Financial Management Alignment
By Daniel Yaw Domelevo, Chairman of the Economic and Organized Crime Office,Accountant and former Auditor-General of Ghana, Global Fund WCA Audit and Finance Committee Member
As part of its ongoing mandate to promote sustainable health financing and sound governance, the Africa Constituency Bureau (ACB) supports efforts by African countries to align external funding with national systems. The recent high-level meeting on the alignment of Global Fund financing with national Public Financial Management Systems (PFMS) marked another step forward in this shared vision of accountability, efficiency, and sovereignty.
Driving Ownership and Sustainability
From November 4–7, 2025, senior government officials, development partners, and global health leaders gathered in Dakar, Senegal, for a pivotal dialogue hosted by the Government of Senegal, in collaboration with the Global Fund . Delegates from 15 Francophone African countries convened to explore how national PFMS can enhance transparency, efficiency, and long-term sustainability in health financing.
Opening the meeting, Senegal’s Minister of Health and Public Hygiene called for unified financial management across domestic and external health resources, emphasizing that “every franc spent should translate into better health outcomes for citizens.” He stressed the need to maximize value for money and strengthen collaboration to achieve lasting impact.
Adda Faye, Chief Financial Officer of the Global Fund, underscored the timeliness of this agenda.
“In a context of shrinking donor resources and rising citizen expectations, countries need strong, transparent systems to manage funds effectively,” she said. “Public Financial Management is the bridge between sustainability and sovereignty.”
She highlighted ongoing collaboration between the Global Fund, the World Bank, WHO, and Gavi to build country capacity, invest in human resources, and promote transparent management of public funds.
Progress and Lessons from Francophone Africa
Country presentations revealed encouraging progress in integrating donor financing into national budgets and treasury systems, particularly in Benin, Burkina Faso, Côte d’Ivoire, Mali, Madagascar, Chad, and Togo. Reforms such as digitalization of expenditures, strengthened audits, and enhanced coordination between ministries of health and finance are helping create more coherent, resilient systems.
While challenges remain, especially limited capacity and fragmented reporting structures, participants agreed that the long-term gains from strengthening PFMS outweigh short-term fiduciary risks. Strong national systems are essential for accountability, efficiency, and resilience in managing health investments.
Key Takeaways
- Integration builds resilience : Aligning donor and domestic funds under one system strengthens sovereignty and coherence.
- Ownership drives sustainability: National leadership in PFM reforms ensures lasting results.
- Accountability institutions matter : Supreme audit institutions safeguard transparency and trust.
- Reducing parallel systems improves efficiency: Harmonization cuts costs and duplication.
- Transparency builds confidence : Strong PFM systems reinforce good governance and equitable health financing.
The Road Ahead
Participants committed to:
- Develop country-specific action plans tailored to each nation’s PFM maturity;
- Establish monitoring frameworks with measurable milestones;
- Foster peer learning and collaboration across Francophone countries; and
- Maintain regular follow-ups to track progress and sustain momentum.
Toward Health Sovereignty
For the 15 participating countries — including Senegal, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Madagascar, Mali, Niger, and Togo — this meeting reaffirmed a collective commitment: external investments must strengthen, not bypass, national systems.
As Ms. Faye concluded,
“Each investment must lead to stronger, transparent systems that serve our people. Together, we can build resilient health systems — for Africa, in Africa, and with Africa.”
This gathering reflects a shared African vision of sovereignty in health financing , one rooted in trust, accountability, and partnership.