Sovereignty, Scale, and Sustainability: Financing Frameworks for Adolescent Health Across Africa

Bridging Fiscal Policy to Scale Health Care in the Era of Aid Contraction About the session As international aid contracts and debt pressures grow, governments across Africa are facing a difficult question: how do you protect and expand essential health services when the financing model that supported them is changing? For adolescent girls and young women, the stakes are particularly high. Services addressing unintended pregnancy, HIV, gender-based violence, and wider sexual and reproductive health and rights (SRHR) have often depended heavily on external funding. Moving those services into sustainable public budgets requires much more than a commitment to domestic resource mobilization. It requires answering practical questions about who pays, what evidence unlocks public investment, how money moves through decentralized health systems, and how governments can verify that funding is actually translating into accessible, high-quality care. This session brings together Tiko, and The Guttmacher Institute, to examine that transition from three connected vantage points: macro-fiscal policy and advocacy, evidence and costing, and the realities of delivering and scaling services at subnational level. Rather than keeping the conversation at the level of national pledges and ministerial declarations, the session will look at what co-financing can mean in practice. How can Ministries of Finance make the case for adolescent health when resources are scarce? What happens when responsibility for primary healthcare sits with states, counties, or provinces? How should governments and partners structure financing so that services can move from externally supported programs into statutory public-health budgets? Country experience, including work in Nigeria and South Africa, will help ground the discussion in the realities of building financing models across different political and health-system contexts. The wider question is one many health organizations are now confronting: as aid declines, what does a responsible transition toward greater government ownership actually require from governments, advocates, funders, researchers, and implementers? What to expect A practical conversation that connects the high-level debate about health financing with the decisions being made much closer to where services are delivered. The three co-hosts will bring different pieces of the financing puzzle into the room: the political case for greater public investment, evidence on costs and returns, and experience working with governments on co-financing and last-mile delivery. Participants will explore where current approaches break down, how national and subnational financing need to work together, and why adolescent health may require coordination across health, education, protection, and other government departments rather than a single budget line. The emphasis will be on making a complex financing transition understandable and concrete: what is already being attempted, what still needs to be solved, and what different actors can do to make the shift more sustainable. Who this is for This session is for government officials, funders, development-finance institutions, health and SRHR practitioners, advocates, researchers, philanthropies, implementers, and others trying to understand how health systems can sustain and scale services as international aid contracts. What you will get out of it A clearer picture of what the shift from donor-funded services to greater government financing looks like in practice Insight into how fiscal policy, costing evidence, and service delivery need to connect Lessons from subnational approaches to financing adolescent health A better understanding of the barriers governments face when absorbing externally supported services into public budgets Practical questions for funders, policymakers, and implementers navigating the next phase of health financing in Africa Hosted by Tiko The Guttmacher Institute