This week, African leaders gathered in New York with a message that sounded both bold and overdue: Africa must take greater control of its own health systems. Ghanaian President John Mahama launched a new report called A Sovereign Future for Health, arguing that countries should build health priorities around their own needs instead of […]

This week, African leaders gathered in New York with a message that sounded both bold and overdue: Africa must take greater control of its own health systems.

Ghanaian President John Mahama launched a new report called A Sovereign Future for Health, arguing that countries should build health priorities around their own needs instead of constantly reorganising themselves around outside funders.

It is difficult to disagree. Political independence means very little if a country cannot reliably protect the health of its own people. Yet the conversation becomes uncomfortable when we move from the language of sovereignty to the reality of who pays for medicines, clinics, health workers and disease prevention when a donor walks away.

Zambia already knows this discomfort. Last year, the United States announced that it would cut US$50 million in annual health assistance following investigations into the theft and resale of donated medicines. This year, a proposed health agreement worth more than US$1 billion remained unresolved amid questions about accountability, data, national contributions and the wider terms of the relationship.

Those are political negotiations, but the consequences do not remain in government offices. They eventually reach the person collecting antiretroviral treatment, the mother taking a child to a clinic, the patient looking for insulin or the rural health worker trying to serve a community without enough supplies. Governments and donors argue at the top. Ordinary people feel the gap at the bottom.

This is why I become cautious when self-reliance is presented as an instant response to disappearing aid. Yes, African countries need stronger domestic financing, local manufacturing, transparent procurement and far more control over health priorities. But saying “we must now stand on our own” does not immediately replace a disrupted programme or restock an empty pharmacy.

The new Accra Reset report makes an important distinction. It does not simply call for donors to leave. It argues that international cooperation should strengthen country-defined systems instead of creating separate projects, reporting structures and priorities. In other words, the goal is not isolation. It is partnership that leaves something solid behind.

For decades, aid has saved lives across Africa. It has supported vaccination, HIV treatment, malaria control, maternal health and the training of health workers. We should not rewrite that history simply because the funding model has weaknesses. Gratitude and criticism can exist together. Something can save lives today while still failing to build enough security for tomorrow.

The harder question is why temporary support so often becomes permanent dependence. A pilot programme launches with vehicles, staff, allowances and branded materials. Communities begin to rely on it. Then the funding cycle ends, the team leaves and the service shrinks or disappears. We call the project successful because its targets were met, but rarely ask what remained after the final report was submitted.

There is also a problem with how African governments sometimes use donors. Outside money can quietly become permission to postpone difficult domestic choices. Health budgets compete with debt, infrastructure, salaries and politics. Prevention is easy to praise but less visible than a new road or building. The benefits may take years to appear, while election cycles demand something people can see now.

Yet health cannot be funded only when there is an outbreak, scandal or emergency. Diabetes, hypertension, cancer and kidney disease do not wait for a new grant agreement. They require continuous medicine, trained professionals, reliable laboratories and patients who can return for care. A system built around short funding cycles is badly matched to conditions that last a lifetime.

The diaspora understands another side of this story. Many of us abroad already act as private welfare systems, sending money for prescriptions, hospital bills and emergency treatment. Families are grateful, but this too can hide a structural problem. A relative in London, Perth or Dubai should be able to help out of love, not because one missed transfer could determine whether somebody receives care.

Self-reliance therefore has to mean more than replacing foreign aid with family money. It means collecting and protecting public revenue, buying medicines transparently, investing in local production where practical and making health spending visible enough for citizens to question. It also means admitting when corruption is not merely financial misconduct but a direct threat to somebody’s life.

Donors have responsibilities too. Abrupt withdrawal may satisfy a political demand for accountability, but patients should not become collateral damage in a dispute they did not create. Transitions need time, clarity and protection for essential services. If the stated purpose of assistance is to improve health, the exit should not destroy the very care it helped establish.

There is a lesson here for charities, foundations and well-meaning individuals as well. Giving is valuable, but donating products for one day is different from building a dependable service. The question should not only be, “How many people did we reach?” It should also be, “What can continue when we are no longer here?”

Africa should absolutely want sovereignty over its health. Zambia should want a system that cannot be destabilised by one foreign decision. But sovereignty is not declared at a conference. It is built slowly through budgets, institutions, accountability and the unglamorous work of keeping promises after public attention has moved elsewhere.

I think the real test of any health partnership is not how much money arrives, how large the launch appears or how impressive the targets sound. It is what remains when the donor walks away, and whether the patient is still standing when they do.

Kaajal Vaghela is a sportswear designer and cultural wellness consultant with over three decades of lived experience managing Type 1 diabetes in Zambia and the diaspora. Having previously served as Chairperson of the Lusaka branch of the Diabetes Association of Zambia, she remains a passionate advocate for breaking down myths and building awareness about diabetes. For more personalised coaching or corporate wellness workshops, visit: www.kaajalvaghela.com and for any feedback: diabetes.by.kc@gmail.com