Much of the global health financing debate is about how much money is available. Far less is said about what happens to it once it reaches government. In Africa, the last mile from treasury to clinic is where health financing too often breaks down.
Government health spending in Sub-Saharan Africa averages just $38 per person. In low-income countries it can be as little as $12, against a recommended minimum of $80 for basic needs. Over the past decade spending per person has risen by just 3%, and inflation has wiped out most of that. Health ODA has fallen by nearly 50% from its 2021 peak, and donors are increasingly being pushed to channel what remains through government systems rather than around them.
When resources are this scarce, efficiency stops being a technical detail. It becomes the whole challenge. Every dollar has to be spent in full, tracked properly, and shown to have gone to the services it was meant for. There is a harder truth underneath that. A government that cannot show its finance ministry and its partners that the money is working will struggle to argue for more. Accountability here is not about good governance for its own sake. It is what secures the next allocation.
Priority areas where public financial management determines whether health spending actually reaches the frontline. Scroll across to explore each.
PFPR teams take established diagnostic tools and apply them to the most pressing PFM questions in each country's health system. They work with government to set a baseline, then design reform actions that government owns and drives.
PFPR does not deliver a report and move on. It stays through implementation, helping government adjust as things change and build on what works. What is learned in each country goes back to the Africa School of Governance, where it is turned into practical knowledge and shared with others across the continent.
Alongside country-level technical assistance, PFPR invests in the practitioners, tools and institutions that will sustain health PFM reform. Working through the Africa School of Governance, PFPR adapts established diagnostic tools to the African context and develops a dedicated curriculum covering both long-term certification programmes and short-term courses for senior officials.
The aim is a group of practitioners who know the continent's health and finance problems well, and who have learned first-hand what it takes to fix them. They are the core of PFPR's technical assistance, working in-country alongside government teams. Every engagement feeds back into the Africa School of Governance and keeps the curriculum close to the realities of reform.
The institutions working on public finance and those working on health financing mostly run in parallel. Reform tends to stall in the space between them. PFPR exists to close that gap, bringing development banks, donors, NGOs and continental bodies around one practical question: how health money is budgeted, spent and accounted for.
PFPR does not duplicate what already exists. It does the joining-up: getting finance and health ministries into the same room, coordinating how donors use country systems, and making sure what is known about PFM actually reaches the sector. In each country it brings government, partners and civil society around a shared reform agenda. Across countries it connects reformers facing similar problems so they can learn from each other directly.
Vanguard Economics created and launched PFPR in 2024–2025, and delivers it in partnership with the Africa School of Governance. The two provide the institutional base for PFPR's first phase.
