From “Your Turn to Suffer” to Shared Abundance: One More Reason to Build Self-Reliant Health Systems in Africa

Edward Oladele

Dec 17, 2025 |

4 mins

On a recent journey, I sat with colleagues to look back at the disruptions they had experienced in 2025. In the lighthearted, yet profound discussions, one phrase captured a deeper undercurrent. It is phrase you may not have read elsewhere: “Good for you, it is your turn to suffer now.” This was reportedly directed at laid-off local staff of international NGOs who, during periods of abundant funding, had lived in relative financial comfort and become de facto benefactors for extended families and communities—a form of “Black Tax” that was never fully sustainable and could never meet every demand. They were high flyers.

When donor cuts came, jobs vanished and that informal safety net collapsed. The resentment that surfaced was not only about employment loss; it reflected structural fatigue with an aid model whose stability depends on external political and fiscal decisions rather than domestic resilience. Donor-driven projects expand and contract in cycles, producing job losses, service disruptions, and broken expectations (you can read more in our recent article on preventing service disruptions during project transitions here: https://doi.org/10.9745/GHSP-D-24-00186). This volatility shapes how communities perceive not just projects, but the broader health system itself.

We must see that these moments of tension are more than my brother being happy at my misfortune, they expose deeper flaws in the aid architecture. Many health programs are designed and financed in ways that governments struggle to sustain once external funding ends. Human capital and technical expertise are often concentrated in donor-funded projects, leaving Ministries of Health with weakened strategic capacity just when they are most needed to lead reforms in health financing, insurance, and governance. Communities, having experienced intermittent access to services and abrupt program withdrawals, become understandably skeptical of initiatives that ask for their contributions but cannot guarantee continuity.

Importantly, this reflection comes at a time when several bold, homegrown initiatives are already underway to change this trajectory. Across the continent, governments, regional bodies, and partners are advancing domestic health financing frameworks, new accountability mechanisms, and strengthened public health institutions that aim to put African priorities, data, and leadership at the center. These efforts—including recent work led by Africa CDC and the African Health Catalyst Forum to rethink health financing and advance self-reliance—demonstrate that an alternative path is not only necessary, but feasible.

As some aid flows begin to return, there is a real risk that these promising reforms could be diluted or quietly jettisoned in favor of familiar, projectized approaches. These reflections are not an indictment of any single donor or partner, but an invitation for all of us—African governments, external partners, civil society, and communities—to resist the gravitational pull of “business as usual” and stay the course on building genuinely self-reliant systems.

The phrase “it is your turn to suffer now” from kith to kin is, therefore, a diagnostic signal that the current model has reached its limits. It points toward a new paradigm in which African health systems are anchored in local ownership, domestic resource mobilization, and durable institutions, with external funding configured to reinforce, not replace, that foundation.

Moving forward, several intertwined shifts are essential. External support must be closely aligned with and channeled through national plans and budgets rather than operating in parallel structures that disappear with the next funding cycle. Investments must prioritize building resilient public institutions capable of planning, governing, and financing health beyond individual projects—exactly the kind of institutional strength many of today’s reforms are trying to build. And countries must intentionally harness the power of African professionals—both on the continent and in the diaspora—alongside the innovation and capital of the private sector to design, implement, and scale solutions rooted in local reality.

In this context, the call is simple but urgent: do not abandon or downgrade the reforms already in motion just because aid is returning. Instead, let renewed external resources help to accelerate the transition to self-reliant health systems, rather than fund short-term projects.

When this transformation is complete, no one will need to “have their turn to suffer”; it will finally be our turn—together—to enjoy abundant, healthy lives.

This article was first published on LinkedIn