Sustainable Financing for Health: A User Guide for African Governments (the Guide) is a practical resource designed to support African governments in financing priority health investments in a fiscally responsible and sustainable manner. It is written primarily for Ministries of Health (MoHs) and Ministries of Finance (MoFs) and is intended to strengthen collaboration between them as they identify health priorities, assess financing options, and structure transactions that align with national development plans and macro-fiscal frameworks. The Guide responds to growing demands from governments for clear, action-focused guidance at a time of tightening fiscal space, rising debt pressures, shifting donor support, and increasing health system demands.

The Guide does not introduce new instruments. Rather, by building on established global practices and African experiences, the Guide demonstrates how existing financing mechanisms can be applied effectively to health priorities. It examines debt-for-health swaps, sustainability-linked and use-of-proceeds instruments, public-private partnerships (PPPs), and credit enhancement tools, explaining how each can be structured, governed, and implemented within national legal and institutional frameworks. Through case studies, practical tools, and structured guidance, the Guide helps officials assess readiness, manage risks, understand documentation and process requirements, and adapt these instruments to country-specific fiscal conditions and health sector needs.

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This user guide is based on research funded by the Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect the positions or policies of the Gates Foundation.