Dr. Laëtitia MAKITA-NGADI, Founder & CEO SEMEN AFRICA Consulting, Initiator of the Summit on Investments in Health Systems in Africa (SISSA)
Within the Central African Economic and Monetary Community (CEMAC), the high number of medical evacuations abroad is no longer just a symptom of fragility: it now embodies a true financial hemorrhage and a revealer of systemic dependence. Member states, already weakened by chronic budget deficits and debt sometimes exceeding 70% of the annual GDP, a threshold set by Regulation No. 12/07-UEAC-186-CM-15, see their foreign exchange reserves evaporate to cover external care. This currency drain is not just a budget constraint: it undermines economic sovereignty and exposes the region to strategic vulnerability in the face of global health crises.
An economic and social issue
CEMAC currently has nearly 63 million inhabitants and is expected to reach 83 million by 2030. However, over 32% of this population lives in extreme poverty, with approximately 20 million people surviving on less than $2.15 per day. This demographic dynamic increases pressure on already fragile and underfunded healthcare systems.
The diagnosis is stark. In Gabon, between 2010 and 2015, nearly 14 billion CFA francs were spent on the care of only 1,488 beneficiaries evacuated abroad. In the Central African Republic, the situation is not much different: between 2019 and 2020, the cost of evacuations reached nearly 3.5 billion CFA francs for 229 patients out of 326 cases. Other states, strangled by debt, have had to temporarily suspend evacuations. The BEAC itself is not immune to this reality, as it also bears significant financial burdens in this area for its staff. These figures reflect a double fracture: a social fracture, where only the most privileged have access to care, and an institutional fracture, where states lose their ability to act sovereignly.
These structural vulnerabilities were brutally highlighted during the COVID-19 pandemic. It revealed the limitations of national healthcare systems and their dependence on external funding. The support of the WHO and international partners, while appreciable, highlighted the lack of real autonomy. Health dependence has become a major geopolitical risk, reducing states’ capacity to protect their populations and control their collective destiny.
On a macroeconomic level, CEMAC’s GDP growth reached 3% in 2024, but per capita income only increased by 0.2%, insufficient to reduce poverty. The regional budget deficit widened to -1.5% of GDP in 2024, compared to a surplus of 0.6% in 2023. Public health expenditures remain low: on average 5 to 7% of national budgets, far from the 15% target set by the Abuja Declaration (2001).
Creation of a regional reference center
Faced with this reality, the Bank of Central African States (BEAC) proposes a strategic shift: the creation of a regional medical reference center. This project is not just a hospital infrastructure, but an attempt at strategic rebalancing. It aims to reduce outward financial flows, preserve foreign exchange, and offer specialized care that was previously inaccessible locally. It is an act of sovereignty, comparable to the creation of a central bank or a regional army: a tool of power and resilience.
The expected benefits are clear: reduction of costly evacuations, training of specialists, research adapted to local pathologies, collective resilience in the face of crises. But this ambition raises governance questions: who finances? what cost-sharing among member states? how to avoid excessive dependence on a single regional center? Anticipating these objections is essential to make the project credible and prevent drift.
The strategic vision of the BEAC is part of a logic of profound transformation. It aims to establish a mechanism for regional resilience, capable of reducing structural dependence and anticipating crises. In a context where digitalization is accelerating the modernization of economies, health becomes a strategic battleground: one of sovereignty, competitiveness, and social stability.
-This ambition faces a revealing budgetary reality. In 2023, the BEAC spent over 5.627 billion CFA francs on health expenses, of which 1.977 billion was for medical evacuations involving 145 people. The destinations chosen according to the pathologies – mainly South Africa, Turkey, and France – reflect a persistent dependence on foreign structures. This dependence reveals a systemic risk articulated around three dimensions: health, weakened by insufficient local capacities; finances, under pressure from the continuous erosion of foreign exchange reserves; and sovereignty, weakened by the loss of strategic control in the face of external structures.
Beyond the numbers, these financial flows highlight a dual challenge: on the one hand, the need to strengthen local capacities to reduce external dependence; on the other hand, the opportunity to transform health into a lever for regional sovereignty. Current expenditures, if not redirected, risk consolidating structural fragility. But if capitalized in an endogenous investment logic, they can become a vector of competitiveness and sustainable stability.
The need for a holistic approach
While the BEAC and the WHO are central actors, health sovereignty cannot be limited to financial and international institutions. African universities, medical orders, local e-health startups, professional associations, and all other stakeholders must be integrated as pillars of this transformation. Their role is twofold: to give shape to an adapted model, train specialists, and develop medical innovations rooted in local realities.
Health sovereignty will only be credible if it is based on true autonomy in the various pillars of the health sector: training, pharmaceutical industry, logistics chain, infrastructure, hospital governance, and legislation. It must also align with the priorities of the African Union’s Agenda 2063, which places health at the heart of Aspiration 1: A prosperous Africa, aiming for a high standard of living and well-being for all.
The construction of regional hospital infrastructures is a crucial lever. It would limit costly evacuations, train specialists, develop research adapted to local pathologies, and reduce dependence on external resources. But such an ambitious and structuring project could hardly succeed without strong and constant political commitment to prevent this noble vision from ending in disappointment.
A sector with transversal impacts
Beyond access to care, the impact on human development is crucial. The democratization of healthcare would strengthen social equity and improve well-being, education, and productivity indicators. A healthier population is not just a humanitarian goal: it is a factor of economic competitiveness and political stability.
The macroeconomic consequences are equally strategic. Reducing foreign exchange outflows would free up resources for productive investments. The construction and operation of the center would create skilled jobs and attract private capital. In the short term, reducing evacuations would free up vital resources while initiating a virtuous circle of self-sufficiency; in the medium term, CEMAC could position itself as a hub for regional medical tourism; in the long term, it would aim for complete health autonomy.
The BEAC’s initiative invites us to rethink health as a lever of economic intelligence, that is, a strategic investment capable of transforming a budget constraint into a growth and stability lever. Long perceived as a sector dependent on NGOs and international funding, health must now be considered a pillar of economic diversification and sovereignty. Health becomes a strategic asset, on par with energy, the environment, or natural resources.
The regional medical center project is not just a health initiative. It embodies a strategic shift, an attempt to reconquer sovereignty. But it also carries a requirement: that of exemplary governance, capable of transforming ambition into tangible reality.
Successfully implemented, this project would be a political and social victory, a decisive step towards regional health sovereignty. An unfavorable outcome, on the other hand, would be more than a setback: it would be a sign of increased vulnerability, exposing CEMAC to reinforced dependence and heightened fragility in the face of future crises. The Kingdom of Morocco and Rwanda are deploying a strategic vision of health sovereignty with strength and depth. Health sovereignty is not an option but a condition for economic and political survival for a continent with constantly growing demographics.
