ABSTRACT:
Despite sustained political commitments to Universal Health Coverage (UHC), health systems across Africa remain chronically under-financed, characterized by heavy reliance on out-of-pocket payments and volatile external aid. In response, taxation has re-emerged in policy discourse as a potential lever for strengthening domestic resource mobilization for health. This paper critically examines taxation as a sustainable component, though not a panacea of public health financing in Africa, with particular attention to its functional roles, structural constraints, and political economy conditions. A conceptual–analytical policy analysis was conducted, drawing on internationally harmonized secondary data (including tax-to-GDP ratios, government health expenditure, and out-of-pocket spending), peer-reviewed literature, and policy reports. The analysis is guided by established health financing frameworks and political economy perspectives, using comparative country illustrations to identify patterns rather than to infer causality. The analysis finds that taxation contributes to health financing sustainability primarily through predictability, pooling, and redistribution, rather than revenue volume alone. Tax-financed revenues are uniquely suited to funding public goods, subsidizing excluded populations, supporting prevention through health-related excise taxes, and underpinning health system resilience. However, their impact is constrained by narrow tax bases, informality, administrative capacity limits, elite capture, macroeconomic volatility, and intense budgetary competition. Comparative illustrations from Nigeria, Ghana, Rwanda, and South Africa demonstrate that taxation strengthens health financing only where it is embedded within coherent governance arrangements and explicit political prioritization of health. The findings suggest that effective tax-based health financing requires institutional reform, transparent budget processes, progressive tax structures, and strategically designed, often partial earmarking of health-related taxes. Taxation should anchor, but not replace, complementary financing sources such as insurance, donor support, and innovative mechanisms. Concluding that taxation can serve as a sustainable and equity-enhancing foundation for public health financing in Africa when positioned realistically within mixed financing architectures and supported by strong fiscal governance.