Sustaining health systems in sub-Saharan Africa: public–private partnerships in a new era of reduced donor funding

Recent reductions in US global health funding have disrupted essential programs in sub-Saharan Africa, highlighting the region's vulnerability to external financing shocks. The suspension of the United States Agency for International Development initiatives has affected disease control, maternal care, and health system operations across 47 countries, raising urgent questions about how to sustain progress without reliable donor support. This commentary examines the potential of public-private partnerships (PPPs)-structured collaborations in which governments and private actors share financing, risk, and managerial responsibility-to strengthen domestic capacity. Drawing on examples from Senegal, Nigeria, and Kenya, we explore how service-, concession-, financing-, and technology-focused PPPs can mobilize additional resources, expand access, and improve service delivery. We also address key challenges, including governance risks, fiscal constraints, and shifting global power dynamics. While not a substitute for aid, well-designed PPPs aligned with national priorities can support more resilient, equitable, and self-reliant health systems in sub-Saharan Africa.