To Claim True Sovereignty, Africa Must Invest in Its Daughters
By Serah Malaba * Africa is navigating a profound moment of self-determination. Facing a sharp contraction ininternational development budgets, our governments are rewriting the rules of public health,rethinking and rebuilding more sustainable, domestic systems from within. Nowhere are thesta
*Africa is navigating a profound moment of self-determination. Facing a sharp contraction ininternational development budgets, our governments are rewriting the rules of public health,rethinking and rebuilding more sustainable, domestic systems from within. Nowhere are thestakes higher than for girls, who face a triple threat that no policy, budget or health system canafford to ignore: new HIV infections, sexual and gender-based violence, and unintendedpregnancy, three crises that feed one another and can derail a girl’s life before it has trulybegun. Get this moment right, and Africa doesn’t just protect a generation of girls – it builds theblueprint for a healthier, more self-reliant future. For too many girls, navigating the healthcare system means becoming entirely invisible, left tofall through the structural cracks of a network meant to protect them. Instead of finding a safeharbor for healing, they are frequently met with deep-seated stigma, discrimination, and apervasive sense of judgment that silences their pain. When their symptoms are dismissed ortheir realities misunderstood, it forces a profound isolation, leaving them to carry the weight oftheir health struggles alone, unseen, and unheard by the systems that should care for themThe triple threat persists because fewer than half of the region’s girls can access the vitalmedical care needed to protect and support themselves against it. This crisis is fueled by atoxic mix of limited awareness, deep-seated social stigmas, high out-of-pocket costs, anddeeply fragmented health services. Without urgent, coordinated action, millions more girls willbe left stranded without essential care-ultimately compromising the health, agency, and potentialof an entire generation. By 2050, more than a third of the world’s adolescent girls will live in Africa-representing amassive, vibrant generation of leaders, entrepreneurs and changemakers. Yet, this promise isseverely jeopardised by the triple threat. Securing their well-being against these overlappingcrises is not a luxury to be deferred. The path to a truly independent, thriving continent lies in asingle, vital choice: defeating this triple threat and unlocking the “girl dividend” through directcommitment to the health, safety, and fundamental opportunities of Africa’s daughters. The United Nations estimates that failing to invest in adolescent girls’ health will cost the globaleconomy $110 trillion between now and 2050. Conversely, The Lancet estimates a tenfoldmacroeconomic return for every dollar invested in adolescent health. When a girl is supportedthrough the volatile transition into adulthood, she stays in school, enters the workforce on herown terms, and reinvests the vast majority of her income back into her community. The real question is no longer whether the investment is worth making. It is whether Africangovernments are willing to structurally alter their budgets to make it. The urgency is immediate. Right now, governments across the continent are designing nationalhealth insurance benefit packages, primary health care funds and results based financingmechanisms, among others. They are deciding which services will be covered as sovereignhealth entitlements, and which will be left to the “project layer” -perpetually underfunded,fragmented, and at risk of vanishing when the next development funding cycle ends. Girls must not be left out of these emerging financing instruments or funding portfolios. Toooften, our systems treat the triple threat as three distinct problems managed by separate,siloed ministries operating through disconnected policies and service streams. A girl should nothave to navigate a labyrinth of fragmented services. Within the health sector, she faces a maze,forced to travel to one facility for HIV testing and another for contraception, a disconnectmirrored cross-sectorally when unintended pregnancies disrupt her schooling due to frictionbetween the health and education systems. When it comes to sexual and gender-basedviolence (SGBV), the fragmentation deepens into a chasm; survivors are left to navigate theseparate, uncoordinated worlds of healthcare, the education system and disconnected supportwhen it comes to safety and legal pathways through the justice system, and social protectionservices. True integration means tearing down these silos, ensuring a girl can accesscomprehensive, dignified care at a single, unified point of entry. The only path forward for African health policy is a unified ecosystem of care. For too long,fragmented health systems have failed girls, trapping them in disconnected care. Because true“one-stop shops” remain rare, our real breakthrough lies in creating seamless,community-based cross-sector referral linkages that bridge public clinics, private providers,and are supported by peer mobilisers and community-based organisations. This is theintegration model Tiko has proven: a dynamic public-private mix across all levels of health thatensures a girl navigating the system experiences a continuous safety net rather than a series ofdead ends. When we unify these disparate services and tie funding to verified health outcomesrather than bureaucratic processes, efficiency rises, costs drop, and accountability improves. By equipping clinics to deliver integrated HIV, contraceptive, and trauma-informed care forsexual violence simultaneously, we eliminate costly duplication and scale skilled healthworkers who are better able to serve girls without judgement. The economics of this ecosystemapproach are clear: as this cross-sector network scales, it becomes inherently more affordableand resilient, offering a definitive blueprint for girl-centred care. If African leaders want to assert true health sovereignty, they must take one concrete steptomorrow: explicitly include adolescent girls as a named, ring-fenced, and fully fundedpopulation in every health financing currently under redesign. Not as a footnote to maternalhealth. Not as a donor-funded add-on. But as the best way to change how health systems cansupport girls when it matters most. The gridlock facing Africa’s adolescent girls is not inevitable; it is the mathematical result ofdecades of policy choices that siloed care, masked girls in aggregated data, and treated theirsurvival as a series of isolated problems rather than a demand for wraparound support. Toooften, this fragmented approach means girls fall through the structural cracks, left feelinginvisible, stigmatized, and judged by the very health systems meant to protect them. At Tiko,our goal is to shatter this status quo by ensuring 3. 5 million girls annually over the next fiveyears stay in school, stay protected, and transition into decent work of their choosing. Cross-sector partnerships -stretching from local communities to national ministries,are how wecan support African leadership to finally move past the empty rhetoric of empowerment,dismantle these systemic silos, and permanently write the future of Africa’s girls into theprosperity of their own nations. We must recognise that failing to make substantive, immediate investments to ensure thesegirls reach adulthood thriving is no longer just a moral failure; it is an existential and real threat. If we choose inaction, we are willingly compromising the very sovereignty, wealth, andeconomic ambitions of the entire continent. *Serah Malaba is the Co-CEO of Tiko, an African-led non-profit organisation partnering withgovernments and health providers to re-engineer healthcare systems for adolescent girls acrosssub-Saharan Africa.