PREAMBLE
We, the Delegates of the the Second International Primary Health Care Conference,
Gathered in Arusha, United Republic of Tanzania, at the Arusha International Conference Centre, from 9 to 11 September 2026, for the Second International Primary Health Care Conference, under the theme “Towards Universal Health Coverage: Strengthening Sustainable Health Financing, Efficiency and Quality Improvement within Primary Health Care”, and under the patronage of Her Excellency Dr Samia Suluhu Hassan, Guest of Honour, President of the United Republic of Tanzania and African Union Champion for Maternal and Child Health, duly represented by the Honourable Dr Mwigulu Lameck Nchemba, Prime Minister of the United Republic of Tanzania;
Recalling the Declaration of Alma-Ata of 1978, which first proclaimed Primary Health Care as the key to attaining health for all, and the Astana Declaration of 2018, which renewed that pledge for the twenty-first century; and affirming that Arusha carries this lineage forward into an African era of health security and sovereignty;
Recognizing that Africa’s population will rise from 1.4 billion currently to 2.5 billion by 2050, that development assistance for health has contracted by roughly half in four years — from USD 25.8 billion to approximately USD 13 billion — and that average external debt now stands at nearly 66.8 percent of GDP, converging to compress the fiscal space available for health precisely as demand for care is rising fastest;
Alarmed that out-of-pocket payments remain the dominant source of health financing in most AU Member States; that financial hardship from such payments ranges from 12.6 percent to 53.0 percent of the population; and that domestic health expenditure ranges from below one percent to above five percent of gross domestic product, a proof that Universal Health Coverage in Africa will be won or lost at the level of public financing and protection, not aspiration;
Affirming the Africa Health Security and Sovereignty Agenda, endorsed by the Assembly of Heads of State and Government of the African Union in February 2026, and its five pillars — reforming the global health architecture, advancing a continental agenda for pandemic prevention, preparedness and response, securing sustainable domestic and innovative financing, accelerating digital transformation, and building local manufacturing — as the continental framework within which Primary Health Care transformation must be pursued;
Noting that no single imported model of reform will serve every nation, and that each country must chart its own pathway towards the shared destination of Universal Health Coverage;
Welcoming the Lusaka Agenda of 2023 and its call to move from fragmented, disease-specific vertical financing towards integrated, nationally owned health financing;
Building on the endorsement of Her Excellency Dr Samia Suluhu Hassan as African Union Champion for Maternal and Child Health to accelerate the attainment of the Three Zeros for a healthier Africa: zero home deliveries, zero preventable maternal and newborn deaths, and zero unvaccinated children;
Guided by the Africa CDC-led 2026 Continental Report on the Causes and Drivers of Maternal, Newborn and Child Mortality in Africa, which underscores that many maternal and newborn deaths remain preventable and calls for stronger financing, frontline quality and health-system accountability;
Convinced that Primary Health Care (PHC) is the delivery gateway through which every other health and development ambition on this continent must pass, and that health sovereignty is ultimately measured by what a single African family can reliably receive from its health system, on an ordinary day and in a moment of crisis;
