Viral hepatitis in Africa: peer learning and the 2030 targets
Peer learning can support Africa’s hepatitis response. Progress towards the 2030 targets still depends on surveillance, sustainable funding and access to care.
Africa accounts for around 26% of the global viral hepatitis burden and recorded nearly 125,000 deaths linked to hepatitis B and C in 2020 (Lancet Gastroenterol Hepatol, 2024), although prevention, diagnostic and treatment tools exist. The deficit is therefore systemic rather than therapeutic: weak surveillance, scarce sustainable funding and insufficient national expertise available for deployment.
Against this background, the African Union and the Africa Centres for Disease Control and Prevention (Africa CDC) have changed their approach. Top-down vertical interventions are giving way to decentralised peer learning intended to equip each state with national surveillance and treatment systems for the 2030 elimination targets. A peer-learning workshop held in Cairo in June 2026, after which more than 130 national programme officials from over 30 member states had reportedly been trained in operationalising hepatitis prevention and control and structuring sustainable finance, according to Africa CDC figures (Africa CDC), confirms this direction. This brief examines the economic rationale. It argues that peer learning may reduce the marginal cost of capacity-building—a plausible benefit not established by an independent cost-effectiveness assessment—and that its effectiveness remains conditional on institutionalising surveillance and securing domestic funding.
Strategic context
The scale of the burden explains the stakes. According to WHO Africa, more than 70 million Africans live with chronic hepatitis—around 60 million with hepatitis B and 10 million with hepatitis C—with at least 200,000 deaths annually, while fewer than one in ten people access testing and treatment (WHO Africa). The region also accounts for 63% of new hepatitis B infections, while birth-dose vaccination remains uncommon (WHO Africa / HepCOP).
The 2030 elimination target—a 90% reduction in new infections and a 65% reduction in mortality (WHO Africa)—faces a dual governance and funding deficit. The regional scorecard found that, among 28 countries with national strategic plans, most plans remained at the draft stage and only a few had secured substantial domestic funding. Birth-dose coverage illustrates the same fragility: in 2022, only 18 of 55 member states had introduced it (Africa CDC).
In institutional economics terms, these figures reflect disparities in knowledge and capacity more than a shortage of technical tools. Externally funded vertical programmes have produced plans that are often unfunded and weakly owned nationally. Contracting international aid and the priority given to domestic resource mobilisation (Africa CDC) make this model unsustainable and shift attention towards building national human capital and allocating scarce resources efficiently.
Case analysis: the African Union’s peer-learning framework
The framework originates in the Cairo Declaration on Viral Hepatitis, adopted by AU heads of state and government in February 2020 (Africa CDC), followed by the Continental Viral Hepatitis Prevention and Control Programme, launched in October 2022 with support from the Korea International Cooperation Agency (KOICA). It helps the 55 member states establish or strengthen national programmes across three areas: continental coordination, workforce development and South–South collaboration, and African guideline development (Africa CDC).
South–South cooperation centres on transferring the Egyptian model, recognised by WHO as the first large-scale success on the path to hepatitis C elimination (Egypt State Information Service). Successive training cohorts met in Cairo—a pilot in 2022, a second cohort from six states in 2023 and a third in November 2024—bringing the number of member-state experts trained to 26 by the end of 2024 (Africa CDC). The programme then expanded: after a five-day regional workshop bringing together thirty-three officials from thirteen countries in 2025, the June 2026 Cairo workshop reportedly brought the total to more than 130 national programme officials from over 30 AU member states, according to Africa CDC (Africa CDC, June 2026). Growth from 26 experts at the end of 2024 to more than 130 in 2026 indicates rapid expansion. Africa CDC presents this as an alternative to the top-down model; publicly available data do not yet independently establish peer learning as the decisive cause of the progress.
The model has frequently cited economic strengths: knowledge may spread at low marginal cost; training is contextualised by peers facing comparable constraints; and national ownership is strengthened when each country develops its own plan. These benefits remain plausible rather than established: no published cost-effectiveness assessment has yet compared this model with earlier approaches. A community of practice launched in October 2025 with twelve priority countries (WHO Africa) institutionalises the exchange. A neutral assessment nevertheless finds these gains fragile: programme funding relies heavily on one donor, epidemiological data remain scarce, and most national plans are neither published nor sustainably financed.
Policy pillars and recommendations
1. Institutionalise national surveillance
Scarce prevalence data are the first obstacle to efficient allocation. Integrating viral hepatitis into routine surveillance—notification, monitoring tools and seroprevalence surveys—determines states’ ability to target interventions and measure progress towards 2030. Peer capacity-building has lasting value only if it feeds permanent national data-collection and analysis systems. This nevertheless has a cost: building and maintaining these systems competes with testing and treatment for resources.
2. Secure sustainable domestic financing
Peer learning reduces capacity-building costs, but vaccination, testing and treatment require sustained resources that few states have secured. Including hepatitis funding in national budgets and medium-term expenditure frameworks, supported by continent-wide domestic mobilisation mechanisms (Africa CDC), is essential if plans are to move beyond the draft stage. Two concrete mechanisms could help. First, integrating hepatitis testing and treatment into national health insurance benefit packages and emerging universal health coverage arrangements would tie funding to a structural revenue stream rather than occasional allocations. Second, earmarking revenue from health taxes on alcohol and tobacco for chronic diseases, including hepatitis, would draw on a relatively predictable yield and a tax base consistent with public health goals. Both have limitations: health taxes are considered regressive and politically contested, while benefit-package inclusion faces limited fiscal space and trade-offs between diseases.
3. Sustain skills transfer
Moving from occasional cohorts to established national capacity requires institutional support: training trainers, African care guidelines and embedding trained experts in national programmes. Financing lessons from continental summits (Africa CDC) confirm that local ownership is central to continuity. Retention is the main difficulty: trained staff may emigrate or be reassigned, dissipating the investment.
4. Integrate hepatitis into primary care
Integrating hepatitis with HIV, tuberculosis, malaria and neglected tropical diseases into primary health care—a strategy endorsed by more than fifty states in November 2024 (Africa CDC)—shares fixed costs and expands access. Wider birth-dose vaccination and the triple-elimination strategy for mother-to-child transmission provide the most directly measurable levers. Integration can nevertheless dilute hepatitis-specific accountability and make it dependent on the strength of primary care.
5. Pool procurement and develop local production
Low birth-dose uptake—18 of 55 states in 2022—also reflects cost and vulnerable supply chains. Regional pooled procurement of vaccines and antivirals, acting as a single continental buyer, could influence prices and secure volumes. Longer term, African pharmaceutical production of vaccines and treatments would reduce import costs and exposure to disruption, in line with continental policies linking local manufacturing, pooled purchasing and supply resilience (Africa CDC). These levers involve trade-offs: local production often means higher short-term unit costs, and pooled procurement requires complex interstate coordination and governance.
6. Support demand through civil society and community engagement
The preceding levers concern supply, but their returns depend on demand. With more than 90% of affected people receiving no care and many unaware of their status, effective use of testing and primary-care facilities requires community outreach. Funding civil society organisations, already involved in co-developing national action plans (Africa CDC), is crucial to informing communities, countering stigma and converting installed capacity into actual service use. An elimination strategy that neglects demand leaves supply-side investments unused. Financing these organisations nevertheless raises questions about sustainability and measuring impacts that are often difficult to isolate.
Limitations and objections
Three methodological qualifications temper the analysis. First, most available evidence comes from the institutions running the programme—Africa CDC, WHO Africa and the Egyptian authorities—without independent external evaluation; favourable expansion indicators must be read accordingly. Second, correlation between peer learning and national progress is not causation: there is no counterfactual attributing the observed advances to this model alone. Finally, capacity-building has no measurable effect unless supported by sustained financing and effective demand; otherwise, it may produce skills and plans the system can neither retain nor use.
Institutional challenges and conclusion
Beyond these qualifications, the trajectory is shaped by viral hepatitis’s position among the world’s infectious causes of death, on a level with tuberculosis (WHO, Global Report 2024). Partners—KOICA, the Egyptian health ministry, technical coalitions and civil society—are best understood as components of a cooperation ecosystem rather than participants in isolated announcements. Diversifying their funding is essential to the programme’s resilience.
Peer learning lowers the entry cost of capacity-building and replaces a top-down model with national ownership. It provides a starting point, not a standalone solution. The decisive indicators are not workshop numbers but the proportion of states with published, funded plans, birth-dose vaccination coverage and mortality trends towards the 2030 targets. These are the measures by which the continental framework’s value should be assessed.