The African Journal of Health Economics, Systems and Policy: origins, commitments, and the work ahead

¹UNICEF Centre of Excellence for Child Survival and Development, Nairobi, Kenya, ²School of Public Health, University of Sydney, University of Sydney, Australia, ³African Constituency Bureau for the Global Fund, Dubai, United Arab Emirates, ⁴Institute for Health Metrics and Evaluation (IHME), University of Washington, Washington, United States, ⁵KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya, ⁶Institut de Recherche en Sciences de la Santé (IRSS)/CNRST, Ouagadougou, Burkina Faso, ⁷University of Oslo, Oslo, Norway, ⁸Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Accra, Ghana, ⁹WHO Regional Office for the African Region, North-West University, Potchefstroom, South Africa, ¹⁰School of Medicine, Duke University, Durham, North Carolina, United States, ¹¹Health Economics, School of Public Health, University of Ghana, Accra, Ghana

^&Corresponding author
Alex Olateju Adjagba, UNICEF Centre of Excellence for Child Survival and Development, Nairobi, Kenya

Editorial    

A conversation that became a journal

In 2021, one of us reached out to a small group of colleagues in African health economics with a simple question: Should we create a dedicated journal for this field? The group of researchers across Ghana, Kenya, Nigeria, and Benin responded quickly. The answer was yes. What followed was four years of deliberation: what to publish, how to govern it, how to serve both Anglophone and Francophone research traditions, and how to make it financially accessible. By launch, eleven founding editors had committed, representing ten countries and a collective record of more than 750 peer-reviewed publications.

The gap this journal addresses

Africa's health economics research output has grown substantially over two decades, covering several topics, from catastrophic expenditure and health insurance design to domestic resource mobilisation, pharmaceutical pricing, and UHC implementation. Yet the infrastructure for publishing and disseminating this evidence has not kept pace. The journals that shape the field are headquartered in Europe and North America; their review processes were not built for African institutional contexts; and their content reaches African decision-makers, where it reaches them at all, through paywalls, with no equivalent for researchers in high-income settings. The structural disadvantage extends to the review process itself: a large case-control study of more than 6,000 manuscripts across 22 biomedical journals found that first authors affiliated with institutions in low- and middle-income countries were significantly less likely to have their papers accepted after peer review, independent of methodological quality [2]. These are not incidental features of a system that happens to underserve Africa. They are structural properties of a knowledge architecture that was not built with African health systems in mind.

A less-discussed dimension of this gap concerns language. Francophone African research on user fee removal, mutual health organizations, performance-based financing, and subnational budget execution is systematically underrepresented in the indexed peer-reviewed record. AJHESP is, to our knowledge, the first indexed journal in health economics and health systems to operate a genuinely bilingual editorial model, reviewing and publishing in both English and French as languages of equal standing, and with plans to accept and review manuscripts submitted in Portuguese and Spanish in the near future.

What the African Journal of Health Economics, Systems and Policy is committed to

All AJHESP content is freely available from the publication. In its first year of operation, authors based at African institutions who are not in receipt of major external research grants pay no article processing charges. The journal publishes nine thematic areas, from health financing systems and UHC to pharmaceutical economics, fragile states, and methodological frontiers, and accepts many types of papers, such as original research, reviews, policy papers, commentaries, and perspectives. The journal operates under a published editorial independence policy. No funder, government, or external partner has any editorial influence over acceptance decisions, reviewer selection, or published recommendations.

Governance and rigour

Methodological rigour in applied health economics is inseparable from contextual knowledge. A researcher who has spent a career studying Kenya´s health insurance architecture assesses a manuscript on the SHA transition differently and better than a reviewer whose knowledge of Kenya is derivative. AJHESP´s Associate Editors, drawn from more than forty specialists with deep engagement with African health systems research, hold this peer-review authority. The journal adheres to methodological rigour while also embracing methodological pluralism: the appropriate method is the one that best addresses the research question in context, not one that conforms to a hierarchy imported from another field.

This inaugural issue: three lenses on the same question

The launch of AJHESP arrives at a moment of acute structural disruption in global health financing. Development assistance for health in Africa has contracted sharply in recent years, creating acute fiscal pressure on health systems that had relied on external support [1]. The question has shifted from how to optimize donor partnerships to how to govern and finance health systems on terms that African states define and own. This inaugural issue opens that conversation through three commissioned commentaries.

Boima Kamara, former deputy central bank governor and twice minister of finance, now Director General of the West Africa Monetary Agency, reframes the financing gap as an evidence gap. His commentary offers an indispensable macrofiscal starting point, including a largely absent dimension in the health economics literature: how regional monetary convergence in ECOWAS shapes the fiscal space available for health. Olusoji Adeyi, Edwine Barasa, Yuniwo Nfor, Eric Arthur, and Chris Atim provide the governance framework that turns diagnosis into action. Their four levers of public policy, legislation and regulation, institutions, financing, and learning give policymakers an operational architecture for the transition from dependence to self-reliance. Their analysis of bilateral side-deals and short-term financial relief is essential reading for any government navigating the new geopolitical landscape of global health. Angela Apeagyei completes the triptych with the metrics dimension.

Drawing on the most recent IHME tracking of development assistance for health, she argues that arbitrary budget benchmarks are an insufficient accountability peg when both donor and domestic resources are constrained. Her three-pillar framework, fiscal capacity, outcome-based targets, and strategic efficiency provide a more rigorous basis for measuring progress. Read together, these three commentaries share a refusal of nostalgia and of paralysis, and a conviction that the African health financing question is now, finally, an African question to answer. African Journal of Health Economics, Systems and Policy exists to be part of the infrastructure that makes that possible.

The road ahead

A journal is only as strong as the research it receives and the rigour with which it reviews it. We call on African governments to invest in domestic health economics research capacity; on research institutions to support researchers in submitting their best work to venues that understand their contexts; and on donors that fund African health research to require open publication in accessible venues with meaningful African intellectual ownership. We invite researchers, reviewers, and readers to engage with AJHESP as a shared intellectual institution. Submit your work. Review seriously. Readers can also look forward to an upcoming call for papers focused on Africa´s health financing; details to follow shortly at www.africanjhesp.org.

Beyond the published page, AJHESP hosts a bilingual podcast, “...turns out, we had that data” (French: “Il s´avère que nous le savions”), where researchers and decision-makers interrogate evidence together, in both English and French, asking why the distance between what we know and what we do remains so stubbornly wide. It is available wherever you listen to podcasts. We did not build this journal because the field lacked journals. We built it because the field lacked a journal that placed African health systems evidence at the centre of its editorial purpose, in both of Africa´s major scientific languages, openly accessible, and governed by the people who live the evidence.

Competing interests     

The author declares no competing interests.

Authors' contributions     

This editorial was drafted by Justice Nonvignon and Alex Olateju Adjagba and reviewed, revised, and approved by all eleven members of the founding editorial board of AJHESP.

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