By Dr Vivian Manyeki

African health systems are under severe strain due to limited budgets, chronic understaffing, and rising rates of preventable diseases. For example, in rural Kenya, Nurse Amina starts her day before dawn, caring for dozens of patients in a dilapidated clinic with minimal resources. She constantly improvises, repurposing supplies and working extra hours to compensate for absent staff. The need for essential resources and improved strategies is urgent. Without swift, effective public health action, these systems may collapse. Harm reduction is an urgent necessity for African countries facing significant health disparities.

A Continent at a Crossroads

Africa is at a pivotal moment in public health. Tobacco use kills over eight million people each year. While smoking rates drop in high-income countries, smoking-related deaths are rising rapidly in Africa, increasing three times faster than in wealthier regions. Without policy changes, tobacco-related illnesses will claim millions of lives and cost billions in healthcare over the next decade. These funds could be redirected to establish new clinics or vaccination programmes. Adopting harm reduction strategies could cut this burden in half, enabling resources to focus on infections, maternal health, and child survival. The poorest populations are most vulnerable due to limited access to healthcare and cessation support. Countries such as Kenya, South Africa, and Nigeria face significant expenses in treating tobacco-related diseases, straining already limited health budgets. This highlights the urgent necessity for harm reduction in Africa.

Harm Reduction: A Proven, Underused Strategy

Harm reduction recognises that individuals will engage in risky behaviours such as smoking, alcohol use, unsafe sex or drug use. Complete abstinence is unrealistic for many, so practical interventions are needed to prevent avoidable illnesses and death. These include safer nicotine products, opioid substitution therapies, condoms, needle exchange programs, and policies that protect dignity. African countries should act without delay. In tobacco control, harm reduction requires providing less harmful alternatives such as nicotine pouches, e-cigarettes, and heated tobacco products for those unable or unwilling to quit. While some risks remain, these options are much safer than combustible cigarettes. Delays and restrictive policies, often driven by misinformation, are costing lives and worsening health inequalities. Immediate action is essential.

The Cost of Inaction

Delaying harm reduction measures puts vulnerable groups at greater risk. Without immediate access to safer alternatives, low-income smokers face higher rates of illness, disability, and financial hardship. For example, in rural Uganda, if a primary breadwinner becomes ill from a smoking-related disease, the family may lose its main income, fall below the poverty line, and withdraw children from school, perpetuating poverty. These ripple effects—lost productivity, educational decline, and deepening poverty—require urgent policy change. U.S. research, including studies by Prof. Abigail Friedman, shows that e-cigarette regulations can quickly affect health outcomes, particularly across different social groups. Restricting safer products for lower-income smokers in Africa increases health disparities. Within the next year, governments can commit to legislative steps that make safer alternatives accessible and affordable. Setting clear deadlines can turn urgency into action. Harm reduction is essential to protect the poor, empower individuals, and ease the burden on health systems. With most African smokers lacking cessation support during ongoing disease outbreaks, immediate action is critical.

A Call for Evidence-Based Policy

Africa’s health future relies on prioritising science and public health over stigma. Harm reduction is essential when quitting is not possible, and denying access to lifesaving tools undermines health equity. Africa must act now by prioritising education, strengthening healthcare, advancing gender equality, reducing poverty, and ensuring good governance. Immediate steps include setting clear rules to distinguish combustible tobacco from reduced-risk alternatives, funding local harm-reduction research, encouraging ongoing dialogue among communities, health workers, and policymakers, and ensuring that safer alternatives are available, affordable, and regulated. As Nurse Amina from Kenya states, ‘Without access to these harm reduction tools, we see too many preventable deaths in the community.’ These frontline perspectives demand swift action to protect the most vulnerable.

To implement these recommendations, key governance actors must be involved. Health ministries, the African Union, and regional health committees such as ECOWAS should lead these efforts. These organisations can ensure that the evidence-based benefits of harm reduction are realised through accountable policies and effective implementation. Collaboration among these institutions is essential to bridge the gap between scientific research and policy, enabling a unified, continent-wide response to health challenges.

A Matter of Justice

In Africa, inequality determines who becomes ill and who receives care. Harm reduction is not only a practical policy but also an urgent moral obligation and a matter of justice. Africa’s health systems are at a breaking point and require immediate relief. Harm reduction should protect those most at risk and help make public health a right for everyone, not just the privileged. Readers can support harm reduction by endorsing a model harm reduction bill in their communities or countries. This action can turn conviction into collective progress toward equitable health solutions.

Dr. Manyeki is a public health specialist, and THR advocate