From Aid to Equity: Blockchain as a Tool for African Healthcare Autonomy in the Era of Nationalistic Populism

In an era of rising nationalistic populism and shifting global power dynamics, African healthcare systems remain precariously dependent on Western aid frameworks and, increasingly, China's profit-driven digital health expansions. This dependency perpetuates structural inequities, leaving nations vulnerable to external agendas while stifling local innovation. This qualitative, exploratory study interrogates the potential of blockchain technology to reconfigure healthcare financing from a paradigm of donor reliance to one of autonomous, equitable resource mobilization. Focusing on Africa, the research critically examines emerging models—such as tokenized health bonds and blockchain-based aid tracking—that could decentralize financial sovereignty, enhance transparency, and foster self-sustaining health ecosystems. The study contrasts Western philanthropic approaches, often entangled with conditionalities and bureaucratic inefficiencies, against China's strategic, commercialized health infrastructure investments, probing how blockchain might offer a third way—leveraging decentralized finance (DeFi) to reclaim agency. Key questions include: How can blockchain mitigate the politicization of aid in an age of populist retrenchment? Can smart contracts and tokenization democratize health financing while ensuring accountability? Drawing on stakeholder interviews and policy analysis, the presentation argues that blockchain's disruptive potential lies not merely in technological innovation but in its capacity to recalibrate power dynamics—positioning African nations as architects, rather than beneficiaries, of their health futures. By centering African perspectives, this research challenges deterministic narratives of technological solutionism, instead framing blockchain as a contested but potent tool for decolonizing health financing. The findings aim to provoke debate on the intersection of decentralized technologies, post-colonial autonomy, and the urgent need for equitable health sovereignty in a fragmenting global order.