The improvement of health in Africa is confronted with many challenges. The financial resources devoted to health are insufficient, but to increase them is not enough. It is essential to reinforce the systems of health care and to improve efficiency of the public and private expenditure in health. In the majority of the countries, the budgetary constraints are strong, but there is room for maneuver to increase the public health expenditure, by domestic financing or by foreign assistance. It is advisable, however, to be particularly vigilant as to the negative effects which could possibly result from this on the various elements which might play a significant role in the improvement of health. States must exploit relevantly all possibilities of increasing the health expenditure which become available. A majority of them are not able to afford to neglect direct payments, even although they have to be integrated into a coherent strategy of financing, carefully analyzed and implemented.