There is hardly any doubt that failing health systems result in poor health outcomes and hamper progress towards the attainment of the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). In Africa, health systems are hobbled by leadership and governance challenges, extreme shortages of health workers, corruption in procurement systems for medical products and technologies, poor information systems, and health financing constraints. This brief discusses ways in which decision-makers can hurdle these challenges. Attribution: Daniel Mwai & Theresa Ndavi, “What Ails Health Systems in Africa? An Economic Perspective,” ORF Issue Brief No. 431, December 2020, Observer Research Foundation. Introduction Most African countries gained independence between the 1950s and 1960s. In order to build their economies, import substitution policies were encouraged as a conduit for economic growth and industrialisation. Advocates of import substitution argued that developing countries should promote domestic industries and reduce their dependence on foreign trade.