Health Diplomacy in Limited‐Resource Settings in Africa: What It Takes Towards a Realistic, Resilient and Equitable Agenda?

ABSTRACT Health diplomacy (HD) in African nations is often characterized as limited settings due to resource scarcity, weak governance and fragmented health systems. Although HD is crucial for addressing the continent's interconnected health challenges, including endemic diseases, infectious threats, antimicrobial resistance (AMR), climate change, persistent conflicts and foundational weaknesses, its effectiveness is frequently undermined by the structural persistence of hidden power, a legacy of colonialism that controls agenda‐setting and perpetuates dependency. Drawing on decolonial theory, this article argues that a purely technical application of HD is insufficient. It proposes a strategic framework for HD implementation that builds long‐term resilience and sustainability. Achieving a realistic agenda requires a commitment to local ownership and co‐leadership, health systems strengthening (HSS) and context‐specific adaptation. Simultaneously, an equitable agenda must proactively tackle power imbalances, prioritize a rights‐based approach and enhance local agency in diplomatic negotiations. By strategically linking health initiatives to broader security/development goals (smart power) and framing health as a fundamental human right, this framework enables HD to transition from a mechanism that risks reinforcing inequalities to a powerful tool for achieving resilient, sustainable, and truly equitable collective health security.