COVID-19 has led to a sharp deterioration in livelihoods in Africa and plunged many people into extreme poverty, increasing the number of people excluded from health services. This situation is exacerbated by security issues in regions such as the Sahel, which weaken health budgets in favour of security budgets. Countries in the Sahel have health systems that struggle to provide their populations with the health services they need. The most disadvantaged groups are excluded from healthcare. The COVID-19 pandemic has exposed the fragility of social protection systems and reaffirmed the challenges facing health systems, as well as the need for equitable and transformative implementation of health policies. This means that health services and models must include the poor and their specific needs and provide an opportunity for multisectoral engagement so that health is a cross-cutting issue that should be addressed in other areas of the lives of the poor beyond the health system. Using the COVID-19 crisis as a starting point, this chapter uses comparative analysis to examine fundamental health policy issues in general and those affecting the poor in particular, based on the cases of four countries: Burkina Faso, Benin, Mali, Niger, and Senegal.