Wildfire smoke exposure is an emerging public health challenge across Africa, yet its interaction with healthcare accessibility remains poorly characterised. We developed the Health-Exposure-Resource Mismatch Index (HERMI), combining satellite-derived PM<sub>2.5</sub>, population density, and geocoded health facilities to quantify spatial imbalances between exposure and care. Nearly two-thirds of Africa’s population live in areas of mismatch, with severe hotspots in Angola, the Central African Republic, and South Sudan. Urban centres show lower mismatch despite higher exposure, underscoring the role of healthcare capacity in mitigating environmental risks. Although constrained by incomplete facility data and simplified accessibility measures, HERMI provides a scalable framework to identify intervention priorities and delivers actionable evidence for climate-resilient health planning across the continent.