Pharmacogenomics studies how a person's inherited genes influence response to therapeutic drugs. Many drugs do not work in all patients and pharmacogenomics can assist in the identification of patients who are better suited to particular drugs or patients who need adjusted drug doses to reach better treatment outcomes. This stratification of patients could be beneficial in Africa as it would allow drugs that would ordinarily be discontinued due to toxicity on a proportion of the populations to be used in a directed manner in people for whom it is not toxic. However, there has been limited use of pharmacogenomics. One of the key issues has been the need to demonstrate the economic benefits of adopting pharmacogenomics implementation and the impact on healthcare cost drivers. Integration of pharmacogenomics into clinical practice has huge potential in Africa due to the large genetic diversity in African populations. This Perspective article explores the current pharmacogenomics landscape, the health economics associated with its implementation, and future directions for pharmacogenomics research translation in Africa.