Speaking for parliamentarians from 11 African countries, Hon. Lilani Brinkman, a Namibian Member of Parliament, framed preventable maternal deaths as a leadership issue, not just health. “We already know what works, Midwives can provide 90% of all essential reproductive, maternal and newborn, child and adolescent health services”. She argued for countries to invest in recruiting, training and retaining them, “because investing in midwives, is investing in saving lives.” she said, pointing to workforce investment as one of the known solutions to accelerate progress.

Brinkman presented joint parliamentary commitments to achieving Every Woman, Every Newborn Everywhere targets. They pledged to advocate for dedicated financing to ensure life-saving maternal and newborn commodities reach underserved populations. They also resolved to strengthening regional collaboration through pooled procurement and market-shaping mechanisms to improve affordability and expand access.

Central to the commitments, Hon. Brinkman recommended achieving the Abuja Declaration target of allocating at least 15 percent of national budgets to health. She cautioned against returning home without action.

“We cannot continue to gather in conferences, speak passionately, and then return home unchanged. This must be the turning point.”

~ Hon. Lilani Brinkman

In his closing speech, the Principal Secretary, State Department for Medical Services Kenya, Dr. Ouma Oluga, shifted attention to what he described as the most critical weakness in maternal and newborn health systems. This is the widening gap between what is planned and what is implemented on the ground. “Preventable maternal and neonatal deaths is the greatest indictment of any healthcare system and the best indicator of health system performance,” he said, noting that “we must do everything to reverse these trends.”

He called for building stronger accountability systems across governments, health workforce, and development partners, urging a shift away from process-driven financing toward measurable impact. “In the past, we have done health financing for reports, not for results. Conference after conference, we’ve presented very good reports of the work that we’ve done, even when we have not made actual progress and this has left a gap” Oluga noted.

The conversations at IMNHC 2026 emphasised that reducing maternal and newborn deaths will depend less on new strategies and more on execution. The discussions pointed toward aligning political commitment with measurable delivery where financing follows impact, data drives accountability, and partnerships reinforce national priorities. If this momentum continues beyond Nairobi, the conference may help turn shared ambition into real improvements in care and survival for women and children across Africa.

Presenting the global overview of maternal and newborn health, Dr Allisyn Moran, Unit Head for Sexual, Reproductive, Maternal and Newborn Health at the World Health Organization, outlined the scope of the challenge. “In 2023, we had 4.5 million deaths, and we still have 4.5 million deaths of women during pregnancy and childbirth, as well as newborns and stillbirths,” she said, noting that “progress has really not accelerated since 2015/2016.”

She reminded delegates of the 90-90-80-80 targets introduced in 2023, which focus on antenatal care, skilled birth attendance, early postnatal care, and access to emergency services.

“These targets have been the driving force behind the different work that’s been going on at country level, Yet, we’re still far from the targets that we were hoping to achieve by 2030”

~ Dr Allisyn Moran

On the importance of equity and quality, Dr Allisyn stressed that coverage alone is not enough, highlighting the need for strong health systems, a skilled workforce, reliable commodities, and actionable data as essential building blocks for progress.

Building on this, Dr Gagan Gupta, Unit Lead, Maternal and Newborn Health, UNICEF, shared early EWENE-CSA 2026 findings. He noted that although many countries have strengthened policies and data systems, these gains have yet to translate into real improvements for maternal and newborn outcomes. “The progress is mixed,” he explained. “We have strong frameworks on paper, but coverage of essential services and reductions in mortality remain frustratingly slow.” This message points to a critical disconnect between planning and implementation, showing that policy advances alone are not enough without effective delivery on the ground.

Dr Gupta further noted gaps in financing and implementation identified in the report. “Countries said that they have a maternal and newborn health plan, but only 15% of them have it fully financed,” he said, adding that high-impact interventions such as emergency obstetric care and care for small and sick newborns “are very much underfunded and under prioritised.”

Despite these challenges, Dr Gupta acknowledged policy gains.

“We have seen major gains in policy shifts. Last time we reported, 59% of countries said they had moved to eight antenatal care visits. Now, 83% of countries have made that shift. Similarly, the proportion of countries with a birth companion policy has increased from 54% to 78%, and for postnatal care, a marked improvement has been noticed,” he said.

Ahead of the 2026 World Health Assembly where the final report will be presented, the focus is shifting from what must be done to how quickly and equitably commitments can be turned into measurable improvements for women and newborns.

Despite years of global commitments, from maternal health action plans to universal health coverage agendas, progress has remained uneven. Speakers pointed to systems that are not delivering at scale, with inefficiencies, fragmented planning, and weak coordination undermining progress.

In his speech, Africa CDC Director General, Dr Jean Kaseya, emphasised that Africa is at a defining moment, shifting the conversation away from technical fixes to something more political and urgent.

“Africa is facing its own defining moment. We are confronted with an unacceptable maternal neonatal mortality rate...It’s not just a health issue… For me, it’s a justice issue, a development issue, a sovereignty issue. A continent that cannot protect its mothers and children cannot claim full sovereignty over its future”

~ Dr Jean Kaseya

Kaseya proposed a “New Deal” for maternal and child health in Africa. It was a call for system-wide transformation rather than incremental change, tied to a broader continental vision of health security and sovereignty, built on domestic financing, stronger primary healthcare systems, digital infrastructure, and local manufacturing of essential commodities.

The shift from commitment to execution was echoed in the opening remarks delivered on behalf of Kenya’s President, Dr William Ruto, by Cabinet Secretary for Health, Hon. Aden Duale, who positioned the country as a testing ground for what accelerated delivery could look like.

“We are rolling out the Rapid Results Initiative to accelerate reductions in maternal and newborn morbidity and mortality,” he said. “The RRI is about urgency… tracking results in real time, and delivering measurable change where it matters most.”

Duale pointed to Kenya’s expanding Social Health Authority, investments in primary healthcare, and a growing digital health system as examples of how policy is being translated into practice particularly by reducing financial barriers and improving access to care.

Together, the messages from the opening plenary reflected a broader shift in African health policy. Maternal and newborn health is no longer being framed solely as a sectoral issue, but as a test of governance, financing, and state capacity. From universal health coverage to domestic resource mobilisation, from digital systems to local manufacturing, the agenda outlined in Nairobi ties maternal survival to the continent’s wider push for health sovereignty.

Yet, as African countries face persistent gaps in financing for health security, new bilateral arrangements with external partners are raising questions about equity, legal clarity and access to these benefits.

The importance of PABS is most evident in Africa’s experience during the COVID-19 pandemic. When South African scientists shared data on the Omicron variant of SARS-CoV-2 within days of its detection, the discovery gave the world a crucial head start in understanding the virus. Yet the region faced immediate travel bans, while access to vaccines and other medical countermeasures remained constrained. For many African policymakers, the PABS system is meant to prevent a repeat of that imbalance, ensuring that countries providing critical outbreak information are not left waiting at the back of the queue for vaccines, diagnostics, and treatments.

However, as negotiations over the PABS annex continue, the absence of an operational multilateral framework is creating space for bilateral agreements and other arrangements outside the PABS framework. In several African countries, new bilateral health agreements that include provisions on surveillance, data sharing, and research collaboration are being pursued. Some of these arrangements do not include binding benefit-sharing commitments, and without such safeguards there is a risk of reproducing the very imbalance the PABS system is intended to address.

Africa’s Role in Global Pathogen Surveillance

According to a diplomatic official familiar with the negotiations, Africa is often at the centre of global discussions on infectious disease, accounting for 25% of the global disease burden. As a result, pathogen samples and genomic sequence data generated on the continent are highly valuable for global research and pharmaceutical development. Early access to such data can provide countries with an important scientific advantage in developing countermeasures and strengthening national preparedness.

This strategic importance also shapes the implications of new U.S bilateral partnerships emerging across parts of Africa. While these agreements can bring much-needed financial and technical support to national health systems, they may also create uneven exchanges. Countries providing outbreak information could enable external partners to gain early access to pathogen data that supports research and development, without binding obligations to share the vaccines, diagnostics, or treatments ultimately developed from that information.

The emergence of these bilateral arrangements has intensified the importance of ongoing negotiations over the Pathogen Access and Benefit-Sharing (PABS) system. The framework is intended to establish a multilateral mechanism linking access to pathogen materials and genetic sequence data with more predictable benefit-sharing obligations, including access to vaccines, diagnostics, and treatments resulting from their use.

During the fifth session of the Intergovernmental Working Group negotiating the Pandemic Agreement, some member state blocs signalled that they were unwilling to compromise the PABS annex simply to meet the Seventy-Ninth World Health Assembly deadline. While acknowledging progress in the current draft, they argued that significant gaps remain, particularly around legal clarity, enforceability, and the rights and obligations of both providers of pathogen materials and users of the system. Speaking on behalf of the Group of Equity and the African, Eastern Mediterranean and South-East Asia regions, Indonesia cautioned:

“Legal certainty cannot be something we simply hope to settle down the road...we understand the pressure of timelines, but we should also be clear on the choices and decisions in front of us. We are aiming for an annex by May that can deliver a functioning PABS system in totality, but if we cut too many corners now, we will pay for it later in credibility and implementation”

Negotiators’ emphasis on legal clarity is essential, the diplomatic official noted, but even a robust PABS framework can only succeed if countries have the capacity to detect, report, and share pathogen data in a timely manner. African countries continue to face gaps in laboratory infrastructure and workforce capacity, and in some cases, pathogen samples must travel across borders before they can be analysed in certified laboratories, delaying outbreak detection and response.

At the same time, several African countries have recently signed bilateral memoranda of understanding with the United States that include provisions related to surveillance cooperation and specimen sharing. These agreements are emerging in parallel to ongoing negotiations on the PABS system. While some of these MoUs are now publicly available, the specific provisions governing specimen sharing have not been fully disclosed.

The diplomatic official also highlighted workforce shortages as another structural constraint. According to the World Health Organization (WHO) Health Workforce Support and Safeguards List 2023, 55 countries, including many in Africa, have critical health worker shortages, defined as fewer than 49 health workers per 10,000 population, and require priority safeguards against active international recruitment. Despite these protections, large numbers of trained professionals continue to migrate to high-income countries, leaving already strained health systems with limited personnel to support surveillance, diagnostics, and outbreak response.

Without sustained investment in surveillance networks, laboratories, and public health institutions, early detection of outbreaks will remain difficult regardless of the international rules governing pathogen sharing.

Why This Matters

Africa’s contribution to global pathogen surveillance is invaluable, but without a robust PABS framework, there is a risk that countries sharing critical outbreak information could be left behind when vaccines, diagnostics, or treatments are distributed. Bilateral arrangements may offer short-term support, but they cannot replace a legally binding, multilateral system designed to ensure more equitable access to pandemic countermeasures.

At the same time, national capacity remains essential. Laboratories, surveillance networks, and trained health workers are the backbone of effective outbreak detection and response. Persistent gaps in these systems, alongside the migration of health professionals, continue to limit Africa’s ability to detect and respond to emerging health threats quickly. Ultimately, a functioning PABS system must be matched by stronger national health infrastructure. Without sustained investment in laboratories, surveillance systems, and the health workforce, the inequities seen during COVID-19 could easily be repeated in future pandemics.

The study, led by the Bandim Health Project, aims to examine the health impacts of the hepatitis B vaccine on infants who receive it at birth compared to those following Guinea-Bissau’s current immunisation schedule, which begins at six weeks. Researchers involved argue that the trial does not remove existing vaccines as half of the children receive an additional hepatitis B vaccine at birth that is not yet part of the national program. Critics, however, insist that not extending a proven, life-saving intervention to all enrolled newborns in a high-prevalence country is unethical under standard global ethical frameworks. Beyond the specifics of this trial, the debate points to a wider concern in Africa about how ethical decisions are made, especially when studies are designed and financed by external partners.

In Guinea-Bissau, the hepatitis B virus poses a serious risk, particularly for infants. Babies exposed at birth are more likely to develop chronic infection, increasing their chances of liver disease or cancer later in life.

The World Health Organization recommends that newborns receive a hepatitis B vaccine within 24 hours of birth. Administered on time, the dose has been shown to prevent an estimated 70–95% of mother-to-child transmission, and more than 115 countries have incorporated it into their national immunisation schedule. Guinea-Bissau, however, currently administers the vaccine at six weeks, with plans to introduce the birth dose by 2028.

It is within this gap between global recommendation and national policy that the current trial has taken shape. Instead of using available resources to expand immediate protection for newborns, the study randomise access to the birth dose, giving some babies the vaccine at birth while others continue the routine six-week schedule, a design intended to aid researchers observe how the timing of vaccination affects health outcomes. This approach has raised ethical concerns, as international research standards emphasise that interventions already proven to be safe and effective must be incorporated thoughtfully, with clear scientific justification and measures to reduce potential harm.

Beyond science, the Guinea-Bissau controversy has reignited debates around global health ethics, double standards in clinical research, and whether trials that would undergo strict regulatory review in high-income countries are more easily advanced in low-resource settings and questions about whether this particular study met the scientific and ethical safeguards required under the relevant national oversight frameworks.

Ethics Is Not One-Size-Fits-All

The controversy surrounding the hepatitis B vaccine study in Guinea-Bissau draws attention to a fundamental reality, that ethical approval in global health research cannot be entirely procedural. Beyond clearance, it must consider local epidemiology, historical experience, mutual agreements, and asymmetries between sponsors and host communities, including differences in resource and decision-making power that affect community participation and access to benefits.

A similar concern surfaced during the COVID-19 pandemic, when a study on ethics review in public health research identified perceived inequities and mistrust despite full regulatory compliance, suggesting that procedural approval alone does not address questions of equity and community perspectives in research ethics.

Africa’s research history also provides important lessons. From the 1996 Pfizer trial of the antibiotic drug Trovan in Kano to HIV prevention trials later stopped in Cameroon, some studies that had initially received ethical approval were subsequently criticised for failing to adequately reflect local realities or ensuring equitable benefit. These experiences show that a study considered acceptable elsewhere cannot be applied in a higher-risk setting without careful adaptation to the local context.

Regional Safeguards: African Institutions as Ethical Gatekeepers

If ethics must align with local realities, then the question becomes institutional: who sets the standards of what is acceptable?

Across Africa, regional bodies are taking ownership of research oversight, using their authority to define acceptable standards and safeguard local interests. One example is the African Vaccine Regulatory Forum (AVAREF) which provides a platform for joint ethics and regulatory review of vaccine and clinical trial applications, bringing national regulators and ethics committees together to strengthen technical scrutiny and harmonise standards.

This expanding institutional role extends beyond AVAREF. In response to an enquiry from Africa Health Watch on its role in ethical oversight, the West African Health Organization (WAHO) emphasised that, under its ECOWAS mandate, it serves as a convening and harmonising body, rather than a passive observer. Through the West African Network of National Ethics Committees, WAHO supports alignment of national reviews with shared standards and facilitates joint assessments when research protocols raise concerns, helping to reduce the risk of sponsors exploiting regulatory gaps in individual countries.

At the continental level, the Africa CDC has also clarified its role. During a briefing, Director General Jean Kaseya stressed that for any clinical study to take place, authorisation must be granted by the host country. He also noted that Africa CDC’s role is limited to providing regulatory and ethical review support rather than replacing national authorities. In a separate Africa CDC weekly press briefing, Dr. Mosoka Papa Fallah, Acting Director of the Science and Innovation Directorate, outlined plans to establish an independent continental platform of African scientists and ethicists to advise on complex or contested studies.

“We are working on a concept to have this continental body of prominent African scientists and ethicists that will be around from multiple countries. Whenever countries have an issue or need an external opinion to guide and advise them on ethics or the scientific rigor for any study, they can consult. We are working internally...... In the couple of coming weeks or so, we'll launch it. It will be an independent body of scientists that can always be available to Africans to review studies that are coming up”.

~ Dr. Mosoka Papa Fallah

Together, these responses signal a shift in Africa’s research landscape, with regional and continental bodies increasingly taking ownership of ethical oversight and providing guidance to ensure studies are conducted responsibly within the continent.

Why This Matters

Countries across Africa are at an important inflection point in how research is conducted and governed. As clinical trials expand and external research bodies continue to seek research partnerships in high-burden settings across the African continent, the tension between advancing science and protecting participants is becoming more visible. In settings where resources are limited, and disease burden is high, ethical standards cannot quietly bend under the weight of urgency or scarcity.

Regional bodies such as WAHO and Africa CDC are well placed to further strengthen their roles in supporting national regulatory and ethics review systems for clinical trials. Alongside these institutions, the African Vaccine Regulatory Forum (AVAREF) provides a valuable platform for joint ethics and regulatory assessments, bringing national regulators and ethics committees together to review complex trial protocols and share expertise. Through regional coordination, technical guidance and platforms for independent scientific exchange, they can help promote more consistent standards and reinforce the principle that research conducted in African countries is shaped with local leadership and aligned with regionally defined priorities.

The Accra Reset at Davos opened with a call for “A New Bandung Spirit”, an idea that progress happens when countries act together at the right scale, at the opportune moment, and with the right balance of incentives.

Speaking to this vision, Ghana’s President, H.E John Dramani Mahama, framed Africa’s approach to global governance as practical and urgent. While the post-independence era has delivered important gains, it has also left the continent vulnerable to aid dependence, shifting geopolitical interests, and limited control over the value of its own resources. He described this as a “triple dependency trap” where countries rely on external actors for security decisions, depend on donors to sustain health and education systems, and supply the world’s critical minerals while capturing little of their value.

For Mahama, the Accra Reset is meant to move beyond rhetoric. He presented it as a practical blueprint for advancing African sovereignty, structured around five core pillars:

(i) investing in skills: digital, green energy, and manufacturing skills that match real jobs.

(ii) building together: regional industrial and digital platforms that create economies of scale.

(iii) negotiating as one: pooling bargaining power on minerals, trade, and climate finance.

(iv) producing at home: from vaccines to semiconductors, ensuring Africa controls critical supply chains.

(v) holding governments accountable to their citizens, with Mahama explaining that Africa cannot credibly demand global investment while tolerating corruption, waste, and systems that fail to work.

Former Nigerian President, Olusegun Obasanjo, chairman of the Guardians Circle of the Accra Reset, agreed that Africa’s triple dependency has fostered a dangerous habit that trains countries to negotiate from fear, plan from scarcity, and implement amid constant disruption.

“Sovereignty is not a flag that we have come to wave. Sovereignty is discipline. It is the ability to make choices and carry them through... It is the ability to coordinate regionally, mobilise capital, incentivise resources and implement at scale that lead to sustainable development and growth. If you cannot execute, you cannot be sovereign. If you cannot coordinate, you will be divided, if you cannot negotiate, you will be prized, packaged and positioned by others....”

~ H.E Olusegun Obasanjo

Echoing the call for action, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus explained that Africa loses more to illicit financial flows than it receives in aid. He stressed that countries must mobilise domestic resources, combining short-term measures like taxes on alcohol, tobacco, and sugary drinks with long-term solutions such as social health insurance and community-based systems to strengthen sovereignty.

Turning Vision into Action

Drawing on the Global Fund’s 24-year partnership with African countries, Executive Director Peter Sands, reflected on how country-led strategies have long enabled governments and communities to set priorities and drive delivery. “What’s changed,” he said, “is both the ambition and the global context. The Accra Reset is an opportunity to accelerate self-reliance while leveraging the benefits of global scale.” He also highlighted three key executional challenges that must be navigated: maintaining the benefits of global scale; protecting hard-won gains against major disease during the transition; and ensuring the push for sovereignty is not misread as a signal for donors to withdraw prematurely, particularly in conflict-affected settings where external support remains lifesaving.

Sands concluded on a note of partnership, reaffirming the Global Fund’s long-term commitment to Africa, noting that the goal remains eventual self-reliance. “You have had the Global Fund as a partner for 24 years and we will continue to be your partner until you do us out of a job, and we will celebrate when that day happens.”

From the perspective of delivery, Dr. Sania Nishtar, CEO of GAVI stressed that countries must be empowered to make real decisions at the local level, while global institutions streamline and simplify operations, not add layers of complexity. Her experience leading Gavi’s reforms, such as Gavi Leap showed that giving governments discretion over resources and merging overlapping programs at the last mile can turn ambition into tangible results for communities.

In his closing remarks, President Mahama formally announced the establishment of the global Secretariat of the Accra Reset, a permanent political and strategic hub to ensure continuity between Heads of State and the Guardians Circle. He also launched a high-level panel on global health governance and confirmed Ghana’s commitment to co-host a technical Secretariat with a North partner under the North-South Dialogue. This framework will coordinate policy exchanges on investments, critical minerals, AI, digital infrastructure, and skills development, with partners including India, Indonesia, South Korea, and Singapore, reflecting a renewed Bandung-inspired approach to cross-regional cooperation.

Why This Matters

The Accra Reset and the drive for health sovereignty are unfolding against a backdrop of deep shifts in global health and foreign policy. The United States, historically one of the largest funders of many global health initiatives, formally withdrew from the World Health Organization on 22nd January 2026, weakening multilateral health coordination and introducing new risks for pandemic preparedness and vaccine collaboration. At the same time, the U.S. is increasingly favouring bilateral agreements with African countries over multilateral support, raising questions about how health priorities are set and how accountability is maintained.

These shifts make the push for health sovereignty urgent and tangible. With official development assistance (ODA) models changing and countries navigating bilateral deals often shaped by donor priorities rather than negotiated with national interests fully at their centre, Africa’s ability to set its own health priorities is no longer just a matter of equity. It is central to building resilient systems that can deliver for communities, safeguard progress, and ensure that Africa is driving its own future.

Several African countries have signed bilateral Memoranda of Understanding (MoUs) with the United States under the America First Global Health Strategy. These agreements designed as government-to-government compacts include joint commitments on financing, U.S. funding reductions, and performance expectations over multiyear periods.

In East Africa, Kenya became the first, securing a five-year agreement valued at $2.5 billion, of which $1.6 billion is expected from the United States and $850 million from the Government of Kenya. Rwanda followed with a five-year MoU that includes up to $158 million in U.S. support and a $70 million commitment in increased domestic health spending. Uganda has also signed a five-year agreement valued at nearly $2.3 billion, combining up to $1.7 billion in U.S. support with a $500 million domestic co-investment pledge. Ethiopia joined with an agreement valued at $1.466 billion, including a $450 million domestic co-investment commitment.

In West and Central Africa, Cameroon made commitments of up to $400 million in U.S. support, alongside a $450 million increase in domestic health spending. Côte d’Ivoire entered a larger arrangement, combining up to $487 million in U.S. support with $450 million in new domestic health investment, of which $125 million is earmarked for frontline health workers and essential commodities. Liberia’s agreement is valued at $176 million, with $125 million expected from the United States and $51 million in domestic co-investment. Nigeria, the largest signatory to date is committing nearly $3.0 billion in new domestic health spending with close to $2.1 billion in planned U.S. support, while Sierra Leone’s agreement is valued at over $173 million, with $129 million from the United States and more than $44 million in domestic co-investment.

In Southern Africa, Botswana has signed a three-year health cooperation agreement of $487 million, with $106 million expected from the United States and a $381 million increase in domestic health spending. The agreement comes with a five-year data-sharing arrangement aimed at modernising health information systems and strengthening disease surveillance and outbreak preparedness. Mozambique has signed a five-year agreement, under which the United States plans to provide up to $1.8 billion to expand HIV/AIDS prevention, including the rollout of lenacapavir, advance malaria prevention, and strengthen maternal, newborn, and child health. Malawi also signed an MoU valued at $936 million and under the agreement, the U.S. intends to provide up to $792 million over five years, while Malawi commits an additional $143.8 million in domestic health spending.

Madagascar’s agreement is valued at over $175 million, while Lesotho and Eswatini have entered agreements worth $364 million and $242 million respectively.

These commitments, however, carry no guarantees. MoUs are not legally binding, and release of funds depends on both congressional approval and national budget allocations in each country.

The First Tests of a New Aid Model

The real measure lies in how quickly and clearly these agreements move from paper to practice. Implementation, disbursement, and domestic accountability mechanisms will determine whether they translate into real health gains or remain largely diplomatic instruments.

In East Africa, Kenya has moved furthest into the operational phase of the new bilateral model, making it the first country where the implications of implementation have surfaced publicly. Legal challenges and civil society pushbacks have led a Kenyan court to temporarily halt aspects of the agreement, citing concerns that data sharing provisions could undermine constitutional privacy safeguards and national data protection laws. The case has made Kenya the first testing ground for how these new agreements interact with domestic legal systems, public accountability, and data governance frameworks.

Nigeria presents a different set of challenges. Despite being the largest signatory under the America First framework, the full text of its bilateral health MoU has not been made public, raising questions around transparency, legislative review, and public oversight.

Civil society organisations and health accountability advocates have called for greater disclosure and parliamentary engagement, particularly given the agreement’s conditionalities and its implications for national health priorities. Concerns have also been raised about continuity, as the framework allows U.S. authorities to pause or terminate programmes that no longer align with U.S. national interests. For domestic stakeholders, this reinforces the need for stronger safeguards to ensure predictability and alignment with long-term national plans, highlighting a widening gap between diplomatic momentum and execution.

Why This Matters

The America First Global Health Strategy represents a deliberate shift from traditional, open-ended aid toward time-limited, bilateral, co-financed agreements that demand new absorptive capacity from partner governments, not just signatures. Despite broad political support, this fragmented approach could weaken long-standing multilateral coordination mechanisms and create implementation challenges at the national level. These dynamics are already visible in the legal scrutiny and public debate around data governance in Kenya, where courts and legislators are shaping how the agreement will unfold.

Meanwhile, countries are negotiating a global Pathogen Access and Benefit-Sharing (PABS) system under the World Health Organization’s Pandemic Agreement, with talks set to resume in Geneva from January 20–22, 2026, and bilateral MoUs that include pathogen or health data-sharing could overlap with these multilateral negotiations, creating friction between U.S. agreements and long-term global frameworks for equitable pathogen sharing and pandemic preparedness.

The bigger question remains whether these parallel tracks will complement each other or create new tensions at a moment when alignment, accountability, and negotiating power matter most.

For decades, Africa’s health landscape has been shaped by a series of disconnected efforts. Donor-driven agendas have priortised vertical disease-specific programmes over holistic health system strengthening. Governments have overstretched public systems with limited budgets, while the private sector has built parallel services that rarely align with national priorities. The result is an ecosystem where everyone is working hard, but not working together.

This fragmentation has become an invisible architecture holding Africa back, with clear consequences: parallel supply chains, duplicated programmes, underfunded public hospitals alongside world-class private clinics, and innovations that fail to scale because they sit outside national systems. The call for a co-owned ecosystem is therefore not theoretical. Lessons from global Public–Private Partnership models shows that successful PPPs depend on clear governance structures, shared objectives, and mutual accountability, elements largely missing in much of Africa’s public health architecture.

As the global health order shifts and financing become increasingly unpredictable, Africa can no longer afford an uncoordinated approach. The continent’s health future depends on building co-owned ecosystems in which governments, the private sector, development partners, and communities invest, plan, and measure success together.

This message shaped discussions at the WHX Leaders Africa Summit 2025 in Accra, which convened leaders under the theme “Catalyzing Africa’s Health Revolution through Investment, Innovation, Impact, and Infrastructure.” Across panels, speakers stressed that realising this vision will require a new public–private compact anchored in co-investment, shared accountability, and clearly defined joint targets.

Ghana’s Hard Lessons

This challenge was brought into sharp relief during the summit through Ghana’s own experience. In his keynote address, President of Ghana, His Excellency John Dramani Mahama, shared a sobering lesson. Reflecting on his time as Vice President and later as President, he recalled how Ghana invested more than $250 million in retooling hospitals with MRI machines, CT scanners, X-ray units, and other diagnostic equipment.

“At the time, we believed we had brought healthcare back up,” he said. On returning to office as a president years later, Mahama found that much of the equipment had broken down in the public facilities and patients routinely referred to private facilities. The promise of better healthcare had stalled, not because of lack of funding, but due to poor maintenance and mismanagement.

Under the newly launched Ghana Medical Trust Fund, also known as MahamaCares which has been allocated 2.1 billion cedis, Ghana has the resources to begin covering the rising burden of non-communicable diseases. The President made it clear that public–private partnerships are no longer optional, they are essential.

“We are going to put money into diagnostics and treatment facilities, but we’ll only do it in conjunction with the private sector. We are not going to repeat the mistake and put very expensive equipment in government hospitals and 5,6,7 years later, all those equipment are not working. And so, the private sector, this is the opportunity to partner with government to make sure that we have Universal Health Care in Ghana.”

~ H.E John Dramani Mahama

President John Dramani Mahama emphasised that Ghana’s experience reflects a wider reality across Africa, where well-intentioned investments fail because systems for maintenance, accountability, and performance are either weak or absent.
His remarks reinforced a central message of the summit, Africa cannot catalyse its health revolution through investment, innovation, impact, and infrastructure without rethinking how governments and the private sector work together.

Why This Matters

Africa is standing at a pivotal moment. The continent’s healthcare market is projected to exceed $259 billion by 2030, fuelled by a rapidly growing population, rising urbanisation, and a growing middle class. Beyond a market projection, this is a signal of where Africa’s health future is heading. However, this growth is unfolding at a time when global health financing is shrinking. Recent aid cutbacks including USAID’s withdrawal from several programmes have exposed the vulnerabilities of systems overly dependent on external support. This tension between growing demand and shrinking aid is forcing African governments to confront hard choices about sustainability and ownership.

This is why the call for stronger, smarter public–private collaboration is not just a policy preference, but a survival strategy. With shrinking aid, overstretched government budgets, and an increasingly competitive global economy, the private sector is no longer a peripheral player but a central pillar of Africa’s health ecosystem. What emerged clearly at WHX Leaders Africa was that political leadership matters, a point demonstrated by the active participation of Health Ministers at the summit. Governments must set direction, align incentives, and back commitments with domestic resources. This aligns with the broader Accra Reset, which calls on African countries to move from dependency to deliberate domestic resource mobilisation, putting national capital behind national health priorities.

The Summit opened with Ghana’s Minister of Health, Hon. Kwabena Mintah Akandoh, welcoming delegates by framing the summit as a launchpad for action rather than another stop on the conference circuit. “This gathering is more than an annual event. It is a call to mobilise strategic investment, forge meaningful alliances and accelerate the emergence of world class resilient healthcare systems across the continent,” he said. His opening address painted a bold picture of Africa’s health landscape in 2050, where population growth becomes a competitive advantage if backed by strong reforms, regional manufacturing hubs, and proper technology transfer.

Ghana’s Minister of Trade, Agribusiness and Industry, Elizabeth Ofosu-Adjare, in her statement titled “Made in Africa, Saving Africa” argued that the continent’s long-term health security depends on producing what it consumes. For too long, Africa has relied on distant suppliers for medicines and medical technologies, a dependency that drains resources and magnifies vulnerability. She urged leaders and investors to focus on six enablers: transparent policies and regulatory frameworks, modern infrastructure and capacity building, long-term financing and smart partnerships, regional integration, innovation and technology transfer, and sustainability. The goal, she stressed, is to build “world-class local health manufacturing ecosystems” capable of serving African needs first.

The session continued with the President of Ghana, H.E John Dramani Mahama, who took the stage to deliver his keynote address, not just as a statesman, but as a voice for Africa’s health future and sovereignty.

“Health systems are being redesigned, supply chains are being rewired, and new geopolitical realities are forcing every region to rethink the issue of resilience. These transformations present both a challenge and an opportunity, but the truth is simple, Africa cannot afford to be a bystander. Africa must be a participant across our continent”

~ President John Dramani Mahama

President Mahama reminded delegates that the continent still carries deep inequities, fragile supply chains, and insufficient investment in primary healthcare, vulnerabilities that were exposed during COVID-19, when Africa was often the last to receive critical support.

A shared concern among the speakers was the challenge of structural dependency and long-term under-investment as they acknowledged how global market shocks repeatedly expose Africa’s inability to manufacture what it needs, when it needs it.

The real test, however, will be whether the alliances formed at WHX 2025 translates into the implementation, financing, and infrastructure that can anchor a truly resilient health future in Africa.

The Global Fund has saved an estimated 70 million lives since 2022 and reduced deaths from AIDS, tuberculosis and malaria by 63%. Yet as highlighted in its 2025 Results Report, this momentum has begun to stall. This slowdown is particularly concerning given the world’s ambition to end these diseases by 2030. As World AIDS Day was commemorated under the theme “Overcoming Disruption, Transforming the AIDS Response” these concerns become more urgent. Millions still lack access to lifesaving HIV services, and key populations remain disproportionately affected.

The World Health Organization has urged countries to accelerate six strategic priorities as part of efforts to overcome disruptions and transform the AIDS response:

- scaling up HIV testing and treatment to close the gaps in the 95–95–95 cascade

- integrating HIV, hepatitis, and STI services into reproductive and maternal health

- expanding equitable access to new prevention tools like lenacapavir

- strengthening digital and data systems to guide decision-making

- safeguarding domestic and donor financing to ensure service continuity during crises

- empowering communities by eliminating stigma and discriminatory laws that push people away from care.

In 2024, 630,000 people died of AIDS-related causes, 1.3 million were newly infected, and tuberculosis remained the world’s deadliest infectious disease, claiming 1.23 million lives. Malaria also continues to threaten the most vulnerable, especially children under five, as climate shocks, conflict, and insecticide resistance drive its resurgence.

Rising challenges such as drug resistant TB, displacement, and extreme weather are making it harder to keep people in care and protect communities. For countries on the frontlines, especially in Africa, where the burden is highest, decades of progress hang in the balance. In light of these trends, the Global Fund’s Eighth Replenishment, co-hosted by South Africa and the United Kingdom, becomes critical.

Insights from Global Leaders

In his opening remarks, South Africa’s Minister of Health, Dr. Aaron Motsoaledi, reminded delegates that the summit was not about charity, but shared responsibility. He outlined five pillars guiding the co-hosting vision, solidarity, sustainability, innovation, equity and transformation. He emphasised that achieving these pillars will require a more effective and responsive Global Fund, one that strengthens the health ecosystem through simpler processes, integrated service delivery, and approaches that place communities at the centre. He added that this is not only a health ambition but also an economic and security imperative.

“For every dollar invested, we expect a return of $19 in health and economic gains. These pledges are among the smartest investment the world can make to strengthen global health security, pandemic preparedness and create a healthier, safer and more equitable world. Our call to action as we move into the pledging session: let us be bold and let our commitment reflect the ambition of global health and the determination of communities on the front lines.”

~ Dr Aaron Motsoaledi

For World Health Organization Director-General, Dr. Tedros Adhanom Ghebreyesus, the Global Fund is “family.” Reflecting on his journey from serving as Ethiopia’s Minister of Health to chairing the Fund’s Board during the 2009 global recession, and now leading WHO, he noted that this long view has given him a front-row seat to the scale of progress achieved. “Thanks in large part to the Global Fund, HIV, TB and malaria now kill half as many people as they did twenty years ago,” he said.

Dr. Tedros highlighted both the opportunities and challenges ahead. New mosquito-control tools, long-acting therapeutics, improved bed nets, and the possibility of a TB vaccine offer a glimpse of hope. Yet rising drug and insecticide resistance and persistent gaps in access, continue to undermine trust and weaken health responses. In a resource-constrained world, he stressed, integration of services and strengthening collaboration across partners will be crucial.

Following Dr. Tedros’ reflections, Global Fund Executive Director Peter Sands urged the world to view the Eighth Replenishment not only as a response to crisis but as an opportunity to reset what is possible in global health. He noted that, for the first time, low and middle income countries are accessing breakthrough tools such as the new long-acting injectable PrEP, lenacapavir shown to be nearly 100% effective against HIV, at the same time as high-income countries. This, he said, demonstrates that innovation can be deployed at speed and at scale when partners align. Sands added that advances such as AI-powered TB diagnostics and next-generation mosquito nets offer a credible path to ending the epidemics, but only if the world sustains the focus, resources, and solidarity required to ensure these tools reach the communities most at risk.

Co-host of the event, United Kingdom Prime Minister Keir Starmer, highlighted the significance of the eighth Global Fund replenishment, noting that it marked the first time the summit was co-hosted by partners from both the Global North and South, with the UK and South Africa leading together. He underscored a shift toward a development approach rooted in partnership rather than paternalism, with a focus on supporting countries in the Global South to mobilise domestic resources, tackle unsustainable debt, and attract private investment.

Concluding the replenishment session, the total pledges for the eighth Global Fund replenishment were announced at $11.34 billion, a milestone expected to save millions of lives and strengthen health systems. His Excellency Cyril Ramaphosa, President of South Africa, noted that this reflects the determination of a diverse coalition committed to ending HIV, TB, and malaria, and he called for continued solidarity, innovation, and efficiency to sustain progress.

Why This Matters

As the world marked World AIDS Day 2025, the Global Fund’s Eighth replenishment underscored the urgency of sustained financing for global health. The Fund set an ambitious target of US$18 billion to support its priorities across HIV, TB, and malaria, alongside investments in health systems and pandemic preparedness. The current pledges of US$11.34 billion represent a strong start in what remains a rolling replenishment, with additional commitments anticipated.

This year’s replenishment carried particular significance as it coincided with the first-ever G20 summit hosted in Africa, reinforcing the message that global health is both an economic and security priority. World AIDS Day serves not only to recognise progress but also to remind governments that ending HIV, eliminating malaria, and driving down TB require sustained resources, political commitment, and equitable access to proven tools and locally adapted innovations.

In her opening remarks, United Nations Population Fund (UNFPA) Executive Director Diene Keita offered an important reminder:

“Family planning is not only a matter of health, it is a matter of rights. When women and adolescent girls have access to contraceptives, their pregnancies are more likely to be planned and safe, they are more likely to complete school, be employed and fulfil their potential, their children are healthier, and their societies are more prosperous.”

She warned that despite nearly one billion women using modern contraception today, progress is fragile—particularly for those displaced by conflict, living in poverty, or facing climate shocks. These inequities, she argued, demand faster, bolder action.

The urgency of this echoed throughout the youth pre-conference, where young advocates pushed for communities to interrogate its own habits. In a session led by Reproductive Health Advocates, Esenam Amuzu and Goodness Ogeyi Odey, participants were asked to take what they called an “Equity Pause” — a deliberate moment to examine whether their work in advocacy, communication, programming policymaking or budgeting leaves anyone behind. It was a simple idea with uncomfortable implications: equity cannot remain a theme for panels; it must be embedded in how decisions are made, how programmes are designed, and who is allowed to contribute to them.

At the heart of these discussions was a shared recognition of the pressures African countries face. Years of heavy dependence on external donors have left family planning programmes vulnerable to fluctuations in political priorities and global financing. As support declines, governments are forced to confront difficult questions about sustainability, domestic resource mobilisation, and the true meaning of health sovereignty. The pushbacks in the reproductive health space, from funding restrictions to gag rules and shrinking civic freedoms, only heighten the stakes.

For African policymakers, advocates, and practitioners, the message from Bogotá was clear: the path forward will require smarter investments, strategic integration of services, and procurement systems that maximise returns in tight fiscal environments. It will also demand more intentional communication and the active involvement of people most affected by reproductive health policies. These are not abstract aspirations; they are the practical ingredients of equity.

If there was a unifying thread at ICFP 2025, it was that the continent cannot afford for equity to remain a buzzword. As countries push toward self-reliance, their success will hinge on whether equity becomes the organising principle for decisions made long after the conference halls empty — in clinics, community rooms, budget offices, and national assemblies across Africa. Because at the end of the day, equity is something you do, not something you say.

Diamonds have been the backbone of Botswana’s economy for decades, accounting for nearly 80% of exports, one third of fiscal revenue, and a quarter of GDP. This heavy reliance on a single industry has left the country vulnerable to economic fluctuations. When global demand for diamond declined earlier in 2025, driven by the rise of lab-grown alternatives, the impact reached every corner of Botswana’s economy, including the health sector. With reduced revenue, hospitals and clinics faced severe shortages of essential medicines and supplies, disrupting treatment for chronic conditions such as hypertension, diabetes, and cancer.

In response, President Duma Boko, in a televised address declared a national public health emergency, describing the situation as a “failure of the national medical supply chain.” He attributed a huge part of the crisis to the Central Medical Stores (CMS), accusing the agency of inflating prices of medicine, sometimes as much as five to ten times their actual cost. According to President Boko, the CMS had quoted over 705 million pula for a year’s supply of essential medicines, while a task force’s evaluation of the same supplies placed the cost at under 80 million pula. The figures revealed the depth of inefficiencies and systemic failures with the country’s health procurement system.

To provide immediate relief, President Boko announced several emergency measures, including a temporary suspension of procurement restrictions.

“The Ministry of Finance has approved a waiver to bypass current citizen empowerment schemes that have contributed to cost escalations, and for the use of emergency procurement methods as provided in the Public Procurement Act to address this predicament the country is faced with.”

~ President Duma Boko

Lessons from Botswana’s Health Crisis

Botswana has made remarkable breakthroughs in public health response, especially in the fight against HIV. In 2025, Botswana became the first high HIV burden country to achieve the World Health Organisation’s “gold tier” status for eliminating mother-to-child transmission of HIV. The country’s success in HIV and primary health care has helped build its reputation as one of Africa’s most stable and capable health systems. The sudden shift from stability to a national public health emergency is a demonstration of how quickly even the strongest health systems can unravel.

A closer look at Botswana’s crisis reveals more than just depleted funds and mismanagement, it shows how overdependence on a single source of revenue can cripple strong systems. Across Africa, there are many examples of reliance on volatile commodity exports such as oil, copper, especially in health.

Angola, for instance, was forced to cut public spending when oil prices fell in 2020, creating enormous challenges for its health sector. Similarly, Zambia’s copper-dependent economy has repeatedly struggled to sustain consistent funding for essential health services as global prices fluctuate. These examples highlight the importance of diversification of revenue streams, because countries like Mauritius with diverse sources of revenue have fared better.

Since the declaration of a public health emergency in August 2025, Botswana has taken steps to stabilise its health supply chain. The government released 250 million pula in emergency funding to fast-track medicine procurement, and the military was deployed to distribute supplies to facilities nationwide. In October 2025, the United Arab Emirates delivered 91 tonnes of essential medicines and medical supplies, offering crucial short-term relief.

President Duma Boko’s plans to introduce a citizenship-by-investment programme which was unveiled at the 2025 United Nations General Assembly, shows Botswana’s commitment to reducing its dependence on diamonds and attracting foreign investment to stimulate other sectors of the economy.

As Botswana plans for recovery, its experience offers an important lesson to other African countries on how to avoid similar crises. The road ahead will require more than short-term fixes or emergency imports, it calls for a complete rethink of the way public resources are managed. While the crisis has exposed long-standing inefficiencies within the health system, it has also created a window of opportunity for meaningful reform.

Why This Matters

Across Africa, many countries continue to fund essential health services through revenues tied to commodities such as oil, gas, and minerals, sectors highly vulnerable to global price shocks. When these prices fall, it’s not just budgets that shrink, patients lose access to medicines, hospitals run out of supplies, and health workers are left to improvise in already strained systems.

The crisis in Botswana highlights the urgent need for African governments to diversify their economies, ring-fence health budgets from commodity fluctuations and invest in stronger, more transparent procurement systems, where health is not just protected by the market value of exports, but by sound governance and sustainable domestic financing.

Dr. Amit Thakker, Executive Chairman at Africa Health Business, opened with a clear call:

“Health care doesn’t begin at the hospital; it begins at home.”

He noted that roughly 70% of outpatient ailments could be avoided, pointing to prevention and early detection as the most cost-effective tools for better population health. Dr. Thakker pushed beyond the usual calls for more money to argue for smarter, more context-sensitive financing: strategic allocation that prioritises prevention, removes geographic barriers, and extends services, equipment and trained personnel beyond urban centres.

With Official Development Assistance declining, Dr. Thakker urged countries to innovate domestically. He proposed bespoke, country-level health bonds, citizen-driven instruments designed to generate resilient, transparent financing for primary care, and appealed for private sector commitments, notably the idea that even 1% of corporate profits channelled to health could be transformative. He also advocated for crowdsourced platforms to democratise contributions to community health and for socially responsible corporations to embed health equity into their core missions.

Dr. Christine Kaseba, Former First Lady of Zambia, shifted the conversation to people-centred care for women, adolescents and children. Challenging narrow definitions of “women’s health,” she emphasised that care must span adolescence, pregnancy, motherhood, menopause and the years beyond. Even with maternal mortality rates declining from 727 to 441 deaths per 100,000 live births, Africa still accounts for about 70% of global maternal deaths. In 2023, 77% of adolescent girls with HIV globally were in Africa, highlighting persistent vulnerabilities.

Dr. Kaseba argued that the drivers of poor health outcomes are systemic: weak and costly PHC, fragmented vertical programmes, workforce shortages and burnout, low community engagement, and systems that fail to respect cultural contexts. Her prescription is practical: shift to community-centred, human-centred PHC; invest in community health workers and mid-level providers; integrate maternal, newborn, child and adolescent services; scale digital tools for better data and decision-making; and mobilise domestic resources while strengthening local manufacturing of essential commodities. Most importantly, she said, mothers, adolescents and children must be partners, not merely beneficiaries, in designing the systems that serve them.

Dr. Mazyanga Lucy Mazaba, Regional Director for the Eastern Africa Regional Co-coordinating Centre of the Africa Centres for Disease Control and Prevention, closed the session by stressing another existential threat to PHC: antimicrobial resistance (AMR). She warned that AMR undermines the gains of primary care by turning once-treatable infections into expensive, complex problems and straining already fragile health systems. Her priorities were clear: strengthen surveillance and diagnostics at the primary-care level, implement stewardship programmes, secure reliable supply chains for quality medicines, and invest in local capacity for manufacturing and quality assurance.

Dr. Ifedayo Adetifa, CEO of FIND, reflected on what it would take to truly rebuild Africa’s health systems from within.

“If we could press the reset button, I would start by addressing what I consider to be a fundamental truth, that no country can outsource its health security, or indeed its health care system to others to run, to contribute, or to determine.”

~ Dr. Ifedayo Adetifa

He argued that if Africa is to achieve universal health coverage and be ready for future pandemics, it must invest in its own capacity to detect, respond, and deliver care. “Without testing, there is no treatment, no prevention, and no data to drive decisions,” he said, urging governments to see diagnostics not as a cost but as an investment in economic sovereignty.

Adetifa’s analogy of dancing to a new drumbeat struck a chord in the room. He urged countries to be guided by their own national priorities, not by external agendas because only those who wear the shoe know where it hurts.

Picking up the baton, Dr. Nkem Okeke, Founder and CEO of Medicalincs and BIND Associates, brought the private sector lens. With development assistance declining, she argued for smarter, value-based financing and public–private partnerships that work for Africans.

Reminding the audience that while the private sector’s goal is to make profit, “it should not be at the expense of somebody’s life.” Pointing to trends in health investment across Africa, she observed that much of the funding still flows into insurance, diagnostics, and retail pharmacy, which are often driven by external priorities rather than African realities. For Okeke, private investment in health must align with the continent’s needs, not just market opportunities.

Dr. Folorunso Fasina, the country team leader for the Food and Agriculture Organisation (FAO) in South Sudan, drew attention to the climate crisis as Africa’s most urgent and underfunded health challenge. Through the story of a farmer in East Africa impacted by drought, he traced the link between extreme weather, food insecurity, animal health, and antimicrobial resistance.

Drought reduces crop yields, causing food insecurity and pushing wildlife closer to human settlements, which increases interactions between wild and domestic animals. Indiscriminate antibiotics use in livestock fuel antimicrobial resistance (AMR). This cycle undermines human and animal health and deepens economic losses. Fashina stressed that the solution lies in integrated, climate-resilient health systems that unite agriculture, environment, and health sectors under one coordinated plan, preventing crises before they erupt.

Emphasising the urgency of action, he noted: “Climate change is not just a separate environmental issue. It is a single greatest threat multiplier to health and economic security in Africa. We need to address it through a One Health nexus, which is not an expense but the most critical investment we can make in our continent’s future”

Prof. Serge Blaise Emaleu, a global health expert in Emergency Preparedness, Readiness and Response, opened with a reminder: “Africa shoulders 24% of the global burden of disease, yet receives less than 2% of global health research funding. This stark disparity reflects a deep structural inequity, where the greatest health needs exist, the least investment follows.” He noted that over 90% of the vaccines used on the continent are imported, exposing a dangerous dependence on external systems. For Emaleu, building local research and manufacturing capacity is about preparedness, equity, and long-term health security.

From a humanitarian and implementation perspective, Etleva (Eva) Kadilli, UNICEF’s Regional Director for Eastern and Southern Africa, emphasised that the move toward local manufacturing must be anchored in access and equity. She outlined UNICEF’s vision of collaboration with the Africa CDC and other continental actors to ensure that the benefits of regional production reach every community, especially those on the margins. Manufacturing in Africa, she stressed, must be matched by inclusive distribution and regulatory trust.

Bringing the political and structural dimension into focus, Dr. Blade Nzimande, South Africa’s Minister of Science, Technology and Innovation, issued a call to action: Africa’s R&D ecosystem can only succeed when leadership, financing, and governance move seamlessly.

“We need heads of state to set and champion clear continental investment targets, finance ministers must align domestic budgets and incentives, and health ministers must ensure national research agendas reflect local disease priorities.”

~ Dr. Blade Nzimande

Nzimande outlined five interconnected pillars for a resilient African innovation system: funding, human capital, infrastructure and technology, policy and regulation, and partnerships. Each reinforces the other, from financing research to training talent, harmonising regulatory systems, and linking science to equitable access. “When these elements are synchronised,” he said, “Africa can move from plans and pledges to production and performance.”

With coordinated political leadership, sustainable financing, and cross-sector collaboration, Africa can shift from dependency to sovereignty, turning its vast potential into a powerful engine for health security, economic growth, and global partnership. As Nzimande concluded, “The time is now, and the future is made in Africa.”

The Conference which is taking place in Durban, South Africa, under the theme “Moving Towards Self-Reliance to Achieve Universal Health Coverage and Health Security in Africa,” is co-hosted by the Africa Centres for Disease Control and Prevention (Africa CDC), and the Government of South Africa, in collaboration with AfricaBio’s 8th Annual BIO Africa Convention. Participants gathered to continue charting Africa’s course towards resilient health systems and greater self-reliance in healthcare delivery.

In his opening speech, Dr. Nhlanhla Msomi, CEO of AfricaBio, urged African scientists and innovators to take ownership of the continent’s biotechnology future by developing homegrown innovation models, moving away from dependency on borrowed technologies and imported ideas.

Founded 26 years ago, Msomi said AfricaBio was born out of a recognition that the voices of African scientists were often absent in conversations shaping global science and innovation.

“Biotechnology offers an opportunity for the African continent to leapfrog other technology-driven industries because, at the time we started, there were no legacy issues, but over the past 25 years, we have seen that legacy issues can be manufactured and as a result, we can be left behind.”

~ Dr. Nhlanhla Msomi

The reference to “legacy issues” points to the growing structural and policy barriers that have emerged within the continent, hindering the pace of innovation and making it harder for Africa to maintain its early advantage in biotechnology.

He emphasised that Africa must move from research for discovery’s sake to innovation with impact, guided by public health priorities defined by institutions such as the Africa CDC.

AfricaBio, he said, is hoping to work with the Africa CDC to establish a drug discovery and development platform based on the continent’s pathogen priority list. The initiative aims to direct research efforts toward diseases that affect African populations, catalysing the continent’s intellectual and physical infrastructure for science and innovation.

Dr. Msomi underscored that the biotech mission is not only about health, but a lot of emphasis is also placed on entrepreneurship for developing sustainable industries of the future which will be driven by young African scientists and innovators.

A Two-Decade Journey of Reform and Results

Ethiopia’s health reform began with a radical premise: health equity must start at the household level.

The centrepiece was the Health Extension Programme which trained over 30,000 Health Extension Workers (HEWs); mostly women to deliver essential care and health education in rural communities. Within five years, this effort led to the construction of over 15,000 health posts, dramatically improving access to preventive and basic curative services.

Subsequent phases of reform focused on strengthening integration, quality, and financing:

1. Community-Based Health Insurance (CBHI) protected households from catastrophic health spending and built trust in the public system.

2. Ethiopian Primary Health Care Clinical Guideline (EPHCG) standardised care through clear, symptom-based protocols. Displayed visibly in facilities.

3. Electronic Community Health Information System (eCHIS) digitised the work of HEWs, linking local data to national dashboards and performance tracking.

Ethiopia’s health system is deeply data-driven. Health information is not stored in reports, it shapes decisions every day, guiding how services are delivered and how performance is measured across all levels of care.

By the time the Ministry of Health introduced the PHC Re-envisioning Initiative, Ethiopia had already demonstrated measurable progress in maternal mortality, immunisation, and service utilisation. These early gains positioned PHC as the essential foundation for the country’s universal health coverage agenda.

Recent data highlight the impact of Ethiopia’s two-decade health reforms. Maternal mortality fell by 72% since 2000, while neonatal mortality declined by 44%, outcomes directly reflecting two decades of sustained investment in community-based primary care and maternal health services. Ethiopia’s Community-Based Health Insurance (CBHI) now reaches many districts, providing financial protection for households and deepening public trust in health facilities, according to recent Ministry of Health factsheets.

At the same time, Ethiopia’s renewed investment in local pharmaceutical production has increased domestic supply to 36% of national medical needs, saving the country more than US$53 million annually through import substitution and expanded manufacturing capacity. Together, these gains demonstrate how political continuity, community-based financing, and integrated health system integration are driving measurable progress toward universal health coverage in Ethiopia.

From Biyo to Bika: Where Policy Meets People

In Oromia’s East Shoa Zone, two facilities; Biyo Comprehensive Health Centre and its satellite, Bika Health Post, demonstrate how national reform translates into daily life.

At Biyo, facility dashboards track immunisation coverage, health insurance enrolment, and service quality. At Bika, HEWs provide antenatal care, child immunisations, and even trachoma trichiasis surgery, referring complex cases back to Biyo. The two facilities operate as a single ecosystem, reflecting Ethiopia’s philosophy of continuum-based care, one that connects data, financing, and accountability at every level.

Each case treated at the community level represents more than a health outcome; it reflects financial protection and trust in the system. By bringing essential services closer to families, Ethiopia’s PHC model reduces out-of-pocket costs and reinforces confidence in public facilities. This proximity-based trust has become a defining feature of the country’s health reforms, proving that accessibility and credibility grow hand in hand. Evidence from Ethiopia shows that community-based health insurance (CBHI) membership is associated with increased health service utilisation and reduced financial risk, while citizens’ trust in the scheme is shaped by perceived service quality and prior experience.

The Power of Political Ownership

What distinguishes Ethiopia’s PHC model is not only its structure, but its durability. Health has remained a consistent political priority across successive governments, supported by strong domestic financing and institutionalised accountability mechanisms. Over the years, vertical donor programmes have been systematically integrated into the national PHC framework, while domestic budgets have ensured sustained investment and high execution rates in the health sector. Recent analyses reveal that Ethiopia’s PHC reforms rest on three pillars, governance structures, data systems, and financial mechanisms that build resilience. This durability does not stem from the absence of challenges, but rather from sustained political commitment that persists regardless of changes in leadership or donor priorities.

Across Africa: Parallel Pathways of Reform

Across Africa, governments are redefining how primary health care is financed, delivered and governed, and Ethiopia’s model captures this shift, reflecting a broader continental momentum for homegrown reform.

In Nigeria, PHC funding has been embedded into law through the Basic Health Care Provision Fund (BHCPF), allocating 1% of consolidated revenue for frontline care. Under the Health Sector Renewal Investment Initiative (NHSRII), more than 17,000 PHCs are being revitalized, with state-level insurance schemes expanding coverage for vulnerable groups.

Ghana has followed suit, unlocking GHS 3.5 billion to provide free PHC services through the Accra Reset, reframing health as a domestic investment rather than an external obligation. Rwanda, meanwhile, continues professionalising its community health workforce, strengthening referral links between village-level care and district hospitals, and expanding digital PHC platforms to improve service delivery.

Kenya’s devolution embeds community health units in county systems, using digital health to connect telemedicine with maternal and newborn care. Zambia has integrated community health assistants into the civil service payroll, advancing the Lusaka Agenda. Together, these shifts reflect a move from donor dependence to fiscal sovereignty, parallel programmes to integration, and rhetoric to measurable delivery.

Shared Enablers of Success

Across these contexts, several enablers consistently emerge:

• Political Commitment Anchored in Law: When PHC financing is codified in legislation, as in Ethiopia and Nigeria, it outlasts electoral cycles.

• Domestic Resource Mobilisation: Ghana’s health levy and Ethiopia’s local insurance pools show how national treasuries can drive coverage.

• Data Visibility and Use: Dashboards in Ethiopia, scorecards in Rwanda, and digital registries in Kenya make accountability visible and actionable.

• Empowered Frontline Workforce: The professionalisation of HEWs and CHWs in Ethiopia, Zambia, and Rwanda remains the backbone of sustainability.

• Community Trust and Participation: CBHI models, citizen scorecards, and ward committees ensure reforms are not imposed but co-owned.

Sustainability in primary health care is not achieved through funding alone. It is built on ownership; by governments, communities, and frontline workers and reinforced through trust. Where citizens feel heard and invested, health reforms endure long after external support fades.

A New Chapter in African Health Reform

Ethiopia’s PHC re-envisioning phase now integrates digital data, climate resilience, and financing into a future-ready system. Its deeper contribution is proof that systemic change is possible within a generation when reforms are politically anchored, financially domestic, and socially owned.

Across Africa, governments are redefining health sovereignty through accountable partnerships. The next phase is not about new models but scaling what works, investing in communities, data, and governance to build resilient, trusted health systems.

According to Dr. Jean Kaseya, Director-General, Africa Centre for Disease Control;

“The future of Africa’s health will be built at the primary level or not at all.”

Why This Matters

Ethiopia’s PHC journey shows that reform is not a one-time act but a generational commitment. By investing in trust, data, and domestic ownership, Ethiopia, like many of its peers; is rewriting the story of African health systems from dependency to dignity.

It is a reminder that the path to universal health coverage will not be paved by external aid alone, but by citizens, communities, and countries choosing to own their systems, and to believe in their power to sustain them.

In 2023, Africa recorded 263 million malaria cases and nearly 600,000 deaths, with Nigeria alone accounting for 27% of cases and 31% of deaths. “Behind these numbers are people, mostly young children. That means about 1,600 children are dying every single day. It is the equivalent of five jumbo jets crashing daily. In 2025, that is unacceptable. We need a real Big Push against malaria, one that is about action, not just another paper or strategy.” said Dr Michael Charles, CEO of the RBM Partnership to End Malaria.

Beyond statistics, malaria continues to rob Africa of its pregnant women, children, and workers, draining productivity and slowing economic growth. Yet, economists remind us that every US$1 invested in malaria control generates up to US$40 in economic returns, proof that ending malaria is not only a health imperative, but also a sound financial strategy.

Lessons from across Africa: proof that progress is possible

Cabo Verde’s malaria elimination in 2024 stands as Africa’s newest success story. Dr Adilson DePina, Head of the Malaria Elimination Programme explained that the country reached malaria-free status by committing over 70% of programme costs through domestic financing, implementing rigorous case-based surveillance with 24-hour notification, and multisector collaboration that engaged tourism, immigration, and environmental agencies. At the high-level meeting in Abuja, Health Minister Dr. Jorge Figueiredo reminded participants “This is our third elimination, and we know how fragile success can be. Sustained vigilance and financing are the only way to keep malaria away.”

Building on this momentum, Lagos, is demonstrating that Africa’s largest megacity can bend the curve. Malaria prevalence dropped to 2.6% in 2023, with emerging data suggesting it is now below 1%. Through mandatory testing reforms, stronger integration between public and private providers, and the introduction of a “Malaria Elimination Incident Commander” model, Lagos is showing that elimination is not a distant dream but an achievable goal.

Progress remains uneven across the continent. Dr Albert Zeh Meka, Permanent Secretary of Cameroon’s National Malaria Control Programme, noted that malaria continues to take a heavy toll, with parasite prevalence at 26% amid an unstable funding landscape. Yet the country’s strategy of micro-stratification, parliamentary advocacy for malaria budgets, and a national interministerial mechanism shows resilience. “We cannot rely on external donors alone. Our parliament and our treasury must be at the centre of malaria financing,” he stressed.

These experiences illustrate the power of Subnational Tailoring (SNT), using data to stratify malaria risk at district or state level and directing targeted interventions, matched with financing and human resources to turn malaria strategies from broad pledges into measurable outcomes.

The legislators’ panel which brought together parliamentarians from Nigeria, Uganda, Cameroon, Ghana, and Rwanda discussed the Coalition of Parliamentarians to End Malaria in Africa, (COPEMA), which aims to drive domestic appropriation, cross-party accountability, and peer learning. As Ugandan parliamentarian Honourable Rose Obigah reminded attendees, “We must legislate not just for nets and drugs, but for budgets and delivery. Parliament is where malaria promises live or die.”

Equally insightful was the ministerial panel, which included leaders from Cabo Verde, Burkina Faso, and the African Union. They challenged peers to prioritise funding for domestic programmes, institutionalise real-time surveillance, and integrate malaria within broader health systems. Cabo Verde’s cautionary tale of resurgence served as a reminder of the fragility of gains: without vigilance and sustained financing, victories can vanish.

Financing remains the greatest obstacle to progress. Presentations made on the second day by Prof Gbenga Mokuolu, Technical Adviser to Nigeria’s Coordinating Minister of Health and Social Welfare, revealed that less than 50% of the funds required for malaria control in Africa are available. Nigeria alone faces a gap of US$696 million between current financing and what is required for full-scale interventions. Without bridging this chasm, even the best strategies risk faltering.

The event highlighted innovative financing strategies for malaria control across Africa, including:

• Domestic commitments first—ring-fencing malaria allocations in national and state budgets, with quarterly public reporting.

• Efficiency through integration—joint campaigns for malaria, immunisation, and nutrition to reduce costs and reach the same households.

• Private sector partnerships—through national End Malaria Councils, blending philanthropy with corporate social responsibility and health insurance.

• Regional procurement and local manufacturing—to stabilise supply chains, reduce costs, and build African resilience.

This demonstrates integration not as an abstract ideal, but as a practical, cost-saving and patient-centred approach.

As Nigeria’s Coordinating Minister of Health and Social Welfare Professor Muhammad Ali Pate said,

“There are not enough resources to have siloed programmes for HIV, for immunisation, for TB, for malaria. People don’t go to primary healthcare centres and say, I’m here for the malaria line, or the immunisation line, or the TB line. They go because they have a fever. Integration means using the same health worker, the same diagnostics, the same logistics and supply chains—so we save costs and meet people’s needs more holistically.”

A continental roadmap: from Abuja to 2030

Abuja’s outcome was clear: Africa must act collectively, with discipline and solidarity. The following five priorities can guide the Big Push:

1. Make SNT the operating system. Refresh risk stratification annually and link strata to funded intervention bundles.

2. Institutionalise real-time surveillance. Aim for under 24-hour case notification, district-level dashboards, and routine data audits.

3. Hardwire accountability. Legislators must scrutinise budgets; ministers and governors must sign delivery compacts with quarterly public reviews.

4. Mobilise and diversify financing. Use innovative bonds, blended finance, and private sector compacts to attract additional resources.

5. Integrate malaria into health systems. Align with PHC, immunisation, and MNCH to reduce waste and strengthen resilience.

Why This Matters

The Abuja meeting marked a turning point. Africa is no longer short of knowledge, examples, or leaders. Cabo Verde’s elimination proves malaria can be beaten. Lagos shows megacities can drive prevalence to zero. Cameroon demonstrates resilience under financial strain. The truth is clear: the fight against malaria cannot be won by governments alone. It demands every sector, every leader, and every community to move beyond words into action.

Governments must do more than pledge—they must budget, spend, and deliver transparently. Legislators must use oversight to ensure funds reach the frontlines, turning political promises into tangible results. National programmes should tailor strategies sub-nationally, while civil society and communities hold leaders accountable. The private sector cannot remain on the sidelines as malaria drains billions from Africa’s economy. Donors and partners must sustain catalytic financing that reinforces African leadership. Continental institutions like the African Union (AU), African Leaders Malaria Alliance (ALMA), and RBM must ensure accountability through peer review, keeping every country honest and on track.

Every actor has a role, and every actor is accountable. The road to 2030 is short, and the stakes could not be higher. A malaria-free Africa will not be handed to us, it must be built by us, country by country, community by community. Let this be our legacy: a continent that shouldered its burden, rose to the challenge, and ended malaria once and for all. The world is watching. Africa must lead from the front.

In August 2025, leaders at the Africa Health Sovereignty Summit in Accra laid out a plan to reset Africa’s path toward health sovereignty. A key step was to socialise and mobilise the Accra Initiative, taking it from country capitals to AU Summits and the United Nations General Assembly in order to shape global rules on how funding is raised, how progress is reported, and how results are measured.

A month later, that vision is beginning to take shape. At the ongoing UN General Assembly in New York, a high level side event themed Accra Reset: Reimagining Global Governance for Health and Development is spotlighting the Accra Initiative as a model for how countries in Africa can transition from aid dependency to self-reliance. “The models that were built to drive development cannot sustain us in this new dispensation of time hence the reason why leaders are calling for a reset of the development order” said President Mahama in his opening remarks.

After the USAID funding cut, Ghana was left with a $156 million hole in funding for healthcare projects, including PEPFAR programmes such as HIV testing, antiretroviral treatment and medical research. President Mahama responded by lifting the cap on the National Health Insurance Levy. Previously, any revenue above a set threshold was diverted into the government’s general fund for salaries and other expenses. Removing that cap freed up an additional 3.5 billion Ghana cedis, channelled directly into the health system, enough to replace the lost USAID funding and keep critical programmes running.

This move reflects the fourth commitment made at the Accra Summit: to showcase early adopters. By demonstrating in real time how domestic resource mobilisation can deliver measurable results, Ghana is positioning itself as a leading example, while urging other governments to think creatively about shifting resources from lower priorities to areas that can drive tangible impact.

Former Nigerian President Olusegun Obasanjo, co-convener of the Accra Initiative during his remarks emphasised that solidarity should be seen as justice, not charity. He recalled how debt relief campaigns and the global fight against HIV/AIDS demonstrated that international cooperation could save millions of lives when anchored in strong institutions. He made reference to the Ebola outbreak in West Africa, when African governments and private sector actors mobilised over $30 million to send AU specialists to affected countries, evidence that African-led responses can be effective. His message showed that solidarity is most powerful when institutionalised, rather than left to political whims or cycles.

Making the case for why trade must be central to the Accra Reset, the Director-General of the World Trade Organisation, Dr Ngozi Okonjo-Iweala, stressed that building sustainable manufacturing capacity in Africa, will require stronger trade cooperation, both regionally and globally. She noted that the challenge goes beyond supply security:

“Beyond security of supply, there is also a social dimension. The idea that vaccines, diagnostics, and therapeutics are made in Africa for Africans could help counter the rise of vaccine skepticism spreading online and on social media.”

~ Dr Ngozi Okonjo-Iweala

The world has seen the consequences of Africa being left at the back of the line. During the HIV/AIDS crisis of the early 2000s, sub-Saharan Africa was hit hardest, with over 3 million new infections and 2.3 million AIDS-related deaths in a single year, more than 95% of them from low- and middle-income countries. Building on this experience, Winnie Byanyima, Executive Director of UNAIDS, was asked what we cannot afford to carry into 2030. She highlighted three lessons that must guide the future: ensuring equitable access to new health innovations, putting communities at the centre of service delivery, and tackling the social determinants of health.

Ghana’s Minister of Health, Hon. Kwabena Mintah Akandoh, speaking on the implementation of these lessons, noted that removing the cap on the National Health Insurance Levy enabled the government to direct revenue where it was needed most. This, he explained, made free primary health care possible, supported specialist care through the Ghana Medical Trust Fund known as Mahama Care and laid the groundwork for Ghana’s ambition to become a pharmaceutical hub.

Speaking on partnerships and their role in driving these reforms, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, stressed that Africa must adopt a mindset shift, and demand fair terms from partners rather than accepting charity. Citing Ghana’s decision to cover USAID funding gaps as an example of what is possible, he noted that health taxes on harmful products such as alcohol and tobacco could unlock resources, while long-term investments in insurance systems would provide sustainable funding for resilient health systems.

Echoing this vision, former UK Prime Minister Gordon Brown, in his solidarity message emphasised the importance of health sovereignty as African-owned, nationally led, and locally delivered healthcare systems. He commended Ghana’s free primary health care initiative as a model for the continent, urging leaders to consider what could be achieved through collective action.

Together, these perspective capture the essence of the Accra Reset. Countries taking charge of their own health financing, drawing on local solutions, and engaging in fair global partnerships to ensure that everyone has access to healthcare, regardless of location or societal status.

Why this matters

For too long, African countries have relied heavily on external aid, leaving health systems vulnerable when funding is cut or delayed. The Accra Reset seeks to change this by showing that countries can take control of their own health financing, using domestic resources, innovative approaches, and African-led solutions.

While the global health system must rethink whose lives are prioritised and on what terms, African countries are proving that they can lead and innovate. History reminds us, however that delayed access to life-saving medicines, as seen during the HIV/AIDS crisis, can cost millions of lives and stall development gains.

Even though funding is a central part of the Accra Reset, the conversation goes beyond finance. It is about building health sovereignty, creating resilient systems, and ensuring that quality care is accessible to all. In doing so, the Accra Reset is not just a call for resources, but a call for fairness, dignity, and a new development order where Africa’s voice shapes the rules. What must also be clear is that the Accra Reset needs a clear roadmap for implementation, and this must be clearly articulated if the vision is to move from aspirations to results.

How can African countries fund their own health systems in an era of shrinking Official Development Assistance (ODA)?

With aid to the continent slashed by nearly 70% in recent years, governments are under growing pressure to identify domestic financing solutions. One option gaining momentum is the introduction of health taxes, levies on products such as tobacco, alcohol, and other harmful commodities, not only to raise much-needed revenue but also to curb the rising tide of non-communicable diseases (NCDs).

A major setback came in January 2025, when the United States Agency for International Development USAID, paused significant funding. On paper, this cut represents less than 1% of the gross national income of most African countries. In practice however, the impact has been severe, undermining health programmes for HIV/AIDS, malaria, maternal health, pandemic preparedness, and more.

At the same time, Africa’s health systems are under intensifying strain. Between 2022 and 2024, the continent recorded a 40% increase in reported public health emergencies. Alongside these shocks, the growing burden of NCDs now accounts for nearly a third of the total disease burden in sub-Saharan Africa, hindering progress toward the 2030 Sustainable Development Goals.

This has resulted in African governments exploring new financing models to protect and strengthen health systems. Health taxes are increasingly at the centre of this conversation, offering a dual benefit, raising domestic revenue while reducing the risk factors that are driving NCDs.

Funding health through targeted taxes

Described by WHO as ‘Best Buys’, health taxes are intended both to curb consumption by making these products less affordable and to generate revenue that can be directed into health systems. Conversations about health taxes have become more pressing as governments look for sustainable ways to finance healthcare while reducing the impact of noncommunicable diseases. The WHO’s new report, Saving lives, spending less: the case for investing in noncommunicable diseases, presents the investment case, showing that adopting cost-effective interventions, such as health taxes would require countries to spend only about $3 per person each year, yet every $1 invested could yield around $7 in economic and social returns.

These measures are also central to the upcoming 4^th High Level Meeting of the UN General Assembly (UNGA), where the Political Declaration on NCDs and Mental Health will be adopted. The declaration sets ambitious goals to reduce the toll of NCDs. However, the final draft has been met with criticism. The zero draft proposed higher taxes on alcohol, tobacco, and sugar-sweetened beverages, but the reference to sugar-sweetened beverages was removed in the final text. This dilution has drawn criticism given the strong evidence on the harms of sugary drinks, and it demonstrates the extent to which the commercial determinants of health, shaped by harmful commercial practices and industry influence can undermine evidence-based policymaking.

Speaking at the recent Africa Health Sovereignty Summit that took place in Accra on the issue of health taxes, former UK Prime Minister Gordon Brown, pointed to the potential of health taxes as a powerful tool for both public health and domestic resource mobilisation. He pointed out that in the United Kingdom, tobacco is taxed at 80%, in addition to levies on alcohol and sugary beverages.

Building on this, Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO highlighted at the same summit that “a 50 percent price increase on harmful products like tobacco, alcohol, and sugary drinks could generate an additional USD 3.7 trillion globally within five years and save millions of lives.” Evidence from the report The Future of Health Financing in Africa: The Role of Health Taxes, further reinforces this point, showing that such taxes can not only plug the gap left created by shrinking donor support but also provide a critical pathway for addressing Africa’s escalating NCD burden.

During a recent webinar on the report’s findings, Dr. Mary-Ann Etiebet, CEO and President, Vital Strategies noted that;

“Over 90% of countries across the continent already have some kind of health tax in place, but the opportunity in front of us is to make sure countries are able to maximize and optimise the triple win that health taxes can create for their citizens and for their country.”

Several African countries are already putting health taxes to practice. In Botswana, a tax of BWP 0.02 per gram of sugar, which is over 4grams per 100ml was introduced in 2021 on sugar sweetened beverages (SSBs), this was after a 2014 levy that imposed 30 percent duty on tobacco production and imports. Ghana followed suit in 2023, shifting from an ad valorem tobacco tax to a hybrid structure that combines a 50 percent tax on factory prices with a specific levy of 5.60 cedis per cigarette pack. This lifted tobacco tax share from 23% in 2020 to 38% in 2024, doubling revenue to more than GHS 187 million.

Nigeria under the Finance Act of 2021, introduced an excise duty of ₦10 per litre on non-alcoholic, carbonated, and sweetened beverages which took effect in June 2022. This is expected to reduce the rise of NCDs such as diabetes and obesity while generating revenue. In Zimbabwe, the government announced a 0.5% fast food tax implemented from 1 January 2025, targeting sales at fast food outlets to reduce the consumption of highly processed foods. Within six months, the levy had generated nearly US$1 million.

South Africa’s 2018 Health Promotion Levy on sugary drinks remains one of the most notable examples. After implementation, a study of over 3,000 households found that the Health Promotion Levy led to a 51% drop in sugar intake, a 52% reduction in calories, and a 29% decrease in daily purchases of taxed beverages per person. The Health Promotion Levy generated R5.8 billion in its first two years, representing 0.2% of government revenue. However, the funds were not earmarked for specific health programmes and were allocated to the country’s general revenue.

Beyond these, other African countries have also introduced significant measures. Gabon levies a 5% excise tax on sugary drinks, alongside alcohol taxes ranging from 22% to 40% on beer, wine, and spirits. Cabo Verde raised its tobacco excise taxes above ECOWAS minimums, implementing changes in 2019 and 2021 that raised a special consumption tax from 30% to 50%, while Mauritius advanced its health taxation with tax share on cigarettes reaching nearly 78% by 2024, and an excise duty of 12 cents per gram of sugar on beverages, as part of efforts to curb the country’s high rates of obesity and diabetes.

Although health taxes have proven effective at reducing harmful consumption and raising revenue, many African countries have not designed policies and frameworks that earmark these funds for health-specific programmes. In many cases, poor design leaves the taxes vulnerable to inflation and industry interference which limits their impact on public health. It is important to ensure that these taxes are protected, transparently managed and used to improve population health outcomes.

Why this matters

Health taxes are more than just a tool to raise government revenue, they are an avenue to protect people from preventable diseases. By raising the purchasing price of tobacco, alcohol, and sugary drinks, there is a decrease in consumption, reducing the burden of non-communicable diseases. When health tax revenue is reinvested wisely, they can be used to strengthen health systems, fund prevention programmes, and improve access to treatment for vulnerable populations.

Without clear allocation of these funds, the full potential of health taxes is lost, and governments miss the opportunity to simultaneously improve public health and financial sustainability. All eyes will now be on the 4^th High-level meeting of the UN General Assembly where the Political Declaration on NCDs and Mental Health will be adopted, raising the prospect of health taxes being prioritised as part of national strategies, providing countries with a renewed opportunity to reinforce their commitments to addressing NCDs.