“Africa is not a real market”

This statement made during a keynote plenary at the World Health Summit Regional Meeting (WSRM2026), titled “Manufacturing Health in Africa: Sovereignty, Scale and Supply Chains” reflected the recognition that manufacturing alone will not secure Africa’s health sovereignty. There is need for coordinated market systems to sustain it.

The COVID-19 pandemic fundamentally reshaped conversations around health manufacturing and supply chains across Africa. As countries struggled with delayed access to vaccines, diagnostics, medicines, and other important medical supplies, the pandemic exposed the risks of relying heavily on external markets during global emergencies, and brought a recognition that health manufacturing is a matter of sovereignty and resilience, beyond it being an industrial ambition of countries on the continent.

Speaking during the panel, Dr Omar Albush, representing the Principal Secretary for Public Health, Kenya, described manufacturing as a “strategic imperative” tied to both health security and national resilience. “Health security is not charity. It is sovereignty,” he said, emphasising that no country can say it has achieved health security, if it cannot reliably produce and procure health products, in addition to strengthening last mile delivery its population depends on. He noted that Kenya strives to position itself as a leader in this transformation, guided by a presidential directive to achieve 50% local manufacturing of essential health products and technologies by the end of 2026. However, as countries accelerate manufacturing ambitions, panelists repeatedly cautioned that factories alone cannot sustain a manufacturing ecosystem.

For decades, Africa has operated as a supplied market, one where external institutions such as Gavi and UNICEF aggregate demand, negotiate prices with manufacturers, and coordinate distribution on behalf of countries. While these donor-backed procurement mechanisms have expanded vaccine access across the continent, they have enabled a market structure heavily dependent on external purchasing decisions rather than coordinated continental ownership.

Vandana Shah, Vice President, Health Systems Strengthening at the Global Health Advocacy Incubator, identified a conflict at the heart of the agenda. As countries transition from Gavi support, they tend to lose the pooled procurement advantages that previously guaranteed pricing stability, demand consistency and must now buy on their own terms. Meanwhile, procurement systems across the continent are often designed to prioritise the cheapest available product, putting African manufacturers who have not yet achieved the volumes needed to compete on price at a disadvantage. As Shah said, “the market has been shaped by multilateral financing, which brought consistency, but not country-level ownership.”

However, as Shah identified the procurement logic problem, others on the panel challenged a fundamental assumption. Dr. Tala Jallow, Director, African Pooled Procurement Mechanism (APPM), pushed the discussion further by challenging the idea that Africa lacks a viable health products market:

“We have the market...but we have been focused on fragmentation that we don’t have a sense of direction sometimes. One of the things that we are doing with the African pool procurement mechanism is, first, a market shaping tool. We need to leverage our continental purchasing power to be able to shape our market”

~ Dr. Tala Jallow

This reframed one of the central assumptions surrounding Africa’s manufacturing ambitions. Although African countries collectively spend billions annually on medicines, vaccines, and other health products, procurement systems remain fragmented across national borders, with differing regulations, purchasing laws, and market priorities limiting manufacturers’ ability to scale sustainably.

Through the African Pooled Procurement Mechanism (APPM), Africa CDC hopes to aggregate continental purchasing power, support African manufacturers, and create more predictable demand for locally produced health commodities.

Dr. Tala also stressed that efforts to harmonise regulatory pathways through institutions such as the African Medicines Regulatory Harmonization and the African Medicines Agency are intended to ensure that regulation becomes “an enabler for market access” rather than a barrier.

She pointed to the evolution of antiretroviral (ARV) medicines as an example; “when ARVs started, they cost around $175 per patient yearly. Now it’s less than $30 because we kept the market going, scaling up, increasing the volumes....but if we start the conversation by talking about how the prices of African manufacturers is going to be very high, we are killing the market before it even succeeds.”

Why This Matters

When African countries cannot reliably produce and purchase their own health products, the consequences are measured in lives lost, due to outbreaks that spiral because of delays in accessing medical countermeasures. The conversations at the World Health Summit Regional Meeting in Nairobi made clear that the path forward must go beyond building factories. It will require building the market conditions that make those factories viable, sustainable, oriented toward African health needs, with distribution channels that ensure products reach their markets.

Proof of concept already exists in some African countries. Egypt now sources 80% of its health products domestically. Ethiopia has shifted to over 40% local manufacturing. Rwanda is constructing an end-to-end pharmaceutical ecosystem from the ground up, anchored by continental partnerships and long-term vision. These examples show that deliberate policy, sustained political will and coordinated investment can move the needle.

The African region is a large, yet fragmented market, with manufacturers ready to scale. What is now required, is for procurement and distribution to become strategic tools, leveraging on existing mechanism such as the African Continental Free Trade Area (AFCTA) and others. Until that shift happens, manufacturing in Africa will remain an aspiration that remains unfulfilled.

Nigeria has achieved some of the most ambitious malaria control campaigns globally. In 2023, nearly 29 million children were reached through Seasonal Malaria Chemoprevention – the highest number anywhere in the world, protecting children during the peak transmission season. Yet despite this achievement, the country still carries the heaviest malaria burden globally, accounting for roughly 27 percent of all cases.

This exposes a clear paradox. Nigeria can mobilise at an extraordinary scale when a campaign demands it. What it has not yet cracked is the same reliability, accountability, and coordination when it comes to routine care. Across nearly 1,900 health facilities surveyed in northern states, more than half reported stockouts of the malaria treatments needed by patients, not because the medicines were unavailable in the country, but because distribution failed to get them to the point of care.

Delivery failures are not neutral. They fall hardest on the most under-resourced and hardest-to-reach communities – the people most likely to be turned away from care because treatments are out of stock. As such, strengthening delivery systems is not only an efficiency issue, but an equity imperative that needs to be addressed with utmost urgency.

Nigeria already has much of what it takes to combat malaria. The challenge now is translating the efficiency of campaign logistics into everyday system discipline. Achieving this is arguably the quickest and highest-return investment the country can make in malaria today, especially as external health financing contracts and Nigeria, like other high-burden countries, faces growing pressure to do more with what it already has. That makes this the moment to use remaining support to strengthen delivery systems while it still exists. Once that support declines further, the cost of fixing broken logistics will rise significantly.

The question, then, is how Nigeria can make this shift.

Technology has a role to play. Today, one of the biggest constraints in Nigeria’s health supply chain is the difficulty of finding capable logistics providers. The country is home to many qualified providers able to deliver across the country, to the very last mile. Yet they often remain invisible to governments, donors, and manufacturers trying to move health products efficiently. This consistently results in a persistent mismatch between demand and supply, particularly during periods of heightened need.

Centralising this market – using technology to create a single, accessible space where buyers and logistics providers can find each other – therefore becomes important. Platforms like the Logistics Marketplace are beginning to address this by making qualified providers visible and streamlining procurement. Governments, global health partners, humanitarian agencies, and manufacturers can more easily identify, assess, and engage capable providers, turning existing capacity into capacity that is actually used.

But visibility at the system level is only part of the solution. The greater test is whether technology improves decision-making at the point of care. The goal should not be simply to track shipments, but to ensure that the person running a rural clinic knows what they have, what they are about to run out of, and how to trigger a resupply before patients are turned away. Without that level of visibility and agency at the frontline, digital tools risk becoming reporting mechanisms that serve the top of the system rather than the point of care.

Partnership with the private sector is equally central to closing this gap. Like in many other sectors, private logistics networks already move the majority of goods across Nigeria. Integrating this existing capacity into health delivery naturally becomes a practical way to extend reach without building parallel infrastructure. This must be structured so that integration is accountable, transparent, and performance-driven. Poorly designed collaborations carry risks, including inefficiency and diversion.

Senegal offers a lesson on how such partnerships could work. It was the first country to launch the “Zero Malaria Starts With Me” campaign, explicitly integrating the private sector into its response, and achieved a 73 percent reduction in malaria cases and a 13 percent decline in deaths between 2000 and 2019. Its progress was driven by strong national ownership, reliable data systems, and deliberate use of private sector capacity, including logistics. This is a model for what Nigeria could look like with stronger coordination between government and private logistics providers.

Rwanda also offers a complementary lesson on what is possible when delivery systems are treated as core infrastructure. Between 2016 and 2022, malaria incidence fell from 409 cases per 1,000 people to 76, while deaths dropped by more than 89 percent. These gains were not primarily driven by new drugs or major increases in funding, but by deliberate investment in delivery systems. Rwanda trained 30,000 community health workers to diagnose and treat malaria at home, built a reliable last-mile supply chain, and introduced data visibility so managers could act before shortages occurred. As a result, facility-level stockouts fell from around 10 percent to just 1 percent over five years. The lesson is that delivery system investment, not just health product investment, drives outcomes.

These successes are replicable in Nigeria, though we must not underestimate the intricacies of the country. Running reliable last-mile delivery across a country of more than 200 million people, with Nigeria’s geographic and infrastructure variation, is comparable to managing a commercial distribution network across multiple countries. But that level of complexity is not beyond reach. Nigeria already has the people, partners, and underlying capacity required – it now needs to coordinate them more effectively to deliver a reliable system.

Why This Matters

Nigeria's ability to reach nearly 29 million children through seasonal malaria chemoprevention demonstrates that the country can operate at scale. But the persistence of stockouts across more than half of surveyed health facilities in northern states shows that campaign-level ambition has not yet translated into routine system reliability — and it is the most underserved communities that bear the cost of that gap.

The experiences of Rwanda and Senegal suggest that this is a solvable problem. Both countries achieved significant reductions in malaria cases and deaths not by introducing entirely new tools, but by investing in delivery infrastructure, frontline capacity, and structured partnerships with the private sector. Nigeria already has many of these building blocks in place. The challenge is one of coordination, accountability, and sustained attention to the systems that move treatments from warehouses to the point of care.

With external health financing contracting, the window to make these investments is narrowing. Strengthening delivery systems now, while support still exists, is both the most practical and most equitable step Nigeria and other high-burden African countries can take to protect any malaria gains already made — and to ensure they last.

Over the past two decades, countries across Africa have made real progress. Expanded use of bed nets, improved diagnostics, effective treatments, seasonal prevention, and more recently malaria vaccines have saved millions of lives. According to the World Health Organization (WHO), malaria interventions have prevented over two billion cases and millions of deaths globally since 2000, with Africa accounting for the majority of those lives saved.

However, World Malaria Day presents us with an opportunity to ask a longer‑horizon question: what kind of progress will be needed to truly end malaria as a public health threat? Three observations stand out as essential in helping us guide our reflection and action;

(1) Strategies designed for control are not designed for permanence.

(2) Elimination is fundamentally about equity, reaching those who are consistently left out.

(3) Innovation must be understood broadly, as a portfolio of tools and approaches shaped and led by countries themselves to address malaria in a systemic way.

To truly eliminate malaria in Africa, one additional move is needed: beyond technical progress, we must work with our communities to understand and communicate that we are moving past the era of control toward permanently interrupting transmission. It is possible to eliminate malaria. This shift in mindset must be shaped with our communities.

The limits of strategies designed for control
Control has been highly effective at reducing deaths, particularly among children. But it relies on continuous repetition. Bed nets must be replaced, medicines restocked, prevention campaigns repeated year after year. Yet the most recent global data show that malaria cases and deaths remain heavily concentrated in the African region, which still accounts for around 94–95 percent of global malaria deaths, despite widespread coverage of core tools.

These patterns suggest that while control saves lives, it does not always interrupt transmission permanently. Elimination changes the way the problem is framed, shifting attention from managing malaria season after season to breaking the chain of transmission itself, reducing long‑term dependence on repeated interventions.

Malaria elimination is about equity
Malaria increasingly persists in the same places: remote rural areas, border communities, informal settlements, and regions where health systems face chronic constraints. WHO and partner analyses show that a relatively small number of high‑burden countries account for the majority of global malaria cases, even as national tool coverage improves.

Elimination refocuses attention on these remaining gaps. Beyond national averages, success takes into account whether transmission continues anywhere, and why. In that sense, elimination is also about equity, prioritising children and communities who are consistently hardest to reach and sometimes last to benefit. This requires deeper involvement of our communities, not only as recipients of interventions but as active partners and leaders in elimination efforts.

Country-led innovation is a game changer.
Innovation in malaria spans a broad portfolio: the roll‑out of new malaria vaccines now introduced in multiple African countries, next‑generation insecticide‑treated nets, improved diagnostics, enhanced surveillance systems, and approaches that seek to address malaria transmission at its source, alongside more precise delivery strategies.

According to WHO, the combined impact of new tools and improved delivery approaches saved more than a million lives globally in recent years alone, even as emerging challenges such as insecticide and drug resistance threaten existing gains. The core issue here is addressing the challenge in countries across Africa is not the use of any single tool, but how countries assemble the right mix of interventions for their national contexts.

Innovation is also about robust institutions. New approaches must be evaluated rigorously, regulated transparently, and shaped by national priorities. Community engagement is central to this process, and an integral part of how those decisions are made. Trust, governance, and leadership are as essential as technical effectiveness.

Across Africa, scientists, regulators, and public health institutions are already strengthening this capacity, building evidence, reinforcing regulatory oversight, and developing frameworks to govern innovation responsibly at the country level.

Why this matters

Taken together, these observations point in the same direction. Bed nets, treatment, preventive therapies, and vaccines remain indispensable. They are the reason millions of children are alive today. But relying on these tools alone keeps the global response oriented around containment. Complementing them with sustained investments aimed at elimination, stronger health systems, responsible innovation, regional coordination, and community leadership, opens the possibility of a different outcome. Centering community leadership and ownership alongside these investments strengthens the possibility of a different, lasting outcome.

Elimination is demanding. It requires long‑term commitment, cooperation across borders, and the patience to invest even when results are not immediate. But malaria has endured for centuries in part because it adapts to the spaces we leave unattended. Ending it will require sustained attention of a different kind, deliberate, collaborative, and forward‑looking.

World Malaria Day is a moment to reflect on whether we are ready to make that turn.

At a webinar hosted by the World Health Organization Regional Office for Africa, researchers, clinicians, and care providers came together to examine what dementia means for Africa. While it is often viewed as a condition of old age, experts emphasised that its roots begin much earlier, calling for a shift in how the region understands dementia and responds to it.

Dementia is often mistaken for a normal part of ageing, which can make it easy to overlook in its early stages. In reality, it is not an inevitable part of growing older. It describes a group of conditions that affect memory, thinking, and the ability to carry out everyday activities, with Alzheimer’s and vascular dementia accounting for the majority of cases.

An estimated 57 million people were living with dementia globally in 2021, reflecting a growing but often under-recognised public health challenge. That number is projected to rise to 78 million by 2030 and reach 139 million by 2050, driven by ageing population and shifting disease patterns. More than 60% of cases are in low-and middle-income countries, where health systems are often least equipped to respond and where the gap in available care remains significant.

As this burden continues to grow, there is increasing attention at the global policy level. The political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being, situates dementia within the broader NCD and mental health agenda, reflecting its growing recognition as a public health priority.

These realities were at the centre of a recent webinar hosted by the World Health Organization Regional Office for Africa, titled “Dementia in the African Region: Strengthening Policy on Integrated Care and Community Support for Older People.”

Dr Rwafa Madzvamutse, Regional Advisor for Mental Health at the World Health Organization Regional Office for Africa, in her presentation drew attention to the multiple and often intersecting factors shaping dementia risk in Africa. Beyond age, factors such as poorly managed HIV, harmful alcohol use, and nutritional deficiencies are increasingly recognised as contributors to cognitive decline.

Dr Madzvamutse also pointed to existing global frameworks, including the WHO Global Action Plan on the Public Health Response to Dementia, Action Plan on the Decade for Healthy Aging and broader mental health and healthy ageing strategies which provide a roadmap for countries to respond. However, it was noted that translating these commitments into practical, context-specific action remains uneven across Africa.

“57 million people worldwide live with dementia. This is as of 2021 we're expecting an exponential increase and that is up to 80 million by the end of the decade. 1 in 12 adults over sixty-five live with dementia, depending on the region. I am looking at the global data and over 60% of people who live with dementia actually live in low-and middle-income countries”

~ Dr Rwafa Madzvamutse

Insights from Nigeria and Kenya

Offering a practical perspective, Ekezie Ralueke Oluchukwu, a dementia care coach and founder of Blue Torch Home Care Ltd, shared how community-based care is being delivered in Nigeria. Founded in 2012, Blue Torch Home Care was established in response to the growing need for home-based support for older adults. Its model centres on integrating family involvement, community engagement, and professional care, recognising that for many people, care happens primarily at home.

Mr Oluchukwu emphasised that Blue Torch Home Care places strong emphasis on cultural context. Engagement with community leaders, use of familiar social structures, and culturally responsive care practices have helped improve acceptance and uptake of services. In settings where stigma and misconceptions remain, this approach has been critical in opening conversations and encouraging early support. While challenges like late diagnosis, workforce shortages, and financial barriers persist, Blue Torch’s model offers a glimpse of what is possible when care is designed around people’s lived realities and adapted to local contexts.

Additional evidence from rural eastern Uganda also shows how these challenges are unfolding across communities. Presenting findings from a three-year study, Dr Stephen Ojiambo Wandera, a gerontologist, population scientist and a member of the Technical Advisory Group for the UN Decade of Healthy Ageing, highlighted that about 12% of older adults were living with probable dementia, with prevalence increasing significantly with age and disproportionately affecting women.

Beyond age, the data pointed to a convergence of risk factors that are both widespread and, in many cases, preventable. More than half of the older adults studied were socially isolated, while rates of moderate to severe depression were strikingly high. Hypertension was also common, yet many participants were unaware of their status, showing gaps in routine screening and access to care.

In response to these diagnostic and system gaps, tools such as the Informant Dementia Severity Assessment (IDEA) are being used in Uganda, particularly in rural and resource-limited settings.

The tool, which assesses domains such as memory, orientation, verbal fluency, and visuospatial ability, is administered in local languages by trained health workers and is used to define cognitive impairment, with studies showing it to be effective in identifying dementia in community settings where low literacy and limited diagnostic capacity remain major challenges.

WHY THIS MATTERS

The discussion from the webinar shows that dementia in Africa is a social and systems challenge, beyond being seen as a clinical condition. Data from global policy tracking and the WHO Global Dementia Observatory proves that no African country currently has a fully implemented national dementia plan, with only a few, such as South Africa, Ghana, Kenya, and Ethiopia, having drafts that are yet to be operationalised.

Without a national plan, responses to dementia remain fragmented and underfunded. Care is often informal, falling largely on families and communities rather than being supported through structured health systems. This gap is becoming more concerning as Africa’s population ages and the burden of dementia rises. Projections suggest a sharp increase in the coming decades, which will place further strain on already limited care.

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 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.

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.

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.

The Ebola Virus Disease is a deadly infectious disease with a fatality rate of up to 90%. Outbreaks often begin when the virus is transmitted to humans through close contact with infected wildlife, after which it spreads from person to person through direct contact with blood or bodily fluids. A single case can escalate into a large outbreak, especially if there are delays in detection and isolation, as the virus spreads from person to person. When patients with Ebola are admitted to hospitals, where the disease is not initially suspected, facilities can become amplification points. In such cases, when healthcare workers are among the infected or dead, it serves as a critical warning sign.

The Ebola virus was first identified in 1976, and has re-emerged several times in Africa, but the 2014-2016 outbreak in West Africa remains the largest to date. It affected Guinea, Liberia, and Sierra Leone, resulting in more than 28,600 reported cases and 11,325 deaths. The virus spread to seven additional countries, and in August 2014, the World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern. The scale of the outbreak overwhelmed health systems in the three hardest-hit countries and exposed major gaps in Africa’s pandemic preparedness and response strategies.

However, since that outbreak, many African countries have strengthened their health security infrastructure. Health care workers are now better trained to recognise Ebola, apply infection prevention and control measures, and manage cases when they occur. Several countries have established national public health agencies and strengthened their workforce, while tools such as vaccines and therapeutics have become available to prevent and manage cases.

As of 10 September 2025, the outbreak in Kasai province has resulted in 32 suspected cases, 20 confirmed cases, and 16 deaths. Even though the index patient was a pregnant woman in Bulape, efforts are now focused on identifying all infected patients, and tracing their contacts to curb further spread. The rural nature of the affected region poses both challenges and opportunities, while access makes it very difficult for first responders to reach communities quickly, it also limits the ability of infected individuals to travel far beyond the region.

Response from WHO and partners

After laboratory testing at the National Public Health Laboratory (INRB) in Kinshasa confirmed the presence of the Ebola virus, a national Rapid Response Team supported by WHO experts in epidemiology, infection prevention and control, laboratory science, and case management was deployed to contain the outbreak and limit its spread.

To support the response, WHO allocated US$ 2 million from its Contingency Fund for Emergencies (CFE) in September 2025. The first disbursement of US$ 500,000 was to be directed to strengthen coordination, surveillance, and supply of basic protective equipment. This was followed by an additional US$ 1.5 million to expand laboratory capacity, risk communication, and community engagement.

WHO has delivered 12 tonnes of outbreak control materials and two tonnes of emergency health supplies to help manage the outbreak and protect health workers. Meanwhile, a stockpile of 2,000 doses of the Ervebo vaccine was already pre-positioned in Kinshasa, DRC, ready for deployment. This rapid financing mechanism, made possible through the Contingency Fund for Emergencies, established after the West Africa Ebola outbreak, reflects lessons learned from previous outbreaks and marks an improvement on past responses when delays in deploying resources accelerated virus transmission.

For now, the outbreak remains concentrated in Bulape and Mweka zones in Kasai Province, but these areas are difficult to access. Road travel from Kinshasa can take several days, causing significant delay in the movement of personnel, laboratory equipment, and medical supplies.

“The affected localities are hard to reach. We are working round the clock to rapidly roll out response measures to ensure robust outbreak control to stop the virus from spreading further and save lives”

~ Dr Mohamed Janabi, WHO Regional Director for Africa

Globally, past outbreaks have shown how fragile health systems, delayed funding, and weak community engagement can turn a small cluster of cases into a full blown epidemic, claiming many lives. Yet, recent responses suggest that lessons have been learned, with actions now implemented more rapidly. The great unknown, however, is the impact of declining foreign aid. The Kasai outbreak raises an urgent question:

What must African countries do differently now to avoid repeating the mistakes of the past?

The delayed response during the 2014–2016 outbreak allowed the virus to spread widely, resulting in more than 28,600 cases and 11,325 deaths. Human mobility across affected countries made contact tracing very difficult, while unsafe burial practices further worsened transmission. To prevent a repeat, African governments have prioritised community engagement, working with local communities, traditional leaders and faith-based organisations to build trust, educate people, counter misinformation, and promote safe culturally acceptable interventions for their communities.

African countries, both individually and collectively, need to develop rapid response mechanism for future outbreaks. This includes maintaining stockpiles of essential supplies, investing in local manufacturing of personal protective equipment (PPE), diagnostics, and ensuring the safety of the health workforce. This can be done through strong national public health agencies, with continuous training for health workers central to achieving this.

Why this matters

Ebola outbreaks are no longer uncommon in the Democratic Republic of Congo, and each one places additional strain on an already frail health system. Yet with every outbreak, the country’s capacity to respond has improved, supported by the country’s new national public health institute, l'Institut National de Santé Publique. Once the most recent outbreak was confirmed, the response was swift and highly coordinated. The Kasai outbreak really emphasises the urgent need for stronger preparedness, rapid access to vaccines and diagnostics, and sustained investment in local capacity. Until these gaps are addressed, every new case will continue to carry the risk of escalating into another regional, or even global crisis.

Africa’s experience during the COVID-19 pandemic showed that the continent cannot continue to rely on global supply chains for its health security. When the COVID-19 vaccine first became available in late 2020, high income countries representing just 14% of the world’s population, secured more than half of the global vaccine supply. As a result, Africa received less than 2% of the 690 million doses administered in the first quarter of 2021. Deliveries were often unpredictable, leaving countries uncertain about which vaccine would arrive, or when.

For months, frontline health workers and vulnerable populations in Africa watched other regions roll out mass vaccination campaigns. Even as vaccine deliveries gradually increased, Africa lagged behind, accounting for just 1% of the global vaccine production despite making up 17% of the world population.

At the 75th WHO Africa Regional meeting in August 2025, during the side event “Partnerships for Strengthening an Ecosystem Approach to Production of Medicines, Vaccines and Other Health Technologies in Africa and the GAVI-Leap,” Professor Mohammed Janabi, WHO Regional Director for Africa, emphasised WHO’s longstanding efforts to address Africa’s vaccine needs. He noted that the African Vaccine Regulatory Forum (AVAREF), the Regional Office has worked closely with national authorities to build the regulatory foundations for local production. According to Professor Janabi, “Today, eight countries, Ghana, Nigeria, Rwanda, Senegal, South Africa, Tanzania, Zimbabwe, and Egypt have reached WHO Maturity Level 3.” This progress not only builds confidence in local manufacturing of medicine and vaccines but also promotes economic development and brings Africa closer to self-reliance.

The Gavi Leap: shifting power to African countries

The COVID-19 pandemic exposed Africa’s dependence on global vaccine supply chains. Gavi’s new initiative, Gavi-Leap, however signals a shift toward putting African countries in the driver’s seat. As Gavi CEO Dr. Sania Nishtar explained during the panel session, the principle behind Leap is country centricity.

“We’ve put more resources at the decision-making discretion of countries, because we respect your decision-making ability. We know you have your own vision, you know your own problems, and we want to be able to put more money at your discretion, to use as you deem fit”

~ Dr. Sania Nishtar, CEO Gavi

In practical terms, the ‘leap’ is about breaking down barriers that have long slowed down governments. Gavi operates eight grant windows, each with its own timeline, forcing ministries of health to juggle overlapping applications. However, from 2026, this will change, and countries will be able to submit a single, unified application, replacing the fragmented process with a more coordinated and streamlined system.

Gavi is also priortising faster decision making. “Currently it takes 16 months for us to turn around your application. We’ve made significant internal changes to adopt end-to-end automation, change our decision-making structures, ensure decision-making is more streamlined without compromising controls, so that the time it takes for us to get to you with decisions is reduced,” Dr. Nishtar explained.

Beyond governance reforms, Gavi-Leap is also unlocking Africa’s vaccine manufacturing potential. This initiative includes the African Vaccine Manufacturing Accelerator (AVMA), a $1.2 billion subsidy mechanism that provides milestone payments to African producers once they achieve WHO pre-qualification and compete in tenders. As Dr. Nishtar emphasised, AVMA is not a “silver bullet,” but an important tool which, when combined with the right policies, incentives, and off-take agreements, can help move Africa closer to vaccine sovereignty within the next five years.

World Health Organisation Director-General, Dr. Tedros Adhanom Ghebreyesus welcomed the initiative, calling it an important step toward improving vaccine access and strengthening local production in Africa.

As part of Gavi’s 6.0 replenishment cycle, donors have recently pledged more than $9 billion to support the Alliance’s work over the next five years, alongside a $2 billion commitment from the African Export-Import Bank to finance health product manufacturing.

WHO AFRO and IVI: a path to African-led vaccine development

During the regional meeting, WHO AFRO announced a collaboration with the International Vaccine Institute (IVI), a global research body with 56 member states. IVI is recognised for developing the low-cost oral cholera vaccine, which it transferred to manufacturers worldwide without licensing fees. As Dr. Jerome Kim, Director-General of the International Vaccine Institute, explained “We’ve heard about the need for a simplified rural cholera vaccine. That is an IVI vaccine developed in our laboratories, with technology transferred to companies around the world, no licensing fee, no IP. Why? Because this is our commitment to technology, technology transfer and the work we do in global health.”

IVI has already conducted 14 technology transfers of six different vaccines, including to South Africa’s Biovac, which could become the first new vaccine manufactured on the continent since the yellow fever vaccine at IPD.

Backing this effort, Professor Drew Weissman, pioneer of mRNA vaccine technology, pledged $50 million and open access to intellectual property to support end-to-end RNA vaccine and therapeutic development across the continent. This partnership offers an opportunity for Africa to gain access in not just vaccine production but also in intellectual property, data, and training that empowers local scientists to lead research and development.

Why this matters

Africa’s reliance on imported vaccines and therapeutics is nothing new. However, initiatives like Gavi-Leap, the African Vaccine Manufacturing Accelerator (AVMA), and the WHO AFRO–IVI partnership represent solid steps toward reducing external dependency. By building local production capacity, transferring technology, and empowering African scientists and researchers, these efforts aim to strengthen the continent’s ability to respond to health emergencies, improve access to essential vaccines, and participate more in global health research and innovation.

Every year, the WHO Regional Committee for Africa brings together health ministers, policymakers, and development partners to shape the continent’s health agenda. The Seventy-fifth session, held in Lusaka, Zambia on the 25 August 2025, opened with a call for unity, the need for stronger financing mechanisms, and self-reliance in building resilient health systems across the continent. It was no surprise that financing for health was on top of the agenda, given the challenges being faced by the withdrawal of donor funds across the continent.

Speaking at the opening of his first Regional Committee meeting, WHO Regional Director for Africa, Prof. Mohamed Yakub Janabi, reflected on Africa’s most pressing challenges. Shifting financial models, geopolitical tensions, climate change, and the rising threat of antimicrobial resistance, which he described as a “slow-motion pandemic”. He emphasised, however, that Africa’s history is one of resilience and despite these hurdles, he believes the future of health on the continent will be transformed.

Building on this, WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, challenged African countries to take active steps in shaping their health future. He urged governments to “use every tool at their disposal to generate financing for health,” stressing that this is central to charting a future that is healthier, safer, and free from the yoke of aid dependency.

The call for self reliance is an urgent one. Africa currently produces less than 1% of global vaccine supply, despite consuming approximately 25% of global vaccines, causing the continent to be highly vulnerable to supply chain shocks and fluctuating global prices. “We cannot keep depending on someone’s philanthropy for Panadol in our health centres,” said Zambia’s President, Hakainde Hichilema during his inspiring opening address. “The time has come for Government, private sector, WHO and our health systems to work together to drive growth through investment and regional trade”

This ambition, however, is not without precedent. In 2021, African leaders launched the Partnership for African Vaccine Manufacturing (PAVM) under the Africa CDC, setting a bold target to produce 60% of the continent’s vaccine needs by 2040, with interim milestones of 10% by 2025 and 30% by 2030. Though progress has been slower than anticipated, but there are signs of what can be achieved.

Prof. Janabi highlighted Zambia’s progress in increasing domestic health investment, championing local cholera vaccine manufacturing, and reducing maternal mortality as proof that political will and strategic investment can yield tangible results.

The State of Health in Africa

Prof. Mohamed Yakub Janabi in his annual regional Director’s report, covering July 2024 to July 2025, outlined both the challenges and progress made across the region. He acknowledged that the past year tested Africa’s health systems like never before. From funding crisis to three leadership transitions, and more than 160 public health emergencies. However, he stressed, “we stood firm through it all.”

Prof. Janabi’s report rested on four strategic pillars that reflects Africa’s shared vision for health. The first focused on scaling up Universal Health Coverage (UHC) to ensure essential services are available to everyone, especially the most vulnerable. The second emphasised strengthening emergency preparedness and response, so countries are better equipped to act fast in times of crises. The third addressed healthier populations, with an emphasis on nutrition, maternal health, and mental well-being, and the fourth pillar centered on leadership, innovation, and resilient health systems as the foundation for lasting change.

While highlighting the magnitude of WHO’s support to member states over the past year, Prof. Janabi noted that the organisation worked alongside countries to respond to more than 160 emergencies, ranging from cholera outbreaks to floods, displacements, and viral epidemics. “These responses were backed by rapid coordination, strengthened surveillance systems, and efforts to ensure that essential services such as immunisation and maternal care were not disrupted. To sustain these efforts, WHO also mobilised over $66 million through the Africa Investment Round, showing how important the World Health organisation still is for countries in Africa. More than 221 million children were reached through polio campaigns in 24 countries, while 107 million children received measles vaccines in 21 countries. Malaria vaccines were rolled out in 19 countries, reaching over 600,000 children. This is more than a scientific breakthrough,” Prof. Janabi told delegates, “It is a promise of survival and hope.”

Over the past year, 17 countries adopted WHO’s essential NCD service package, and within this framework, 20 countries are already implementing the PEN-Plus strategy, expanding access to critical care at the primary health level.

Prof. Janabi also noted progress in medicine regulation, noting that 33 countries improved their systems to enhance access to safe and effective medicines, citing Rwanda, Zimbabwe, and Senegal as leading examples of progress.

Emergency preparedness and rapid response was another area of focus. In the past one year, WHO supported countries in navigating 168 public health emergencies, monitoring 88 health events, and responding to five Level 3 emergencies. Also, more than 2,300 responders were trained, achieving 77% of the target for building a skilled African Emergency Workforce.

Roadblocks to Resilient Health Systems

However, challenges remain. Prof. Janabi noted that many African countries operate in fragile contexts, where conflict and humanitarian crises disrupt health services and erode public trust. The reliance on external funding, imported vaccines and medicines has also undermined long-term sustainability, leaving populations vulnerable to global inequalities and shocks. In addition, the continent’s health workforce is over-stretched and under supported, limiting the ability to deliver essential services and respond swiftly to emergencies.

To overcome these barriers, decisive action is needed. “Expanding pooled procurement can reduce costs and improve access, while strengthening surveillance and regulatory systems will help detect threats early and respond effectively.” He further highlighted the importance of ensuring access to essential diagnostics, leveraging technology to bridge service gaps, and implementing strong policies to optimise innovation steps that are critical for building resilient health systems across Africa.

“As we look ahead, equity must remain our compass, domestic financing must echo our systems, innovation and data must drive our delivery, and above all, people must remain at the heart of every action we take”

~ Prof Mohamed Yakub Janabi

Why this matters

The Seventy-fifth session of the WHO Regional Committee for Africa is more than a routine meeting. It is an important moment for setting priorities that affect the health and well-being of millions across the continent. With the funding cuts that have left countries to struggle with sustaining critical programmes, the growing burden of non-communicable diseases like diabetes, cancer, and hypertension, recurring outbreaks like cholera and mpox, gatherings like this provides a platform for leaders to re-commit to self-reliance, stronger financing, and collaborative strategies that can turn challenges to opportunities.

In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), while the World Health Organization (WHO) designated it a Public Health Emergency of International Concern (PHEIC). These declarations highlighting the scale of the crisis following the rapid spread of the more aggressive Clade 1b strain across Africa, raising the stakes for global health security and underscoring the urgent need for coordinated action at both regional and global levels.

First identified in the Democratic Republic of Congo (DRC), this novel variant carried mutations suggesting increased human-to-human transmissibility. By 15 September 2024, the outbreak had escalated to over 29,000 suspected cases across the continent.

Due to the rapid spread of the virus in the DRC and rising fatalities, the Africa Centres for Disease Control and Prevention elevated the crisis to a Public Health Emergency of Continental Security (PHECS) which is its highest level of alert. The presence of the virus in neighbouring countries like Burundi, Kenya, Rwanda, and Uganda reflected a clear continental threat with global implications.

One Year On: Tracking Africa’s Mpox Response

On 14 August 2025, exactly one year after mpox was declared a global public health emergency, WHO and the Africa CDC held a joint media briefing to reflect on the journey so far and the continent’s response.

Speaking at the briefing, Dr. Otim Patrick Ramadan, Programme Area Manager at the WHO Regional Office for Africa, highlighted that mpox “remains a serious public health challenge in Africa,” even as progress have been made in containment efforts. He noted that since the August 2024 declaration, 28 countries have reported more than 174,000 suspected cases and nearly 50,000 confirmed cases, alongside 243 deaths.

Ramadan added that while 22 countries are still facing active outbreaks, there are signs of progress as Côte d’Ivoire has brought its outbreak under control, surpassing 42 days without new cases, while Angola, Gabon, Mauritius, and Zimbabwe have each gone more than 90 days without a single confirmed case.

In the past year, WHO and Africa CDC have coordinated efforts under the Global Strategic Preparedness and Response Plan and the Continental Mpox Preparedness and Response Plan, now in its second phase. Working with partners, they established a joint incident management support team, rolled out vaccine access mechanisms, provided essential logistics support, and worked closely with countries to strengthen their response systems.

According to Ramadan, over 3 million doses of mpox vaccines have been delivered across the region, with around 900,000 people receiving at least one dose of the mpox vaccine. “Thirteen of the 22 affected countries currently have vaccine deployment plans, and eight are actively vaccinating high-risk groups,” he said. “Other achievements include the deployment of 112 international experts, training of 4,000 health workers, and $4.5 million worth of protective and laboratory supplies to 30 countries. In total, about $76 million in donor funding has been mobilised to strengthen response operations in affected countries. Testing capacity has also improved in the Democratic Republic of Congo, rising from 20% to 65%.”

Dr Nicksy Gumede-Moeletsi, WHO Regional Advisor for Laboratory and Genomic Surveillance, added that this increase in testing capacity was made possible by the expansion of laboratories in the country, from two to the current number of 27.

Addressing Gaps to Sustain Progress

“Stigma still deters people from seeking care and testing, fuelling transmission,” said Aminata Grace Kobie, WHO Technical Officer for Health Promotion. She noted that “WHO and partners have responded with infodemic management strategies, including culturally sensitive messaging, survivor testimonies, and partnerships with the media to promote responsible reporting.”

Another concern raised during the briefing was limited vaccine access. In response to questions, WHO explained that in collaboration with GAVI, UNICEF, CEPI, and Africa CDC, it established a global solidarity mechanism in September 2024 to improve equitable access to vaccines.

However, vaccine supplies are still reliant on donations and remain insufficient for mass vaccination. “The doses we have are being used to control outbreaks and curb transmission by targeting high-risk groups identified by the epidemiological investigation,” Ramadan explained, adding “For now, the goal is to interrupt transmission and when the vaccine doses are more and our aim has been achieved, we can focus on building immunity”.

He stressed that urgent action is still required to secure additional vaccines, scale up operational funding, and strengthen cross-border coordination to reduce the risk of spread in new areas and beyond the continent.

Outlining the next six months, Ramadan noted that priorities include expanding community-based surveillance in high-risk areas, procuring and distributing essential supplies to remaining hotspots, supporting the integration of mpox response into other health programmes for sustainability, and maintaining targeted vaccination while advocating for more funding for vaccine deployment.

“It is critical that we sustain what works, and what works includes rapid case detection, timely targeted vaccination, strong laboratory systems for early confirmation, and active community engagement.”

~Dr. Otim Patrick Ramadan, Programme Area Manager at the WHO Regional Office for Africa

This shows that while progress has been made, keeping up with the effort would be important in fully containing mpox in Africa.

Why this matters

Public health threats do not respect borders. Mpox, like COVID-19 before it, reminds us that outbreaks are just one plane flight away. For African countries, this means vigilance must never fade once the headlines quiet down. The systems and capacities built during an emergency response, from surveillance to laboratory networks and rapid communication channels, are not temporary tools, but essential infrastructure for resilience. Sustaining these investments, even when cases decline, is what separates countries that are constantly on the back foot from those that can detect, respond, and contain threats before they spiral. Mpox may not be as threatening as it was last year, but the lessons it offers are urgent and enduring for Africa’s health security.

On 5 August 2025, at the Africa Health Sovereignty Summit in Accra, African heads of state and global leaders endorsed the Accra Compact, declaring that a legacy health governance architecture, built for a different era no longer reflects the continent’s aspirations priorities, amid geopolitical tensions, climate-health shocks, economic volatility and shrinking development aid. Amid the applauses, sovereignty must be seen not as a handout, but built daily through political choices, or risk sending the signal that African leaders can agree on vision but not on delivery.

In his welcome, President John Dramani Mahama moved swiftly from the ceremonial ‘Akwaba’ to a call for accountability. He acknowledged the failures of the past that have eroded African dignity, and credited co-convenor President Paul Kagame of Rwanda and former President Olusegun Obasanjo of Nigeria for laying the groundwork for the future, against the backdrop of abrupt donor pullbacks. He made a bold pledge that the Accra Compact would not become yet another ‘glamorised’ but redundant document. President Mahama committed to establish a Presidential High-Level Panel and a time-bound roadmap for a re-imagined health governance architecture, one that aligns national plans with multilateral commitments and explicitly builds on the Abuja Declaration and the Lusaka Agenda.

By endorsing the Accra Compact, and launching the SUSTAIN initiative, a practical, country-led framework to map all health-financing flows, close bottlenecks, mobilise domestic resources, and align private and philanthropic capital, Mahama placed Africa’s vision for health sovereignty firmly on record and on a clock. It signalled a change from being passive participants, to acting as a global partner on “equal terms, with milestones tracked from Accra to the Africa Union and the United Nations.

The Three Key Messages from the Summit;

(1) From Aid Dependence to Health Sovereignty

Sovereignty starts at home, with national budgets as the most efficient and equitable source of health financing and reinforced by partners who align behind country plans rather than run around them.

The Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus commended the continent’s political will as critical for domestic investment and deeper governance reform, citing the landmark resolution to strengthen global health financing initiated by Nigeria at the 78 World Health Assembly, and co-sponsored by over 25 countries including Ghana, South Africa, Senegal and Zambia. He urged using the current crisis to break from aid dependency and embrace a new era of sovereignty, self-reliance, and solidarity. “In 2023, Africa received US$74bn in aid but lost US$90bn to illicit flows and US$55bn to tax exemptions”, he said: meaning the continent lost much more resources to illicit flows than it gained from aid, and that a gradual reduction on the reliance on aid, will actually force countries to act more to keep the resources they have and prioritise the health of their populations.

As President Mahama noted, reimagined sovereignty is already taking shape on the continent, with Ghana’s trajectory as proof, highlighting recent parliamentary reforms to uncap the National Health Insurance Fund (NHIF), and the expansion of free primary healthcare are ways it is filling the funding gap left by donor withdrawal.

“The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations.”

~ H.E, President John Dramani Mahama, President of the Republic of Ghana

Nigeria’s Sector-wide Approach (SWAp), aligning partner support behind a single plan and budget, offers another example. Nigeria’s Health Minister, Prof. Muhammad Ali Pate during his remarks at the summit called this an “authentically African and globally relevant” agenda, showing how health translates to growth infrastructure when driven by domestic choices that endure even amid geopolitical instability.

(2) Health is wealth: Domestic investment as the backbone of sovereignty

Africa must reduce exposure to external shocks by shaping its own markets. By relying on imports for 99% of vaccines and most medicines, the continent’s vulnerability was exposed by COVID-19. The African Union’s Partnerships for African Vaccine Manufacturing (PAVM) set a 2040 target to produce 60% of vaccine doses locally, aligning partners from Gavi to UNICEF and Africa CDC. The Accra Compact ties this ambition to financing reforms: regulatory harmonisation, pooled procurement, and credible offtake under the African Continental Free Trade Agreement (AfCFTA). It will do this by prioritising regional manufacturing of vaccines, medicines and diagnostics, moving from resilience to reliance.

Leaders in Accra were plainspoken about the political economy. Ghana’s Health Minister, Hon. Akandoh, and AU Health Commissioner, Amb. Amma Twum-Amoah, stressed that Africa’s leverage in influencing global change lies not in isolation or fragmented demand, but in collective bargaining through pooled procurement and harmonised regulation. Yet the political-economic realities are hard to ignore. While Ghana’s inflation has eased from crisis-era highs, it remains elevated enough to strain public finances. Across West Africa, regional instability, including the fallout from ECOWAS withdrawals, complicates the picture further. And without stronger commitments to African-led research and development, the push for local vaccine manufacturing risks trading one form of dependence for another. Global support, meanwhile, will not be judged by applause in Accra but by whether partners adapt their financing, reporting, and procurement models to strengthen, rather than bypass national systems.

(3) From Accra to action: Institutionalise delivery across levels

Execution is about turning commitments into results. The Accra Compact shifted ambitions from being a static document to a living, country-led initiative that will turn political will into delivery.

Four steps define the cadence of the events.

(i) endorse SUSTAIN as Africa’s tool to safeguard gains and accelerate sovereign systems by mobilising domestic resources and aligning partners behind national plans.

(ii) set a six-month roadmap, with outcomes tied to action, overseen by a Presidential Task Force and an Eminent Leaders Group to unlock bottlenecks.

(iii) socialise and mobilise: take the Accra Initiative from capitals to AU Summits and the UN General Assembly so continental consensus becomes global rule-shaping on financing, reporting and results.

(iv) showcase early adopters: Ghana and partners will demonstrate in real time how sovereign financing and governance deliver measurable impacts, creating proof points that invite replication.

By 2050, one in four people on earth will be African, with the continent supplying the largest share of the world’s working-age population, a strategic leverage to reset global rules on fair terms. What can set the Accra Compact apart from past unfulfilled moments is the cadence of events over the next six months. Governments should present a presidentially endorsed roadmap endorsed by Presidents and Heads of State with quarterly targets for PHC coverage, budget optimisation to the health facility level, and manufacturing milestones aligned to AfCFTA corridors, then report progress in a continental scorecard.

The Presidential Panel should drive adoption of SUSTAIN as the financing and governance vehicle, naming early adopters as agreed in the communique, and tracking their progress through AU meetings and the UN General Assembly. If leaders hold this line, the Accra Compact could mark Africa’s shift from promises to performance, and from being spoken to, to being heard. This presents a generational opportunity for the continent.