Prof. Lukoye Atwoli, International President of WHSRM 2026, pulled the conversation away from comfort. “One of the unspoken intentions of this convening” he said “is to make people a little uncomfortable by having difficult conversations.”

With over 3,000 participants, the scale of the gathering was evident, but for Atwoli, the convening’s significance also lay in the specific actions that would follow.

Prof. Axel R. Pries, President of the World Health Summit, followed by situating that responsibility within a wider shift. He emphasised that Africa’s health sovereignty can only be built through partnerships within countries, across regions and between sectors. He pointed to the need to move beyond fragmented, under-resourced arrangements toward more coordinated, sustainable and transparent systems that deliver at scale.

The Regional Director for WHO AFRO, Dr. Mohamed Janabi, brought the point down to practice. He noted that the summit showed what alignment can look like when governments, institutions and regions work together. For the first time, three WHO regions – AFRO, EMRO and Europe – came together around a shared agenda, reinforcing the idea that health threats do not respect borders and cannot be addressed in isolation.

“Telling people to wash hands means little if water is kilometres away,” he said, pointing to work in the Democratic Republic of Congo where partners installed water infrastructure, upgraded laboratories and strengthened local health facilities during an outbreak. The result was not just containment, but a more resilient system left behind.

By the time Deputy President of the Republic of Kenya, Prof. Kithure Kindiki took the floor, that message had settled into something firmer:

“The message from Nairobi 2026 is simple and direct. Africa’s health future will not be given to us. It will be built by us. It will require political courage, institutional discipline, sustained investment and an unshakable conviction that African lives matter equally on the global stage.”

His remarks brought together the key issues raised over the three days. Domestic financing, local manufacturing, and stronger institutions were no longer treated as aspirations but were presented as conditions for progress.

The summit also surfaced tangible signs of movement. Two stand out: the launch of a continental immunisation strategy and the establishment of a high-level ministerial committee on global health architecture reform.

What stood out in Nairobi was not the scale of the problem, but the direction of the response.

Whether that direction holds will depend on what follows — in how governments translate commitments into policy, institutions coordinate investment, and systems deliver in practice, not just on paper.

The conversation, moderated by AMREF Health Africa CEO, Dr Githinji Gitahi, began by highlighting the issue of trust. “Many Africans”, he noted, “still do not trust products made on the continent. It’s almost like the ones that are imported are more superior to the ones that we manufacture here and that narrative must change by creating globally acceptable quality products across the continent that are trusted.

Setting the tone for the session, Ibrahima Socé Fall, CEO of Institut Pasteur de Dakar (IPD), pushed back against the idea that sovereignty can simply be declared:

“Sovereignty cannot be just a slogan. We need to create the ecosystem. We need to be able to produce vaccine from end to end, starting with technical expertise, the talent and the workforce needed, this is the minimum requirement”

His point speaks to a deeper challenge facing African health systems. The shift from dependence on imported vaccines and diagnostics to building integrated, self-sustaining manufacturing capacity is complex. The COVID-19 pandemic exposed the risks of that dependence, as global supply chains faltered and African countries found themselves at the back of the queue for life-saving products.

Fall pointed to Senegal’s experience as proof that progress is possible, while acknowledging how complex the path remains. At Institut Pasteur de Dakar, he noted, the organisation has expanded beyond its long-standing yellow fever vaccine production to invest in a vaccine research centre, clinical trials, and new candidates for diseases such as Marburg, Lassa fever and Rift Valley fever.

However, supply chains remain fragile and largely controlled from outside the continent. Africa still lacks a coherent market for its own products. Procurement systems dominated by global actors such as Gavi and UNICEF leave little room for African manufacturers to grow at scale.

Fall called for a continental approach. Countries need to align production with their comparative advantages and build a market that can sustain the industry over time.

From Kenya, Biovax Institute’s Richard Oduor reinforced the scale of the gap. Africa currently produces less than one percent of the vaccines it uses. Closing that gap would need more than infrastructure. It requires building capabilities across the entire value chain, from early-stage research and drug substance manufacturing to formulation, packaging, regulation and distribution.

For Biovax, the strategy is practical. Start where capacity already exists, such as fill and finish, then gradually build backward into more complex stages through technology transfer. Even this approach depends on sustained financing, strong negotiation capacity, and the ability to attract skilled talent back to the continent.

The session made one thing clear: Africa’s vaccine manufacturing ambitions will not be won in laboratories alone. They will be won in procurement rooms, policy conversations, and the long-term commitment to train and retain the scientists the continent is already producing. What remains missing is the coordinated architecture — the markets, financing, and political will — that turns isolated progress into continental self-reliance. Sovereignty, as Fall reminded the room, cannot be a slogan.

The session, “Trust in Science: Advancing Quality Health Information in the Age of Digital Health,” which was hosted by Nature Commission brought together Mercy Korir (Willow Health), Vivianne Ihekweazu (Nigeria Health Watch), Rebecca Ivic (University of Alabama), Nancy Booker (Aga Khan University), Ozge Tuncalp (Institute of Tropical Medicine, Antwerp), Ben Johnson (Nature Commission), and Jacqueline Kitulu (World Medical Association).

Discussions reiterated how the health information landscape is quickly shifting. Digital platforms and artificial intelligence have expanded access to health information, but they have also made it harder to distinguish evidence from distortion.

Traditional gatekeepers of health information such as journals, ministries, and academic institutions no longer determine how information reaches the public. Today, social media platforms, messaging apps, and algorithm-driven feeds increasingly shape what people see, share, and believe.

Examples were made visible across African contexts.

Vivianne Ihekweazu, the managing director of Nigeria Health Watch described how digital platforms have transformed health communication, but also created a space where people often rely on peer networks and online sources over trained health professionals when making decisions.

During the COVID-19 pandemic, misinformation influenced health behaviours, including the use of unverified remedies and vaccine hesitancy in some communities. Those patterns have continued to shape how people engage with health systems long after the emergency phase ended.

“False information travels around the world as the truth is tying its shoes,”

said Mercy Korir of Willow Health, capturing the speed at which misinformation now moves compared to verified evidence.

For Jacqueline Kitulu, president of the World Medical Association, the issue is not only technical but ethical. “We are surrounded by health information, but much of it is unverified, misinterpreted, or deliberately misleading,” she said. “Patients have a right to reliable, evidence-based health information.”

Responses to this shift are beginning to take shape. Rebecca Ivic of the University of Alabama highlighted ongoing work to develop global indicators for assessing the quality of health information, while Booker, Tuncalp, and Johnson stressed the need for stronger governance frameworks and greater accountability in how evidence is produced, communicated, and acted upon.

The session closed with a clear consensus: no single intervention will fix the problem. Building trust requires working across multiple layers simultaneously — accurate information, relatable communication, stronger health literacy, and, importantly, coherence between what people encounter online and what they hear from health workers in clinics and communities.

For Africa, the urgency is clear. Health systems are already overstretched, and misinformation routinely outpaces the public health responses designed to counter it. In this environment, rebuilding trust in health information is not a secondary concern — it is as fundamental to survival as the care itself.

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.

In 2000, Sierra Leone recorded 1,682 maternal deaths per 100,000 live births — the highest maternal mortality ratio in the world. By 2023, that figure had fallen to 354. Dr. Kenneth came to Abuja, Nigeria, not to celebrate that number, but to propose that West Africa builds the system behind it together.

Presenting the Freetown Charter, Dr. Kenneth was deliberate about what drives change. “The buzzword is not the technology. It is not the digitalisation that is going to save lives. Make no mistake, it is actually the decisions that we make and the actions that we take that change things. But digital and innovative technology can position us in such a way that we act fast in response, remain accountable and accurate, and make progress in a very short time.”

Sierra Leone’s journey illustrates exactly that. During the Ebola crisis, the country developed an electronic case-based disease surveillance system, shifting from aggregate to real-time reporting. That system was later adapted for maternal and child health. Every death is now reported immediately. Every week, a national review call connects leadership, specialists, district officers, UN partners, and regulatory bodies. A midwife’s absence, an unsigned supply document, a delayed referral —failures that once went undetected now surface within hours.

The data has also driven direct clinical decisions. When supply chain data flagged heat instability in oxytocin stocks, Sierra Leone switched to heat-stable carbetocin, reducing deaths from postpartum bleeding. When data revealed high anaemia rates, the country shifted from iron and folate to multiple micronutrient supplements. “Data must lead to action,” Dr. Kenneth told delegates.

The Freetown Charter proposes seven priority areas: Data governance and surveillance, Digital infrastructure and interoperability, Contextual and Innovation, Human capacity & workforce, Accountability & Performance, Data Sovereignty & Ethics, and Sustainable Financing. Its targets include institutionalising maternal and child death audits, adopting digital tracking tools across health facilities, and developing AI-based tools by 2030.

“This will not be the end, but the beginning of a collective effort to strengthen health systems across the region”

~ Dr. Satti Kenneth, Chief Medical Officer, Sierra Leone

Sierra Leone’s experience offers an early indication that the Charter’s ambitions are not merely aspirational, but actionable.

Drug resistance in West Africa is spreading and the region’s data systems are not keeping pace. Drug resistance is spreading across West Africa’s borders faster than the region’s surveillance systems can detect it.

This was the central concern raised during the session on West African Health Organisation's (WAHO) Regional Malaria Elimination Framework. A recurring call from health experts was for a regional network that allows Member States to share drug resistance data in real time. Strengthening monitoring committees to track both drug and insecticide resistance was seen as equally urgent. The reasoning was straightforward: resistant strains spread across borders faster than national surveillance systems can detect them. Without coordinated, cross-border data exchange, one country’s emerging resistance problem becomes a regional challenge.

Delegates stressed the need to translate these technical recommendations into ministerial-level resolutions to ensure formal adoption and accountability across Member States. Not recommendations that sit in a report - but commitments that bind governments to action.

“Each country already has its own national strategic plan. Our role as ECOWAS is to support, coordinate, and harmonise efforts across Member States.” said a WAHO Representative.

The conversation moved from data systems to the people those systems are meant to protect. Delegates emphasised the role of communities in malaria control - and specifically on who communities trust. Traditional and religious leaders, they argued, are central to health communication. Their formal integration into malaria strategies was strongly supported, with delegates noting that community acceptance of interventions, from bed-nets to vaccines, often hinges on endorsement from these figures.

Community health workers received similar attention. Already embedded at the front lines of care, they were recognised as essential actors in malaria surveillance. Delegates called for strengthened training and for malaria monitoring responsibilities to be formally incorporated into their roles, a practical step that costs relatively little but extends the reach of the entire framework.

Delegates called for the framework to explicitly address how gender shapes malaria exposure, healthcare access, and caregiving responsibilities. Urging that programming account for the different ways men and women experience and respond to malaria.

Private sector inclusion is also critical for the success of the framework, the experts emphasised. As private channels supply much of the region’s medicines, delegates raised concerns about the quality of medicines and the need for stronger regulatory compliance, noting that substandard and falsified medicines accelerate resistance. They called for local manufacturers to be engaged as active partners producing and supplying quality-assured medicines and commodities, reducing the region’s dependence on external suppliers.

Dr Monique Murindahabi, Global Health Expert and Consultant, presented a regional framework designed to move countries from fragmented control efforts to coordinated elimination by 2030.

Developed through expert consultations in Conakry in March 2025, the framework positions governance, data, commodities, innovation, and financing as interconnected levers for impact rather than isolated interventions.

At the centre is Pillar One: Governance and Coordination, which Dr Murindahabi described as the foundation of progress. While political commitment already exists through the African Leaders Malaria Alliance, she stressed that the real test lies in implementation. She called for stronger regional coordination mechanisms and cross-border collaboration, given that malaria does not respect national boundaries.

“Cross-border coordination is essential. Without harmonised cross-border collaboration and notification systems, malaria elimination will not be possible”

~ Dr Monique Murindahabi

Pillar Two: Data Systems, Surveillance, and Resistance focuses on strengthening regional intelligence. Although countries have improved use of District Health Information Software 2 (DHIS2) platforms, she called for a real-time ECOWAS malaria dashboard and stronger integration of national data systems. She also warned of rising drug and insecticide resistance, urging expanded molecular surveillance, digital tools such as geospatial mapping, and improved cross-border reporting.

Pillar Three: Treatment and Community Health Systems, Dr Murindahabi emphasised safeguarding first-line therapies while preparing for resistance through diversified treatment options. She emphasised community health workers as the backbone of early detection and response. “Community systems remain the first point of care and must be fully strengthened,” she said, also calling for better integration of private sector and traditional health actors.

Pillar Four: Manufacturing, Supply Chains, and Pooled Procurement addresses efficiency and equity in access to commodities. Dr Murindahabi proposed a regional pooled procurement system to reduce costs and prevent stock imbalances across countries. She also pointed to emerging innovations such as Nigeria’s planning model for malaria commodities and discussions on local manufacturing of mosquito nets as opportunities for regional scale-up.

Pillar Five: Research, Innovation, and Capacity Strengthening, calls for better use of existing laboratories, stronger regional research networks, and improved collaboration between academic institutions.

Pillar Six: Community Engagement and Behaviour Change focus on trust and ownership. Dr Murindahabi stressed that even effective interventions fail without community acceptance, urging engagement of traditional and religious leaders, alongside civil society, to drive uptake. “Elimination depends on communities understanding and owning the response,” she said.

The final pillar, Financing and Strategic Partnerships, highlights the need for increased domestic investment while leveraging regional and global partnerships. She called for innovative financing approaches and better integration of malaria into broader health financing systems.

Across all seven pillars, three principles were emphasised: strong governance, data-driven decision-making, and accountability. Dr Murindahabi concluded by stating that a malaria-free ECOWAS region is achievable, but only through coordinated action, sustained investment, and regional solidarity.

Malaria claims the lives of children under five nearly every minute with sub-Saharan Africa bearing the heaviest burden.

This sobering reality hung over the Health Experts Meeting in Sierra Leone, where WAHO presented two consequential documents: a Regional Malaria Elimination Framework and an account of how its budget is evolving. Together, they told one story. Ambition is not the problem. Money is.

The malaria framework, co-created with experts at a meeting in Conakry in March 2025, is structured around seven pillars: governance and coordination, surveillance and data systems, treatment and community health, supply chain and commodities, research and innovation, community engagement, and financing.

Dr. Monique Murindahabi, a WAHO consultant, who led the presentation was direct. “Malaria does not respect borders. We cannot talk about elimination if neighbouring regions do not align their policies.” Cross-border case notification, harmonised drug resistance protocols, pooled procurement, and a real-time regional disease dashboard are among the framework’s centrepieces.

The African Leaders Malaria Alliance (ALMA) has already committed to elimination by 2030, however, participants pushed back on timelines.

On commodities, Dr. Murindahabi was equally explicit. “If we are serious about elimination, we must ensure that when a case arrives at a health facility, it is tested and treated. Commodities must therefore be available at all health facilities.”

Commodities, however, are only one part of the equation. The question of financing soon followed.

Dr Aruba Fallah, WAHO’s Director for Administration and Finance highlighted during his presentation that the WAHO’s approved budget has grown from roughly $47 million in 2018 to $71.6 million in 2025, a trajectory that looks healthy until you examine what is funding it. In 2018, external partners dominated, and by 2023, ECOWAS’s community levy had grown to surpass partner contributions, a sign of growing ownership.

However, the 2024 and 2025 figures are alarming. USAID, the African Development Bank, and Germany’s KfW — once pillars of WAHO’s external funding — have dramatically reduced from the ledger. In 2025, KfW accounted for 41% of remaining external funds, with USAID contributing just 2%.

Against that backdrop, Dr. Fallah set out an ambitious target.

"We have a projection to double our budget from $47 million in 2018 to $100 million in 2026… So there is a strong need for domestic resource mobilisation to achieve this"

~Dr. Aruba Fallah

The ambition is clear, but with ECOWAS covering just 26% of WAHO’s budget and traditional donors retreating, the path to $100 million runs through domestic resource mobilisation — a conversation the region can no longer defer.

This makes what comes next consequential.

“A malaria-free ECOWAS region is possible,” Dr. Murindahabi told delegates. “It is an achievable goal with political will, adequate investment, and regional solidarity.”

That solidarity must now be financial. Without it, West Africa’s boldest public health ambition risks becoming its most expensive unfulfilled promise.

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.

From April 27–29, 2026, global health leaders, policymakers, researchers, and advocates will convene in Nairobi, Kenya, for the World Health Summit Regional Meeting 2026, placing Africa at the center of conversations shaping the future of health systems worldwide.

The 2026 Regional Meeting, hosted by the Aga Khan University in Kenya, marks the second time the convening will be held in East Africa and on the African continent, signaling a growing recognition of the region’s role in shaping global health discourse.

Key Theme: Reimagining Africa’s Health Systems: Innovation, Integration, and Interdependence

The meeting will bring together more than 2,000 participants from over 50 countries and will span high-level plenaries, ministerial and leadership roundtables, technical sessions, youth forums, and community dialogues, creating space for both formal deliberation and cross-sector exchange.

Why This Matters

As African health systems navigate complex challenges ranging from emerging health threats to longstanding structural gaps, this meeting comes at a critical moment. With support from institutions such as the Africa Centres for Disease Control and Prevention and the WHO Regional Office for Africa, the convening reflects a broader shift toward more inclusive and regionally grounded global health conversations.

For Kenya, hosting the meeting presents an opportunity to reaffirm its leadership in health system transformation and universal health coverage. More broadly, it offers a platform to amplify Africa’s collective voice in shaping global health policy and priorities.

Africa Health Dispatch: Live from Nairobi

Africa Health Watch will be on the ground, bringing timely insights through our Africa Health Dispatch series.

Through this coverage, we will track key conversations as they happen, moving beyond headlines to unpack what they mean for health systems across the continent.

Readers can expect:

• Real-time updates from major plenaries and high-level sessions

• Key takeaways from discussions across core thematic areas

• Voices and perspectives from policymakers, experts, and emerging leaders

• Contextual analysis connecting global conversations to African realities

By sharing real-time updates, the Africa Health Dispatch keeps readers connected to the conversations unfolding on the ground.

Register to attend the World Health Summit Regional Meeting 2026

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

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

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

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

~ Hon. Lilani Brinkman

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

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

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

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

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

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

~ Dr Allisyn Moran

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

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

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

Despite these challenges, Dr Gupta acknowledged policy gains.

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

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

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

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

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

~ Dr Jean Kaseya

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

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

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

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

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

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

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

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

Africa’s Role in Global Pathogen Surveillance

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

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

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

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

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

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

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

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

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

Why This Matters

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

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

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

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

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

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

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

Ethics Is Not One-Size-Fits-All

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

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

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

Regional Safeguards: African Institutions as Ethical Gatekeepers

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

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

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

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

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

~ Dr. Mosoka Papa Fallah

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

Why This Matters

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

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

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

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

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

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

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

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

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

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

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

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

~ H.E Olusegun Obasanjo

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

Turning Vision into Action

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

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

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

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

Why This Matters

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

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

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

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

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

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

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

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

The First Tests of a New Aid Model

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

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

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

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

Why This Matters

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

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

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

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

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

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

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

Ghana’s Hard Lessons

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

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

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

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

~ H.E John Dramani Mahama

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

Why This Matters

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

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

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

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

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

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

~ President John Dramani Mahama

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

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

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

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

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

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

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

- expanding equitable access to new prevention tools like lenacapavir

- strengthening digital and data systems to guide decision-making

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

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

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

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

Insights from Global Leaders

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

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

~ Dr Aaron Motsoaledi

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

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

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

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

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

Why This Matters

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

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