Africa’s Perspective on the New Global Health Architecture after USAID

Author: Ralph Achenbach, Executive Director Amref Health Africa Germany

The cuts to U.S. development aid through USAID were a central topic at the Africa Health Agenda International Conference (AHAIC), which took place in March in Kigali, Rwanda. The host was Africa’s largest health NGO, Amref Health Africa, in collaboration with the Africa Centres for Disease Control and Prevention (Africa CDC) and the Regional Office of the World Health Organization (WHO) for Africa. That is probably unsurprising, as the withdrawal of the U.S. marks a turning point: In the past five years, one third of U.S. development aid went to Africa. Of the twenty largest recipient countries of U.S. development funding in the period from 2012 to 2021, more than half were African countries. A large portion of these funds went to the health sector.

Devastating effects on health in Africa

In the short term, concern prevailed among the more than 1,500 AHAIC delegates: The abrupt cessation of established programs – especially in the prevention of infectious diseases and the fight against malnutrition – acutely endangers human lives. Especially in places where health financing was dependent on U.S. support, there are already significant negative effects for the population. Amref, too, was forced to terminate projects, such as tuberculosis screening in Tanzania or HIV/AIDS prevention in Malawi.

A chance in the crisis: More self-responsibility for a new health order

In the long term, however, a spirit of optimism also emerged at AHAIC. There was consensus that a historic opportunity now exists to rethink the global health architecture – with a clear goal: to overcome colonial continuities and take on more self-responsibility for strengthening health systems on the African continent.

Two core messages dominated the discussions on stage and in the corridors of the AHAIC venue in Kigali:

1. More money for health: Increase investments by African states

African governments must increase their health expenditures and view health as an investment rather than a cost factor. Health is ultimately a political decision, and African governments will have to demonstrate strong political will. This also includes building their own infrastructure for the production and distribution of medicines and vaccines, as well as promoting research and development in Africa. New partnerships, especially with the private sector, were seen as particularly relevant in this regard. Amref's Group CEO Dr. Githinji Gitahi summed it up in Kigali as follows:
“The traditional ways of financing healthcare […] are no longer sustainable. We must rethink our strategies to build resilient health systems that can withstand emerging threats.”
To overcome past dependencies, we want to “be strong on our own – locally and across the entire continent,” added Dr. Chikwe Ihekweazu, acting Regional Director of the WHO for Africa, in a comment during AHAIC.

2. More health for the money: Increase efficiency

Money alone is not enough. Efficiency in the health sector must increase.
“Africa must take ownership of its healthcare future. Reducing dependency on external aid requires strengthening local healthcare capacity – it’s not just about how much funding we receive, but also about how efficiently we use resources to improve health outcomes,” said Dr. Sabin Nsanzimana, Minister of Health of Rwanda, during his remarks at AHAIC.
In this context, the delegates emphasized various factors: Firstly, the potential of modern technologies such as telemedicine and artificial intelligence. Equally important: a strong focus on prevention rather than solely on treatment. This includes a fundamental transformation of the health system toward stronger primary healthcare, starting with prevention at the household level. Furthermore, an integrated approach is now needed, which also includes non-communicable diseases that are on the rise in Africa. Social as well as environmental factors such as education, income, and climate change also influence health and are closely linked to it, according to the AHAIC delegates. And last but not least, the AHAIC delegates recognized the central role played by the young generation: More than 60% of Africa’s population is under 25 – over 400 million people between 15 and 35. This group holds decisive potential for societal as well as economic change in Africa, and their perspectives must be incorporated into the redesign of the health architecture – also beyond the conference, which had its own “Youth Summit.”
“Young people are the drivers of change and should be given platforms to shape policy and decision-making,” said Dr. Matshidiso Moeti, former WHO Regional Director for Africa, in a contribution during AHAIC.

International solidarity remains essential

But one thing also became clear: it won’t work without international solidarity. The fiscal space of many African governments is limited. The debt burden in Africa is too high. According to the WHO’s Atlas of Health Expenditures, only South Africa allocated and spent 15% of its government expenditure on health, as actually provided for in the Abuja Declaration. In the region overall, the share of health expenditures ranged from 2.1% to 12%. In 24 countries, expenditures for debt servicing exceed expenditures for health and education combined. Debt restructuring – up to and including debt relief – is essential. Bilateral development cooperation will also remain important, at least during the transition – provided it aligns with local priorities. Above all, traditional funding mechanisms from the Global North must finally take localization seriously and support African NGOs directly, rather than channelling project funds through cost-intensive structures in donor countries.

Germany’s leadership role: key to global health security

Germany plays a decisive role as traditionally the second most important donor nation and a pioneer of international support for global health. A withdrawal from development cooperation would not only endanger the reform processes outlined but also global health security. Because pathogens know no borders, and health security on a global level can only be as strong as the weakest local health system. Strengthening all African health systems is therefore in everyone’s interest.
“If the future federal government were to reduce Germany’s contribution to international development cooperation,” warned Dr. Gitahi, “it would be an own goal that Germany scores against itself.”
AHAIC can therefore also be understood as a call-to-action to the future coalition government to commit to Germany’s leadership role in development cooperation and in global health. The corresponding funds must be stabilized and increased – not cut.

AHAIC – Ten years of African thought leadership in global health

The Africa Health Agenda International Conference (AHAIC) was launched in 2014 by Amref Health Africa to create a pan-African space for knowledge exchange, innovation, and joint solution approaches in healthcare. It brings together actors from governments, NGOs, businesses, and civil society every two years. The goal is to address African health challenges with African solutions – based on local expertise.
This year’s motto was “Connected for Change”, and it also brought the socio-ecological dynamics of public health into focus.

About Amref Health Africa

Amref is Africa’s largest health organization. Founded in 1957 and headquartered in Nairobi, Kenya, Amref today reaches nearly 20 million people annually in sub-Saharan Africa – through basic healthcare and training programs for medical professionals. In Germany, Amref is represented by Amref Health Africa Deutschland, based in Bonn.
You can find more about Amref’s work and how global cooperation and local solutions can transform health systems in Africa on the website of Amref Health Africa Germany.

Picture: Amref Health Africa. From left to right: Dr Adelheid Onyango (Director, Universal Health Coverage/Healthier Populations at WHO AFRO); Dr. Chikwe Andreas Ihekweazu - Acting Regional Director at WHO Regional Office for Africa; Dr. Mercy Mwangangi - Senior Health Strengthening Director at Amref Health Africa; Dr. Githinji Gitahi - Group CEO at Amref Health Africa; Charlotte Muheki - Primary Health Care Director at Amref Health Africa; Dr Kalu Akpaka - Team Leader, Strategy, planning and policy for disease control at World Health Organization (WHO)