Amref Health Africa, headquartered in Kenya, is often referred to as the largest Africa-based international health and development organization providing training and health services to over 20 million people annually in at least 35 countries across the continent, including Ethiopia.
Last week the organization co-hosted the sixth edition of the Africa Health Agenda International Conference (AHAIC 2025) in Kigali, Rwanda. The conference brought over 3,000 global health leaders, policymakers, researchers, private sector innovators, youth advocates, and frontline workers together to discuss pressing health challenges and chart a path toward a healthier, more equitable future.
On the sidelines of the event, The Reporter’s Sisay Sahlu sat down with the global chief executive officer (CEO) of Amref, Githinji Gitahi (MD), and discussed some of the pressing issues facing African healthcare systems, including the impacts of Washington’s recent decision to cut assistance to the continent. EXCERPTS:
The Reporter: Tell us about Amref Health Africa. What does it do? What are some success stories?
Githinji Gitahi: Across the continent, Amref supports HIV care and health financing. Governments don’t have adequate money [for healthcare] so we support them in repurposing their money and making things more strategic for health systems across the continent. In Ethiopia specifically, we’ve been working with the government to ensure that young people have better health services. We have created savings and credit societies in Ethiopia to ensure youth economic empowerment and enable them to take care of their lives and plan their lives through secured productive health.
We train nurses across the continent. We have launched Amref International University, which now has close to 4,000 students, largely in nursing, physiotherapy, critical care, and public health. We are expanding to become a 10,000-student university. We have worked to strengthen laboratory systems on the continent, in South Sudan, in Ethiopia, in Kenya, in Tanzania. Why laboratory systems? Because when you have disease threats, you have to discover the disease early so that you can treat it, like Marburg, like Mpox.
We’ve supported that. And most importantly, we have worked with governments to strengthen the community level of health systems. We work with more than 150,000 community health workers across Africa. They are the first stage of defense for the health system. Ethiopia is a good example. We have been involved in the development of the community health workforce program here.
Your organization is co-hosting the health conference in Kigali. What is its main purpose?
This conference is embedded in its philosophy and how it was created. It was created to be a platform for Africa’s health’s agenda.
We know we have many conferences. We have the UN General Assembly, we have the World Health Assembly, and so on. But none of them is led by African people discussing an African agenda. And yet that African agenda is very different from the global health agenda. The achievements have been that African communities, African governments, have been the leaders of the conference. That means that the solutions they discuss and the way they discuss them are owned by the African people. And we have seen many successes.
We have been able to launch a report of what we call the AHIC Commission on Universal Health Care (UHC). Governments can refer to the Commission in relation to achieving
universal health coverage. It was launched in 2021. We’ve been able to create the Africa Health Policy Leaders Forum of Ministers, where ministers meet informally to discuss, to get to know each other, to solve problems and learn from each other. We’ve been able to bring young people together to talk to their policy leaders. And now in this particular conference, there’s a theme emerging that we need to redesign the health system.
The health systems we have now are not fit for the needs of the future. And the reasons for that are the following. One, there are geopolitical changes. You’ve seen the US government has changed policy. Governments in Europe are changing policy. In many of our countries, the funding of health services has been delivered through foreign aid. Significantly. In countries like Malawi, 56 percent of the health support is foreign assistance. In many other countries, about 30 percent. Now, when foreign aid starts to shift so rapidly, what are those countries going to do? They have to rethink the health system.
The next challenge is the rising burden of non-communicable diseases. We know that by the year 2050, it is likely that up to 80 percent of deaths in Africa will be related to non-communicable diseases. Cancer, hypertension and diabetes. Why? Because the lifestyles of African people are changing. They are moving more towards the urban centers. When they move to urban centers, food, healthy food, is expensive. So they buy unhealthy food. They live more sedentary lifestyles; they are not active. Therefore, we are seeing a rise, a rapid rise.
Three out of every 10 people have hypertension. These people are at risk of stroke and heart failure. But the problem is, because we haven’t invested in systems that can diagnose these challenges early, those people are discovered when it’s too late.
Diabetes is the same. More than 20 million people in Africa are living with diabetes. But if they are not discovered early, you will discover them when their eyesight is gone and their kidneys have failed. Meaning now you have to spend more money on them. Because you have to take them to renal dialysis and all these things. Whereas, if you discover them early, it means you can actually prevent complications and save the money you will have used in the future.
We have to rethink the health system to address these things.
The final threat is climate. Global warming is increasing scarcity of food. It is actually moving more people to urban centers because of a lack of food.
The land that they have is not generating money anymore because of the extreme weather events and uncertainty about rain and water. Many people are abandoning their farms and coming to urban areas, exposing themselves more and more to hypertension and diabetes because of the foods they are consuming.
These changes mean that the health system we have today is not the health system we need in the future. There has been a general agreement in this conference that we need to redesign the health system.
We recently interviewed the Executive Secretary of the Africa Leaders Malaria Alliance (ALMA), who spoke about the massive impacts the US financial support cuts will have unless leaders act now. What are your thoughts on how this will affect African health systems?
The US has been the biggest contributor to donor aid on health. We estimate that the US contributes about six billion dollars a year to the health system in Africa through different mechanisms.
Let’s take the case of a country like Zambia. They were receiving 400 million dollars. That has gone. That money was treating HIV patients. They were supporting more than 1.1 million HIV patients.
In Kenya, they were supporting more than 1.4 million HIV patients. TB patients as well. The health workers who are taking care of these people have lost their jobs and the medicines are no longer supported. Governments have to now look for money to support.
Can they afford 400 million? No, that’s a lot of money and they have other needs. What do they do? They have to decide what to cut and what to maintain. So governments are asking “what can we afford? What must we afford?” Governments are rearranging to ensure they can cover some of the gaps left by USAID. But they’re not able to cover all of them. It’s impossible to cover all of them.
What will the impacts be if political leaders and governments fail to take prompt action?
There will be two major impacts. One is that there will be loss of lives because some people without medication could die in the process. The second thing is that there will be resistance to drugs because of the way we use drugs. Especially for TB patients, who are given drugs for six months to recover. If you break the schedule, when you start again, the bacteria that causes tuberculosis could have developed resistance. So we’ll see more resistance – what we call mold drug-resistant tuberculosis. We may find poor compliance, and there will be more infections of HIV and TB.
The other thing, of course, is loss of jobs. Significant loss of jobs in the hundreds of thousands. These are the key impacts that we are going to see.
African Union member states are often criticized for failing to contribute their annual dues to the organization. How optimistic are you about leaders’ commitment towards the continent’s health systems?
We are convinced that governments want to save their people. Governments have an interest in showing hope to their people because those people are their voters. They can’t be negligent. Do they have the money to do it? No. So they’ll have to sacrifice certain things. But governments cannot avoid responding.
African governments, their economies are small. Very small. To give you just an example, the state of California in the US has more money than the entire continent of Africa. In terms of GDP. Yet the state of California has 50 million people. Africa has 1.34 billion people. Why? That can be a big political question because we are full of minerals, diamonds, gold, oil. There is an issue with corruption and governance.
The second problem is that we have not been able to formalise our economies. A lot of our people are working in informal communities. In Ethiopia, the guy who is selling injera or other commodities by the roadside is difficult to tax.
Only 20 percent of people are taxable. Only those who are employed formally. The ones who are in the farms farming coffee and the ones who are making teff and the ones who are selling injera are not possible to tax. Tax efficiency is very low.
So, we have a small economy that we are not able to tax. We have very little money. If you have little money but big problems, the only way to go about it is to decide what to do with your little money.
In your house, when you lose your salary, or maybe someone loses a job, you go back home and say, let us move my children from private school to public school. Let us sell the car. That’s what the government has to do. Some people will be unhappy because now the child who was in a good school has to go to a poorer school. The child will be unhappy with the father. But what option does the father have?
There is criticism that aid funding has often been wasted on frequent workshops and meetings that do not have an impact on the community. What are your thoughts on this?
We have to look at emergency situations and the general health system. In an emergency situation, governments will need to sit down and look at how much money they are receiving and ask “what does the money do?” Then prioritize those things according to how important they are. Even workshops and training are not unnecessary. They are just less important. Because when you are a doctor, being reminded that there is a new drug is important. But it may not be necessary in an emergency situation.
The government must fund that. Can the government fund that with less money? Yes. Because maybe the drugs that were being bought by the USAID were more expensive. And maybe the government now can find a manufacturer to provide the same drugs at a cheaper cost.
Then you go to health workers. Maybe USAID was paying health workers more money because they were paying them at a rate that is high. Tell those people now, we can’t afford that rate, and we can only afford the national rate. They will be unhappy, but that’s the only thing to do. That’s the first thing governments have to do.
We are committed as Amerf to assist governments to do that analysis and to assist them to shift the money.
In the broader health system, the government might see it cannot afford to take care of more HIV patients because their drugs are expensive. I would estimate it takes about two thousand dollars per person per year. It’s very expensive. If you have local manufacturing, you could reduce that money. If you prevent the infection in the first place, you could save the whole two thousand.
We must also ask the governments to shift more towards prevention. Because right now, I can ask you in Ethiopia, I’m not sure in the recent past you’ve seen a billboard saying use a condom. Those billboards were there before. They’re not there anymore. Because people say, even if you get infected, we have drugs. But who is paying for the drugs? It is the donors.
If the government was to provide people condoms, they would avoid providing them with drugs. Prevention has to be the way we have to rework the health system. We have to go to schools and train people on positive mindset, what we call comprehensive sex education, and then we have to ensure that people know when they have hypertension, when they have diabetes, and we have to prevent them from being complicated.
We have to do those things. We have to avoid teenage pregnancy so that we avoid unsafe abortion. Governments need to start moving back and saying, if we can eliminate cervical cancer by vaccinating every girl before 15 with HPV vaccine, then we don’t have to treat cervical cancer in future. That’s what we have to do.
What specific impacts will this aid cut have on Ethiopia?
In Ethiopia, we had a large project called Kefeta. It was a youth program funded by USAID and focused on three areas. One was sexual and reproductive health. Second was helping them to get education and helping them find jobs. And those jobs are entrepreneurship, not necessarily being employed. It also helped them save by creating savings and credit cooperatives. The program was supported by USAID and it was 60 million dollars to reach thousands of youth over six years. We had already done four years. The two years have been canceled.
What that means is that thousands of youth will go around now without those services. The training that was happening will collapse. Luckily, the savings and credit societies that we helped form are sustainable.
Those youth we are working with have saved about one million dollars within the program over the last two years. That means that there is some sustainability that has remained, but service delivery, coordination, education, all those are going to stop.
Receiving aid is not exclusive to Ethiopia. But with decades of USAID support to Africa, weren’t there any exit strategies?
We must have an exit strategy. And I think that in this whole thing, African governments are not without blame.
If you’ve been receiving aid for 20 years, you should have actually planned on an exit strategy early on. I’ll give you an example. Ethiopia and Rwanda had already started thinking about integrating aid together.
That it is part of the national basket. So that even if one person exits, you still know what they are doing. And therefore, you can take it over. Many countries did not. Many countries said, HIV is with USAID. They are okay. Let them continue. Suddenly, they are pulled out. So they’re like, “oh, my God, what do we do with those people?”
We must have an exit strategy. This is a wake-up call. There is something you may have heard around this conference called the Lusaka Agenda. The Lusaka Agenda is an attempt to make sure any donor in a country must work within the government strategy, within the government plan. You don’t have to give the money to the government, but you must be part of the budget.
Ethiopia has been doing that. Rwanda has been doing that. Many countries have not been doing that. The money that the donors bring does not operate on a common plan, does not operate on a common strategy. This is a wake-up call to implement the Lusaka Agenda to ensure that any donor, any country coming to and working in another country is integrated within the country’s plan because that’s then part of the exit strategy.
But that has been very difficult to do for many years because the thing about aid that Africans must remember is that aid is not charity. Aid is not charity. The person who is giving the money to the country has an interest. They’re not giving it to you for free. There’s an interest and that interest is diplomatic relations, militarization. It is an issue about trade, influence.
And I think the other thing to remember is that aid is not an entitlement. So aid is not charity therefore you must demand the person giving the aid to fit certain conditions that are aligned to your national interest, and it’s not an entitlement. You must know that one day it could go away.
Tell us about the issue of vaccine equity. Are there plans to manufacture vaccines in Africa?
The reason we suffered the big vaccine shortfall during COVID is because, of all vaccines that are used in Africa, 99 percent of them are imported. We were depending on other people, and we never thought that would be a problem until countries closed down and now we had no vaccines.
Since then, it’s been recognized that every continent needs to have some level of security over health products and commodities. There is a big effort to manufacture in Africa.
That effort has been supported by Africa CDC, has been supported by WHO, but that effort must also be supported with capacity.
There are, of course, researchers and developers needed. Manufacturing of vaccines is not manufacturing glass. It is actually a very complex process because you have to control the materials that are manufactured in the vaccine. Some of them are live viruses. You have to handle live viruses, live bacteria, and therefore you have to have labs and manufacturing processes that are safe. We know that we already have vaccine manufacturing in Africa, in Egypt, in Senegal, they manufacture the yellow fever vaccine.
In South Africa, they are manufacturing the COVID vaccine. So we know we have some capacity. What Africa is now doing is coordinating that capacity, but also must overcome its geopolitical competition because now countries might say, because I want to be the big one, I want to only manufacture my own. You can’t do that because the other thing about Africa is that we have 55 states all with borders, all with different regulations.
The question is, if you’re going to be asked, let Ethiopia manufacture vaccines for malaria, let Kenya manufacture vaccines for cholera, they must agree and say, okay, each of you manufacture this and then we must create a common market.
This issue of manufacturing will require Africa to work together as a union to identify a plan for manufacturing. It can’t be every country doing their own. The final point is to ask, who will be the buyer of the vaccines? Because right now I can tell you that 75 percent of all countries that receive free vaccines from the Global Vaccine Alliance are in Africa.
The Global Vaccine Alliance buys vaccines and delivers them to Africa. If we manufacture our own, we must make the Global Vaccine Alliance buy them and deliver them to us. Otherwise there will be no buyer.
If you are manufacturing vaccines for meningitis, but Burkina Faso is receiving them for free from Gavi, why would they buy yours? There are also several issues. Reduce geopolitical competition, have a common regulatory market and then ensure that we are working, we are market shaping so that the buyer of vaccines is buying from our manufacturing. Otherwise it will not work.
What is your message to African leaders and policy makers in this regard?
My message is what I said earlier that African countries must realize that aid is not charity, aid is not an entitlement. Number two is that they must redesign the health systems and focus on prevention, and prevention means water, sanitation, food and immunization.
