My brother Mo Ibrahim,
Excellencies, brothers and sisters,
All protocol observed,
First of all, thank you so much, Mo for bringing us all together here, and also to His Majesty and Morocco for the excellent hospitality.
I would like to thank you for choosing the topic of financing the Africa we want for this year’s Ibrahim Governance Weekend.
That phrase – the Africa We Want – is very significant to me personally.
As you know, it is the catch-cry of Agenda 2063, the 50-year development blueprint for Africa, which I had the honour to shape with Louise Mushikiwago and Moussa Faki, as foreign ministers, and I had the honour to be the Chair of the 50th anniversary of the African Union Executive Council.
However, the most recent report on the implementation of Agenda 2063 shows that despite some progress, our continent is off track on many indicators.
And in the past five years, we have suffered two major setbacks:
First, the COVID-19 pandemic;
And second, sudden and steep cuts to aid that are causing severe disruptions to health services on which millions of people rely.
As the report prepared for this conference shows, billions of dollars in aid has disappeared virtually overnight.
The impact is severe.
Lifesaving medicines are sitting in warehouses, people are missing out on treatments, clinics have closed, health workers have lost their jobs, and health information systems and supply chains are breaking down.
Although this is an acute crisis now, it is a crisis long in the making.
Many health systems around the world, and especially here in Africa, have long suffered from chronic underinvestment.
As a result, out-of-pocket spending is the main source of health financing in 27 African countries.
In 10 nations, more than half of all health spending comes from out-of-pocket payments. In two of these, it exceeds 70%.
At the same time, debt servicing costs in many countries restrict their ability to invest in health.
Globally, in 2023, 3.3 billion people were living in countries that spent more on debt interest payments than on education and health combined.
These conditions have contributed to heavy aid dependency in many countries, as we all know.
Since 2006, aid has consistently surpassed domestic public spending on health in low-income countries.
Much of this aid, however, does not flow through treasuries, but through parallel systems set up by donors. This makes forward planning and budgeting impossible.
This deep reliance has created a deep vulnerability that has now been exposed.
But although many countries are facing serious challenges, many African leaders have told me that they also see this current crisis as an opportunity to leave behind the era of aid dependency and transition towards sustainable self-reliance. I’m very happy to hear this, and I hope this will be a consensus in our continent.
WHO is supporting countries to make that transition, by identifying tools to improve efficiency and generate new revenue for health.
For example, by introducing or increasing taxes on tobacco and alcohol, through pooled procurement, public health insurance, and by using health technology assessments to ensure they get the biggest health benefit for the money.
But the transition to self-reliance is about more than health.
It’s about every area of development. It’s about creating a level-playing field so Africa can compete fairly with the rest of the world.
There are technical solutions that we need to put in place, including collective bargaining, strengthening the continental free-trade area and increasing intra-Africa trade, improved tax collection, and investments in job creation and manufacturing.
Many speakers before me have said this, and we all are thinking the same way, because the solutions are the same, and known.
We also need to fight corruption and illicit trade, which costs this continent more than we receive from official development assistance and direct foreign investment. If you stop illicit financing, then that would be enough for both investment and development.
But primarily, we need a change of mindset. Some people may not like to hear it, but it’s true.
We cannot look to others to solve our problems for us. As Africans, the responsibility lies with us to make the transition to a self-reliant future. The mindset of aid dependency has to stop.
The difference between crisis and opportunity is leadership, from all of us.
First, now is the time for leadership from governments, to shake off the yoke of aid dependency and chart the path to self-reliance.
Second, we need leadership from lenders, in the form of concessional lending, at fair terms.
When African countries pay more to borrow than high income countries, there is something wrong with the system.
And third, we need leadership from generous donors, not to pay salaries and operating costs for health programmes, but to build capacity so we can run them ourselves.
We don’t need support for pet projects cherry-picked by donors, but for national systems, national budgets and national priorities, in alignment with the Lusaka Agenda and the principles of “one plan, one budget, one report”.
WHO stands ready to support all countries, and to work with all partners to turn this crisis into an opportunity.
The choices we make now will shape the future of global health financing. We must get it right.
Because ultimately, health is not a cost to be contained. It is an investment to be nurtured – an investment in people, stability and economic growth.
But there is one thing that is even more fundamental to Africa’s future than health – and I join my brother Mo – that one thing is peace. The best medicine is peace.
Without peace, nothing else will make a difference.
In so many parts of our continent, the biggest barrier to development is conflict.
Perhaps none is so destructive – or so forgotten by the world – as the ongoing civil war in Sudan.
I visited Sudan in September last year, where I saw the effects of the war and met people who are paying the price.
The following week I was in Chad, where I travelled to the border town of Adré and met some of the 900,000 Sudanese refugees who have fled, seeking security and food.
I met mothers clutching their children, who had walked for days to reach the border – they were hungry, tired, alone, afraid. They told us horror stories. Their houses were burned, their crops were destroyed, their cattle were stolen. They left their places empty.
And where war goes, disease follows close behind.
We are now seeing outbreaks of measles, malaria, dengue, diphtheria and polio – all this in Sudan.
We are responding to an especially bad outbreak of cholera, with very high case fatality rates, affecting every region. Thousands are dying.
WHO started vaccinating last week, but without access, we can’t reach those at risk.
We need a ceasefire to allow our teams to reach the areas they need to reach with vaccines to save lives.
Peace is the prerequisite for health.
Peace is the prerequisite for development.
Peace is the best medicine.
And peace is the prerequisite for the Africa we all want: a healthier, safer, fairer Africa.
Thank you so much.