Countries like the US and UK slashing global aid is “painful” for Africa, the head of the continent’s leading health agency says – but it also offers an “opportunity” for governments to drive down corruption and raise taxes to fund their own health systems.
Speaking to The Independent, Jean Kaseya, director general of Africa Centres for Disease Control and Prevention (CDC) which works across 55 countries, says the aid cuts are “not a blessing for us, but today it becomes an opportunity to see how to build a sovereign health system in Africa”.
Across this year, several countries have announced deep cuts to their overseas aid spending, often in a move to shift money to defence. While none has cut as deeply as the US, the UK government is near the top of the pack with planned cuts of 40 per cent over the next three years.
“It’s a painful experience to see that and it’s our choice to sit, to cry, or to wake up and to act, and I think now the action that African countries are taking is to wake up and to move on,” Dr Kaseya says of the sudden cuts, which have wrought serious damage.
The Africa CDC chief says there are untapped ways of African governments raising more money that don’t require overseas aid, for example tackling “corruption” in the way drugs and equipment are bought as well as the problem of “ghost workers”. This is a common payroll scam where salaries are paid out to workers who don’t exist, have died or are duplicates. The money generally ends up in the pockets of a smaller number of government workers.
“In some countries, it can be [up to] 40 per cent of civil servants being ghost workers,” Dr Kaseya says, which costs his home country the Democratic Republic of Congo (DRC) $800m a year.
The Africa CDC head recalls a conversation with one head of state who was in despair after cuts to the global vaccine alliance Gavi in his country. “His first reaction was, we’ll die here,” he says, but then Dr Kaseya asked him “how can we survive?” The country has since introduced a new system to collect taxes to fund the health sector.
But Dr Kaseya concedes aid was still necessary in some areas. “The first source of health expenditure in Africa is out-of-pocket,” he said, in other words, “poor people paying”. Specific aid programmes for example for HIV, tuberculosis (TB), malaria or maternal and child health had relieved people of that burden, but where they have stopped, “someone must pay,” he says.
“The government is not increasing the budget. It means it’s these same people who must increase their out-of-pocket [spending] to cover the services,” he adds.
Looking back on the past year, Dr Kaseya says responses to dangerous disease outbreaks had been compromised by aid cuts, including to Mpox in the DRC. When donors which had pledged money for vaccines, testing and health workers did not fulfil their commitments, he says, “when they stopped, we saw in DRC the testing rate moving from 60 per cent to less than 32 per cent”.
One route to help with this is building up the manufacturing of drugs and medical equipment on the continent, making African countries less reliant on donors.
There are already more than 500 medical manufacturers in Africa, including in South Africa, Egypt, Rwanda and Senegal, Dr Kaseya says, making him “mostly optimistic on the way things will move in Africa”. For example, the continent is moving towards becoming self-reliant when it comes to buying syringes, while in some countries 97 per cent of antibiotics are now bought locally.
“We need to see how to be more balanced and more positive and optimistic,” about the continent’s future, he adds – while focusing on raising domestic funding, building local manufacturing and being more proactive about pandemic preparedness.
“When we do that, we start a conversation with our brothers and sisters from around the world: ‘Do you still think that you have to dictate to us how we can sit and talk together?’
“This is the reform of the global health architecture we are talking about”.
This article has been produced as part of The Independent’s Rethinking Global Aid project
