DURBAN, South Africa — The “Durban Promise”, the ambitious outcome document of the Conference of Public Health In Africa 2025 (CPHIA) will be on the menu when world leaders meet to chew the fat at the Group of 20 (G20) summit in Johannesburg 22-23 November.

That was the message from the conference, which closed on 25 October, with a pledge from its convenors to keep pressing for universal health coverage (UHC) at the next G20 meeting, capitalising on South Africa’s presidency. 

Along with UHC, the CPHIA outcome document cites five key priorities as “pillars of Africa’s Health Sovereignty”. Those include: African manufacturing; innovative health financing; pandemic preparedness and response; and data ownership and governance.

“The Durban Promise and continental commitments is what we are taking out of this conference. From Durban, a unified message resounded across Africa: Health is not charity. It is sovereignty. It is our political choice, and our economic future,” declared Olive Shisana at Saturday’s conference closing ceremony. Shisana, the first director-general of South Africa’s Department of Health under Nelson Mandela, is now president and CEO of the private health research firm, Evidence-Based Solutions.

Shisana said the Durban Promise priorities aim to transform Africa from a “passive recipient” to a “strategic contributor” in the health arena. 

“This marks the birth of Africa’s health sovereignty movement, turning crisis into opportunity and aspiration into action,” said Shisana, who co-chaired the conference’s scientific programme committee and received at the weekend its Distinguished Scientist Award for her work helping to host the annual event since its 2021 inception.   

“It will manufacture vaccines, finance systems, strengthen its primary health care, prepare for pandemics, empower its people and own its data,” she told participants at Saturday’s closing session.  Co-sponsored by Africa Centres for Disease Control, the Government of South Africa, Gavi the Vaccine Alliance, and others, the conference attracted more than 1400 in-person and 16530 livestream participants, with more than 70 countries represented. 

Important financial juncture 

The conference comes at an important financial juncture as Shisana and others reminded participants.

Global health funding to Africa has nosedived, part of a 70% decline in international development assistance between 2021-2025, according to an Africa CDC brief released in April. 

The US shuttered USAID and with it, most of its global health aid programmes, earlier this year.  Major European donors such as Germany and the United Kingdom have also reduced contributions, shifting resources towards the Russia-Ukraine war. Meanwhile, African countries struggled to plug the funding gap, crippled by obligations to pay interest on mounting debt burdens. Official Development Assistance for health (ODA) is projected to continue to decline and could even fall to mid-2000s levels, said the OECD in June. 

What should be done about this precipitous funding drop was a recurring theme at plenaries, special sessions and panel discussions over the course of the five-day conference. 

Shisana, echoing many others, said “Africa must pack away its begging bowl” and find other means to foot its healthcare bills. 

A constant refrain was that when donors do contribute, they must work through the health ministries and treasuries of national governments; they must respect African sovereignty.

“Africa is no longer content to be just being on the side of the global response; we should now shape global health priorities. [The conference] should indeed affirm that our destiny must be African-led, African-financed and African owned,” asserted Joe Phaahla, South Africa’s deputy minister of health.

The hard part — where is the money to come from?

There was no let-up in that message throughout the event – “nothing about us without us”. 

But the hard part — where the money is to come from — and how to get more of it, did not yield easy formulas. 

Various strategies for tapping into the African diaspora were proposed. Collectively,  African nations can boast the third most populous diaspora after India and China. 

Other ideas revolved around the levying of new or better taxes on emerging or overlooked revenue sources. These include the growing informal economies in urban Africa and digital economies. 

‘Sin taxes’ got a look-in too, with some speakers advocating the ring-fencing of revenue from new levies on alcohol, tobacco and sugar so that these can fund health.

There also were discussions on how to grow African economies to expand the fiscal pie, so more funds would be available for competing domestic needs. 

While some speakers deferred to economists to spell out how this might best be achieved, it was agreed that Africa remained heavily dependent on extractive activities, notably mining, with too-little capacity to create value-added from its rich natural resources, robbing the continent of vast export revenue that ought to be funding health.

Shisana mentioned inter-Africa free trade, especially in health products and medicines, as an under-realized opportunity to spur growth and improve public health supply chains.

“If all of us in Africa were to trade across our borders,” economies across the board would be in much better shape, she declared. “We’ve got a big market of 1.4-billion people. There is no reason that Africa should be poor.” 

Less waste and corruption  

Along with the talk about eking out new income sources and tax revenues to underwrite health spending, there was perhaps even more talk on how money being spent could be used more efficiently or redirected. In other words, less waste and corruption.

At the closing,  Placide Mbala, CPHIA’s scientific programme co-chair, summarized takeaways from the event’s eight tracks — broadly themed areas of discussion.  His comments echoed the priorities cited by The Durban Promise, with some special twists.  

For one, he stressed the importance of putting the roles of Community Health Workers on a more formal footing, and involving them in planning, with dedicated budgets and frameworks that recognised them — as part of PHC reform.

Mbala said that the primary health discussions at the conference had also identified the importance of grounding “all interventions in local ownership”.

Solutions must be found that “require domestic investment, data-driven decision-making, and partnerships that position communities as co-designers and sustainers of their own healthcare systems, not passive recipients”, said Mbala.

“When communities lead, services become more equitable and scarce resources are used when they matter most, again reducing costs,” he concluded, quoting Paul Ngwakum, regional health adviser at UNICEF’s Eastern and Southern Africa regional office: 

Zambia’s Christine Kaseba also stressed that primary health care contained the key to unlocking many of the difficulties facing the public health sector in Africa, including its funding crisis.

“We are stuck because we are yet to understand that primary is fundamental to achieving universal healthcare,” said Kaseba, a specialist in gynecology and obstetrics as well as a prominent Zambian politician and the widow of the country’s late president Michael Sata.

Digital innovation and AI 

In terms of digital innovation and artificial intelligence – another Durban Promise priority,  the opportunities technologies may create to provide better services at less cost  loomed large. 

Everyone agreed that digital technology can  provide the solution to many logistical difficulties faced in hard-to-access rural areas, opening up  better, faster, and cheaper patient monitoring and disease surveillance.. 

But there was also a call for focus on health worker digital and AI literacy, with delegates cautioning that new tools need to be well embedded  into existing workflows, rather than assuming that technology alone would drive success.

In the same track, Caroline Mbindyo, chief executive of Amref Health Africa echoed another recurring conference theme:  healthcare as an investment rather than a cost.

“In Africa, we rarely view the health sector as a place for investment or innovation. We need to think differently about how we design digital tools, creating systems that not only improve health outcomes but also provide commercial value,”  Mbindyo said.

African manufacturing and youth engagement 

As for African manufacturing, panelists summing up the discussions on that topic on  closing day all agreed that more political will is needed to foster manufacturing capacity and to provide the necessary investments in skills, infrastructure and technology. 

And while calls for strengthening regulatory measures to safeguard patients and ensure confidence in African health products resonated, manufacturers also stressed that  regulatory bottlenecks were preventing drug makers from realising their potential.

“We can’t wait six years to bring a product to market. We need WHO and national regulators to align and fast-track African innovation,” said Stavros Nicolau, a senior executive at South Africa’s Aspen Pharma Group. 

And Serge Emaleu, a Gabon-based epidemiologist, reminded the audience that without local production Africa will continue to react to crises. 

“The boldest choice Africa can make is to exercise political courage, the political courage for taxing fairly, spending wisely and pooling regionally and collectively for the collective good,” said Emaleu, who is with the Economic Community of Central African States (ECCAS) .

Dr Jean Kaseya, director-general of Africa Centres for Disease Control and Prevention (Africa CDC), the conference’s principal host, highlighted the importance of youth engagement and mentioned the launch at the conference of the YES! Health Youth initiative, in collaboration with conference co-hosts, AfricaBio, a non-profit biotechnology stakeholders association.

The next Conference of Public Health In Africa conference is to be held in Addis Ababa, Ethiopia in November 2026, Kaseya said.

Image Credits: CPHIA 2025 , OECD, 2025 , World Bank, 2019, CPHIA, 2025, Africa CDC , @TuwilikaNafuka.