In the face of a financial crisis and converging health challenges, the Lusaka meeting is an opportunity for WHO AFRO  and Health Ministers to show they can look beyond technical resolutions to address systemic issues 

The seventy-fifth session of the World Health Organization’s (WHO) regional committee for Africa (RC75) will open in Lusaka on Monday (25 August) against a backdrop of transition at both regional and global levels.

 Professor Mohamed Janabi, the new Regional Director for Africa, takes office at a time of mounting expectations. His leadership begins as Dr Tedros Ghebreyesus prepares to conclude his term as WHO Director-General in Geneva, amid debates about how the organisation should adapt to fractured geopolitics, constrained multilateralism and shrinking aid. 

Across the system, WHO is under pressure to prove its relevance, demonstrate accountability, and deliver impact in an era of fiscal austerity. Nowhere are these challenges sharper than in Africa.

African health systems are under extraordinary strain. External assistance for health has fallen steeply in the past three years, while debt servicing has become one of the largest line items in national budgets, often exceeding health allocations. 

In 2025, African governments are projected to spend more than $80 billion on debt servicing, while only a fraction of that goes to health. 

Only a few countries, such as Rwanda, Botswana and Cabo Verde, meet the Abuja Commitment to allocate 15% of national budgets to health. Most fall far below, leaving systems exposed at a time when the frequency and severity of public health emergencies are rising. 

Outbreaks of cholera, Ebola, mpox and others have increased by more than 40% since 2022, often intensified by climate-related disasters.

This fiscal squeeze coincides with a dangerous set of global pressures. Donor retrenchment is evident as major development partners cut or redirect their health aid. 

Climate change is driving extreme weather events that destroy infrastructure, displace populations and worsen food insecurity, with inevitable consequences for disease outbreaks. 

Non-communicable diseases (NCDs), which already account for more than a third of deaths in sub-Saharan Africa, are on track to become the leading cause of mortality by 2030. 

Health workforce migration continues to undermine national capacity as doctors and nurses leave for better opportunities abroad, while local supply chains and manufacturing remain weak and dependent on imports. Underpinning all of this is the persistent lack of reliable, interoperable data systems that can guide effective decision-making.

New global health order

These challenges are not new, and African leaders have already articulated responses. The New Public Health Order championed by Africa CDC calls for strong national public health institutions, expanded workforce capacity, local manufacturing and resilient financing. 

The Lusaka Agenda calls for five strategic shifts for global health initiatives (GHIs) to more effectively and efficiently complement domestic financing to maximize health impacts in support of country-led priorities and trajectories to universal health coverage (UHC). 

Most recently the Accra Initiative calls for a reimagined global health order rooted in sovereignty, equity, and diversified financing. The initiative emphasises that health must be treated not only as a social good but as a driver of productivity and innovation, central to Africa’s industrialisation, trade integration, and geo-economic ambitions. 

These frameworks, along with Agenda 2063, provide a coherent vision of where Africa wants to go. The question is whether the annual assembly of health ministers in Lusaka will align its agenda with this broader context.

Narrow technical agenda 

The RC75 agenda includes a strong set of technical items. Ministers will discuss strategies on rehabilitation, oral health, safe blood supply, primary health care, malaria and health emergencies. 

They will review progress on the Regional Health Data Hub, which aims to integrate and standardise health information across countries. These are important initiatives and deserve attention. Data systems are a long-neglected foundation of service delivery, and rehabilitation services remain inaccessible to most Africans who need them.

Yet the agenda is narrow when set against the breadth of today’s global headwinds. Debt distress and fiscal stress are barely acknowledged, even though they are the defining constraint on health investment across the continent. 

The committee cannot be expected to solve a sovereign debt crisis, and WHO itself has limited tools given its dependence on earmarked donor funding, but it can and should create a forum for member states to confront the reality that health financing is collapsing. Without such recognition, resolutions risk being aspirational rather than executable.

Frank conversation is needed

The retreat of donors and shifts in ODA are also absent from the discussions. This is striking given that WHO itself is deeply affected by these trends, with its programmes increasingly constrained by the volatility and conditionality of partner financing. 

A frank conversation is needed about how to sustain essential services when aid cannot be relied upon. Similarly, the climate crisis is scarcely visible on the agenda despite its obvious health consequences. 

NCDs and workforce migration are also marginal, even though they represent some of the most urgent pressures on African health systems. Local manufacturing and resilient supply chains are mentioned only obliquely through discussions on procurement, without the explicit focus that the New Public Health Order and the Accra Initiative demand.

This is not to diminish the technical items before the committee. Oral health, blood safety and rehabilitation are all areas where neglected needs can be addressed. But the balance feels misaligned when the existential pressures of financing, climate and workforce are sidelined. It is here that WHO AFRO and its member states must recalibrate. 

Even if the secretariat lacks the fiscal or geopolitical leverage to fix the debt crisis or reverse donor cuts, it can help countries navigate these realities more deliberately. It can frame health as integral to debt sustainability, elevate NCDs and workforce retention as cross-cutting threats, and ensure that every resolution is grounded in the current economic and political context.

Converging crises

For member states, the responsibility is even greater. Governments must take concrete steps to mobilise domestic resources, embed climate resilience and NCD prevention in their primary care strategies, and invest in policies that retain health workers at home. 

They need to move beyond pilot projects and declarations towards serious investment in local manufacturing and supply chain resilience. They must also treat interoperable digital systems not as an optional extra but as a core part of health infrastructure.

The Lusaka meeting is an opportunity for WHO AFRO and its ministers to demonstrate that they can look beyond technical resolutions to the systemic issues that determine whether those resolutions can be implemented. 

Success will not be measured by the number of documents adopted but by whether those documents acknowledge the realities of fiscal constraint, climate disruption, donor volatility and workforce attrition. 

If RC75 helps countries confront these constraints honestly and points them towards pragmatic choices that protect primary health care, strengthen data, and invest in resilience, then it will have done its job. If not, it risks becoming another well-intentioned meeting disconnected from the urgent pressures facing African health systems.

At this moment of converging crises, the need is clear. Health must be recognised in debt frameworks, climate and NCD resilience must be elevated in primary care, and digital systems and local procurement must be treated as core investments. RC75 should serve as a pivot towards that reality. Africa’s health future depends on it.

 Dr Ebere Okereke is a global health expert and Chief Program Officer at Reaching the Last Mile.

Image Credits: @daniels_ugochi.