Ibraheem Bukunle Sanusi ¹

A pivotal meeting recently took place at the Africa CDC headquarters in Addis Ababa, Ethiopia. Her Excellency Ambassador Amma Twum-Amoah, the new African Union (AU) Commissioner for Health, Humanitarian Affairs and Social Development, held fruitful discussions with Africa CDC Director General H.E. Dr. Jean Kaseya. Their deliberations, focused on pressing health and humanitarian issues confronting the continent, culminated in a significant agreement: the establishment of a joint coordination team. This team, comprising experts from the AU Commission and Africa CDC, along with representatives from the Africa Medicines Agency (AMA), AUDA-NEPAD, Africa Humanitarian Agency (AfHA), and AfCFTA, is mandated to ensure policy coherence, enhance productivity and efficiency, and forge common positions in implementing health policies across Africa.

This initiative is a welcome and crucial step. It signals a deeper commitment to coordination and collaboration among Africa’s continental health, development, and integration institutions. This article argues that this agreement should be a powerful impetus to explore and ultimately establish a comprehensive African Health Architecture.

A Global Turning Point in Health Governance

We stand at an inflexion point in global health governance. The global health landscape is shifting amid ideological realignments and financial strains occasioned by geopolitical rifts. Official Development Assistance (ODA) for health in Africa has plummeted by 70% from 2021 to 2025, as donor countries redirect funds toward domestic priorities and even military spending in the wake of geopolitical crises. After a peak during COVID-19, global aid fell 7.1% in 2024, the first drop in years, with the U.S. slashing USAID programs by over 50% and others like the UK and Netherlands following suit. The decline “stems largely from shifting global economic conditions, evolving political priorities, and rising geopolitical tensions”. In short, the era of abundant donor support is waning.

As noted in the article Global Health and the “Second Independence of Africa”, global power dynamics around health are changing. During the COVID-19 pandemic, wealthy nations competed aggressively for vaccines and supplies, eroding faith in multilateral mechanisms. Health has emerged as a battleground in today’s geopolitical struggle, reminiscent of past contests for influence in Africa. As powerful countries pursue their own interests, Africa’s health needs too often take a backseat, leading to fragmented responses and a troubling lack of international cooperation during crises. The inequitable vaccine access in the pandemic and the exclusion of Africa CDC from the initial governance of the World Bank’s Pandemic Fund are stark reminders of Africa’s marginalisation. All of these points point to a simple truth: now is a critical moment for Africa to step forward with a cohesive vision and assert its health priorities on the global stage. African leadership and domestic commitment to health have never been more needed. As one expert noted, ultimate responsibility for Africa’s health security rests with African governments investing in health and citizens holding them accountable. The African Union (AU) must seize this moment to unite its institutions, voices and resources for health.

Pressure on Africa’s Health Systems and the Cost of Fragmentation

The changing global health governance dynamics have put Africa’s health systems under immense pressure. As clearly articulated in the “Africa’s Health Financing in a New Era” concept note, the financing crisis alone is staggering, with ODA collapsing, vital programs for pandemic preparedness, maternal health, and disease control at risk. This comes as Africa faces a surge in public health threats: outbreaks on the continent jumped 41% from 2022 to 2024, including Ebola, cholera, Marburg and more, all colliding with climate disasters and conflicts. Yet more than 20 years after pledging to spend 15% of budgets on health (the Abuja Declaration), only 3 African countries meet that target, while most languish below even 10%. The result is chronically fragile health systems now strained to the breaking point.

Current global health governance has often failed to alleviate these strains and, in some cases, exacerbated them. Donor-driven initiatives have saved lives but have also fostered dependency and duplication. When donors abruptly cut funds, decades of health gains can unravel. For example, SpeakUp Africa argued that neglected tropical diseases (NTDs), which afflict over 580 million Africans, saw major progress through partnerships, yet sudden bilateral funding cuts recently exposed the fragility of those gains. African countries were left scrambling for emergency funds to fill the gap, an alarming situation that underlines the risk of relying solely on external charity. As one advocate put it, African nations must not remain in “a position of vulnerability” dependent on donors’ whims. In the realm of non-communicable diseases (NCDs), the story is similar. Chronic conditions like heart disease, diabetes and cancer now account for 37% of all deaths in sub-Saharan Africa (up from 24% in 2000), a “hidden epidemic” that threatens to overwhelm health services. Yet global health financing has historically prioritised infectious diseases, meaning efforts to combat NCDs remain fragmented and under-resourced. Without a unified strategy, African institutions struggle to address cross-cutting issues like NCD prevention, mental health, and lifestyle diseases that don’t fit neatly under any single donor-funded program.

Compounding these challenges is the fragmentation among AU’s own health institutions. The African Union has no shortage of organs and agencies devoted to health or have health as part of their mandates: the AUC Department of Health, Humanitarian Affairs and Social Development (AUC-HHS) sets policies; the Africa Centres for Disease Control and Prevention (Africa CDC) leads on epidemics and broader health topics; the new African Medicines Agency (AMA) will regulate drugs and vaccines; AUDA-NEPAD drives developmental projects and agenda; the AU’s IBAR and PANVAC focus on animal health and vaccines (crucial for zoonoses and food security); and more. Each plays a vital role, but too often they operate in silos or with overlapping mandates. Coordination is ad hoc at best, and critical issues risk falling through the cracks. For instance, Africa CDC has launched initiatives for local vaccine production (like the Partnerships for African Vaccine Manufacturing, now called Platform for Harmonised African Health Manufacturing – PHAHM) while the AMA is tasked with harmonising regulatory standards. Yet without structured collaboration, these efforts may stall. Likewise, “One Health” threats, diseases that leap from animals to humans, cannot be tackled by the Africa CDC or AU-IBAR alone. Recognising this, the AU in 2022 had established an Interagency One Health Coordination Group bringing together Africa CDC, AU-IBAR, the AUC, and others to jointly address zoonotic disease control. This was a positive step, but it underscores the point: when institutions are fragmented, Africa’s response to health challenges is fragmented. In areas from boosting pharmaceutical manufacturing to combating NCDs and NTDs, Africa’s myriad health actors need to move in unison, or risk working at cross purposes.

An AU Health Architecture: A Vision for Coordination and Cooperation

Central to addressing fragmentation is to foster cooperation. There is a need for continental health institutions and related organs with key health-related mandates to work more coherently under an African Union Health Architecture. This would not be a new brick-and-mortar institution, but rather a platform and framework that ties together all AU health-related bodies under a common vision for health security and development. In essence, it would serve as a continental coordination mechanism, similar to the successful African Peace and Security Architecture (APSA) in the security realm or the African Governance Architecture (AGA) in the governance realm. The AGA, for example, functions as a dialogue and coordination framework among various AU-recognised institutions working on governance. We can do the same for health: create a structured forum for the AUC-HHS, Africa CDC, AMA, AUDA-NEPAD, IBAR, PANVAC, and others to share information, align strategies, and speak with one voice.

What would an AU Health Architecture actually do? First, it would institutionalise regular information sharing among these bodies. An architecture’s platform (perhaps an “AU Health Platform”) could convene quarterly coordination meetings, similar to the Senior Officials Meeting under APSA, joint task forces on specific issues, and a unified data hub. Imagine the Africa CDC and AMA jointly monitoring the rollout of a new vaccine with surveillance data feeding directly into regulatory decisions, and AUDA-NEPAD and AfCFTA representatives planning how to scale up manufacturing and distribution. Such synergy is only possible with a formal mechanism for cross-agency communication.

Second, a health architecture would enable joint advocacy and policymaking. Too often, Africa’s health priorities are fragmented when presented on the global stage. A unified AU Health Architecture can coordinate a continental voice in global health forums. Instead of Africa CDC, health ministers, and other agencies each making separate appeals, the AU can assert a single, loud position on issues like pandemic preparedness, financing, or intellectual property for medicines. We saw the power of unity during the TRIPS waiver negotiations at the WTO, with African states that spoke together on vaccine patent waivers having far greater influence. An AU Health Architecture can make this the norm, preparing common African positions for the World Health Assembly, G20 health discussions, and beyond. As African leaders have emphasised in the New Public Health Order (NPHO) initiative, Africa must secure “equitable and fair representation” in global health decision-making. Speaking as one through a coordinated platform is the best way to ensure Africa’s voice is heard and its interests defended. This is also a key pillar of the AU reforms agenda.

Third, an AU Health Architecture will directly address fragmentation on health priorities. It can set overarching continental targets, for example, reducing NCD mortality or eliminating specific NTDs and align the efforts of various organs behind those goals. This means less duplication and more coherence: one AU health agenda that leverages the strengths of each institution. The AU already has high-level strategies (the Africa Health Strategy 2016–2030, the Catalytic Framework to end AIDS, TB and Malaria, etc.), but implementation often falters without coordination. The architecture could establish thematic working groups (on NCDs, NTDs, maternal health, etc.), drawing experts from all relevant agencies. This platform would also help bridge human and animal health agencies in a One Health approach, ensuring that human health, veterinary services, and environmental experts jointly tackle issues like antimicrobial resistance or zoonotic outbreaks. Already, there is a proof of concept: with the AU’s One Health interagency group (co-hosted by Africa CDC and IBAR), which recently launched the One Health strategy for zoonotic diseases. An AU Health Architecture would take such collaboration continent-wide, so that whether it’s Ebola or Ebola in animals (like swine fever), the response is synchronised across sectors.

Finally, the architecture will serve as a platform for coordinating health product manufacturing with regulatory and trade considerations. Africa is making bold moves to produce its own vaccines, medicines, and diagnostics, a crucial step toward health security and self-reliance. But success requires aligning multiple pieces: manufacturers need a favourable trade environment and swift regulatory approvals, and countries need assurances of quality and market access. The African Medicines Agency and the AfCFTA cannot work in isolation; they must work hand-in-hand. Under the AfCFTA agreement, fragmented regulatory systems will be harmonised, and intra-African trade in pharmaceuticals is set to grow. The member states are already leading in this regard with the recently established MoU on Regulatory Reliance Mechanism, agreed to by the eight Maturity Level 3 (ML3) regulatory agencies in Africa. At the continental level, a health architecture would operationalise this by linking AMA’s regulatory harmonisation with the AfCFTA Secretariat’s trade facilitation, guided by input from Africa CDC on public health needs. In practical terms, this could mean creating an African Medicines & Vaccines Forum under the architecture, where AMA, Africa CDC, AUDA-NEPAD (which also has pharmaceutical manufacturing under its mandate), and AfCFTA representatives jointly plan how to boost local production and remove trade barriers. The benefits would be immense: with 61% of Africa’s pharmaceutical needs currently imported and only 3% of medicines traded within Africa, a coordinated approach can change that equation. During a high-level AU side event at the UN, leaders from Africa CDC, AUDA-NEPAD, and AfCFTA together underscored the need to invest in research, strengthen regulatory bodies, and enhance local production for health security. The AU Health Architecture provides the home for turning those commitments into action, aligning investments, regulations, and industrial strategy so that African-produced health products can travel seamlessly across African borders.

Amplifying Africa’s Voice and Sustaining Political Commitment

A consolidated AU Health Architecture would not only streamline internal coordination, but it would amplify Africa’s external voice and help sustain high-level political commitment to health. One of the great lessons of recent years is that Africa can no longer afford to be a passive recipient in global health. Our continent must set its own agenda. With a unified health architecture, the AU can articulate a bold, cohesive vision for health and back it up with collective weight. Consider Agenda 2063, the continent’s development blueprint. Its first aspiration envisions “a high standard of living, quality of life and well-being for all citizens,” including “healthy and well-nourished citizens”. Health is central to Africa’s long-term prosperity. By creating a central health coordination platform, the AU would demonstrate to citizens and the world that it is serious about achieving those goals. A health architecture can regularly track progress toward health targets in Agenda 2063 and the Sustainable Development Goals, holding leaders accountable if commitments waver.

Importantly, an AU Health Architecture would help keep health security at the top of the political agenda even when there isn’t a scary epidemic making headlines. It can do so by instituting accountability mechanisms, for instance, annual “State of Africa’s Health” reports delivered to the AU Assembly, or a scorecard on each country’s fulfilment of pledges (like domestic health financing or immunisation coverage). Just as the AU’s Peace and Security Council meets routinely to address conflicts, a standing health coordination platform would ensure that health doesn’t slip into neglect between crises. This sustained focus is critical to, for example, finally realising the Abuja promise of 15% budget allocation to health. Peer pressure is a powerful tool: if finance and health ministers know that their performance will be reviewed in a continental forum, they have greater incentive to prioritise health in national budgets. An architecture could also facilitate joint resource mobilisation, presenting a united front to development partners for funding strategic priorities, rather than fragmenting donor engagement across many small initiatives. Development partners have long urged “country ownership”; through a health architecture, African nations collectively can take ownership, setting priorities and asking partners to align behind Africa’s plan and priorities, not the other way around.

Crucially, the architecture would bolster Africa’s position in global health governance. When negotiating the new Pandemic Accord or reforming the International Health Regulations, an organised African bloc can shape the outcome, for instance, pressing for equitable benefit-sharing of vaccines and data. African nations want and deserve a seat at the table in shaping global health initiatives. By coordinating continentally, Africa can approach these negotiations not as 55 separate voices but as one powerful voice representing 1.3 billion people. We have already seen the beginnings of this: the Lusaka Agenda (adopted in December 2023 by African and global health stakeholders) called out imbalances in global health and stressed alignment with national plans. An AU Health Architecture would embody that principle of alignment and give Africa the platform to assert its rights in global forums, whether it’s advocating for pandemic financing mechanisms that include African institutions, or championing issues often neglected globally (like NTDs or climate-health links).

Finally, the benefits extend to Africa’s broader integration projects like the AfCFTA and the free movement of people agenda. As the continent breaks down borders for trade and travel, public health cooperation must tighten. With freer movement of persons and goods, these initiatives will certainly impact public health across the continent, as Africa CDC itself noted. A health architecture can work closely with those implementing the Free Movement Protocol to harmonise health regulations, for example, standardising vaccination certificates or collaborating on cross-border disease surveillance so that viruses do not hitchhike along with increased human mobility. It can also inform the AfCFTA on health-related trade measures (ensuring, say, that essential medicines and health equipment enjoy low tariffs and smooth customs procedures across Africa). In doing so, the architecture would help unlock the synergies between economic integration and health security, a link that requires increasing emphasis. Healthy populations are more mobile and economically productive; conversely, integrated markets can support stronger health systems (through pooled procurement, larger markets for local manufacturers, and so on). By embedding health in Africa’s grand integration schemes, the AU Health Architecture would contribute to the vision of Agenda 2063’s “Africa We Want” – an Africa of free movement, one voice, and self-reliant, robust health systems supporting our development.

Learning from the African Governance Architecture: Feasibility and Accountability

Skeptics might ask: will creating an AU Health Architecture add another layer of complexity to an already crowded AU institutional landscape? It’s a valid concern, Africa’s health ecosystem is vast, and coordination is never easy. However, the solution to complexity is not to shy away from it, but to manage it through smart design. Here, the AU can draw inspiration from its own experience. In 2011, faced with numerous bodies dealing with democracy and human rights, the AU established the African Governance Architecture (AGA) as a coordination mechanism for dialogue among stakeholders. This platform did not replace or duplicate the mandates of those bodies; instead, it provided a structured forum for them to collaborate, align their activities, and monitor progress on shared goals. The AGA (and its associated African Governance Platform) clarified roles and created a one-stop framework for governance issues. Crucially, it also introduced accountability mechanisms, for example, an annual, now biennial, high-level dialogue and routine reviews of how AU members uphold governance commitments. The result has been greater coherence in AU actions on governance and human rights, even if challenges remain.

The proposed AU Health Architecture can emulate this model. Defined roles and responsibilities would be a cornerstone: each organ’s comparative advantage should be codified (e.g., Africa CDC as lead on health emergencies and surveillance, AMA as lead on regulatory harmonisation, HHS Department on policy development and health diplomacy, AUDA-NEPAD on program implementation and resource mobilisation, IBAR on animal health, etc.), so that they complement rather than compete with each other. A coordination platform, perhaps the “AU Health Platform”, would meet regularly (as an example, heads of these agencies could convene once or twice a year on the margins of the AU Summits, with working-level coordination more frequently) to ensure everyone is steering toward common objectives. This platform could also include regional representation (from the RECs or Regional Health Organisations) to connect the continental strategy with regional and national implementation. By formalising these interactions, the architecture would move us from the current patchwork of informal cooperation to a predictable, structured collaboration.

Accountability must be the other pillar. Here, lessons from both AGA and the African Peace and Security Architecture (APSA) are instructive. APSA, through the Peace and Security Council and its early warning system, set up clear procedures for conflict prevention and response. A health architecture could strengthen the existing Specialised Technical Committee on Health in this regard. The STC would track countries’ compliance with agreed health commitments (for instance, reporting on how many have met the Abuja 15% target or how preparedness scores are improving). It could also provide a mechanism to rapidly escalate health concerns, such as an emerging pandemic threat, to the highest political level, ensuring AU heads of state take swift, coordinated action. Far from adding bureaucracy, such structures streamline decision-making by cutting through institutional silos. They make the sum greater than the parts.

It’s also worth noting that creating an AU Health Architecture does not necessarily mean setting up a large new institution with heavy costs. Much can be achieved with political will, a clear mandate from the AU Assembly, and a small coordinating secretariat (potentially housed within the AUC or Africa CDC). In fact, the AU Assembly could simply repurpose an existing mechanism, for example, expanding the mandate of the Specialised Technical Committee on Health to function as the political oversight of the Health Architecture, supported by a technical secretariat that coordinates across agencies. The key is to embed the architecture in the AU’s structures so it has teeth: decision-making authority, reporting lines, and the blessing of heads of state. Once that is in place, the various health agencies will naturally orient their work to align with the collective framework. Yes, there will be growing pains such as turf wars and resource questions, but these can be managed by clearly demonstrating that everyone stands to gain. Each institution will be more effective in its mandate when supported by others: Africa CDC gains a broader reach through community networks; AMA gains political backing to enforce standards; AUDA-NEPAD gains technical input for its projects; member states get one coherent guidance instead of multiple voices.

From personal experience, the African Governance Architecture took time to mature, but it showed that complex challenges demand coordinated solutions. Health is no different. By learning from AGA’s experience, setting a unifying vision, creating dialogue platforms, and instituting peer accountability, the AU Health Architecture can be both feasible and transformational. As the saying goes, if you want to go fast, go alone; if you want to go far, go together. Africa cannot afford isolated, short-term fixes for its health challenges. We need to go far and fast together.

Seizing the Moment for Africa’s Health Security

In conclusion, there is no better time to establish an African Union Health Architecture. We are at a pivotal juncture with traditional pillars of global health support wavering, even as the continent faces rising health demands from all sides. Yet within this challenge lies an opportunity to reimagine Africa’s health governance on its own terms. By strengthening coordination and cooperation among our health institutions, we strengthen Africa’s ability to withstand shocks, whether from pandemics or funding cuts. By speaking with one voice, we ensure African priorities like local manufacturing, NCDs, NTDs, and One Health are no longer neglected on the world stage. By aligning health with our broader agendas of economic integration and self-reliance, we move closer to the Africa envisaged in Agenda 2063: prosperous, united, and taking charge of its destiny.

Yes, building an AU Health Architecture will require leadership, political will, diligence, and perhaps a shift in mindset among our leaders and institutions. But the alternative is to continue muddling through fragmentation and that is a recipe for stagnation and vulnerability. Our continent has experienced enough of that already. The COVID-19 crisis has already sparked the vision of a New Public Health Order for Africa, emphasising better coordination, increased domestic financing, and expanded manufacturing. The proposed Health Architecture is the vehicle to drive that vision forward. It would hard-wire collaboration into the AU system and help sustain the momentum for health development long after the headlines fade.

African countries often say, “African solutions to African problems.” This is our chance to apply that credo to health. Let us not wait for the next pandemic or the next donor conference to get our act together. The AU, in partnership with development partners and global health actors, should move now to design and implement a unifying health architecture. It is an investment in our collective security and well-being that will pay dividends for generations. With unity of purpose and structure, Africa can turn this global inflexion point into a launch pad from a continent often spoken about in global health, to a continent that speaks for itself and leads. The health of 1.3 billion Africans, and indeed global health security, will be the better for it.

The content of this article does not represent the views of Amani Africa and reflect only the personal views of the authors who contribute to ‘Ideas Indaba’