Delivering Results, Driving Reform, Securing Africa’s Health Future
Annual Report of the Regional Director — Overview
Foreword
WHO Regional Director for Africa © WHO
The year covered by this report — 1 July 2025 to 30 June 2026 – has been one of the most demanding in the recent history of our Region. It also marks the first full year of my mandate as Regional Director, during which the African Region began to chart a new course towards strengthened health sovereignty, enhanced emergency leadership and institutional reform. To us as a Region, health sovereignty means more robust national systems, greater regional manufacturing capacity, more resilient financing and African leadership in setting and implementing public health priorities.
During this period, the Region faced multiple converging health challenges rarely encountered simultaneously. These included the first-ever outbreak of Marburg virus disease in Ethiopia; the sixteenth Ebola virus disease outbreak in the Democratic Republic of the Congo; a multi-country Rift Valley fever event in Mauritania and Senegal. Alongside these diverse disease outbreaks, the Region maintained a response to sustained cholera, mpox and measles transmission.
The backcloth for all these pressures was the most significant financial reset of the World Health Organization in a generation. However, despite the ensuing unprecedented financial constraints, we protected core technical functions and maintained support to Member States while accelerating institutional reforms.
As this report goes to press, our Region is responding to its seventeenth outbreak of Ebola virus disease – caused by Bundibugyo virus – in Ituri Province, Democratic Republic of the Congo. I extend my deep appreciation to the health workers, communities and partners on the front line of that response, as well as to all those who led and supported outbreak responses across the continent throughout the year under review. The Region is indebted to your commitment and service.
The title of this report captures three core commitments that have guided our work over the past year. We delivered results: flagship outbreaks were brought under control within recommended timelines; tuberculosis deaths in the Region declined by 46% between 2015 and 2024; the African Small Island
Developing States Pooled Procurement Initiative received the 2025 United Nations SIDS Partnership Award in the Economic category; and Member States endorsed the Region’s first comprehensive Oral Health Framework. We drove reform: the Regional Office used the financial pressures of the year under review to accelerate, rather than defer, the modernization agenda. Progress was made in strengthening prioritization, accountability, transparency, data and digital systems, and support to country-offices. The longer-term work of securing Africa’s health future included advancing the Accra Reset and the Lusaka Agenda; supporting the implementation of the Pandemic Agreement and the 2024 amendments to the International Health Regulations, promoting the African Medicines Agency; developing the regional framework for local production; and deepening partnership with the African Union Commission and the Africa Centres for Disease Control and Prevention.
The year ahead will demand sustained effort and focus. We must bring the ongoing Ebola virus disease response in Ituri to a safe and complete close. We must consolidate the operating model established in the past 12 months and safeguard essential health services – including primary health care, immunization, noncommunicable diseases and emergency preparedness and response – from further erosion. At the same time, we must expand pooled procurement and local production beyond their current scope, and position the African Region coherently within the UN80 initiative and in the broader reform of the global health architecture. This will require alignment with the Fourteenth General Programme of Work and the African Union’s New Public Health Order. Lastly, we must maintain our focus on the communities we serve. Behind every number in this report are lives protected, families supported and communities made more resilient.
I thank our Member States, partners across the United Nations system and global health initiatives, civil society, communities and the staff of the Regional Office and our country offices for their commitment throughout this exceptional year. I pay tribute to the memory of Dr Faustine Ndugulile, whose untimely passing led to this office being placed in my care, and to Dr Chikwe Ihekweazu for his stewardship during the transition.
Africa is ready. WHO in the African Region is ready to play its part.
Acknowledgements (5)
The WHO Regional Office for Africa would like to thank Member States for their collaboration and for sharing data that made this report possible. The Regional Office also acknowledges the collective efforts of the teams involved in its preparation.
The WHO Regional Office for Africa would like to thank Member States for their collaboration and for sharing the data that made this report possible. The Regional Office also acknowledges the collective efforts of the teams involved in its preparation.
The lead writers were Bridget Farham and Nicola Richards of the Health Promotion, Disease Prevention and Control Cluster), with Stephan Ngami conducting a technical review. The writers worked closely with the technical programmes of the different clusters at the WHO Regional Office for Africa and with the various WHO country offices, which provided the background information for the report, along with feedback and revision during the drafting process. Technical review and feedback were provided by Dorothy Achu, Yahaya Ali Ahmed, Cedric Bayiha, Marie Roseline Belizaire, Dick Chamla, Mark Chimombe, Ogochukwu Chukwujekwu, Juliane Drews, Thomas Fedjo, Faiza Hassan, Akudo Ikpeazu, Elizabeth Juma, Akpaka Kalu, Francis Kasolo, Janet Kayita, Doris Kirigia, Andrea Luciani, Agnes Midi, Younghong Min, Etienne Minkoulou, Jeremiah Mushosho, Joseph Ngom, Kofi Nyarko, Adelheid Onyango, Laeticia Ouedraogo, Patrick Ramadan, Egide Rwamatwara, Daniel Walter and Ibiteye Mubaraka Yusuf.
The Regional Office also wishes to thank members of the Expert Review Group, who worked together in Kintélé, Republic of Congo, for the final review of the draft report. They are Abba Abakar, Victor Alegana, Magaran Bagayoko, Celestin Danwang, Thomas Fedjo, Akpaka Kalu, Humphrey Karamagi, Neema Kimambo, Lucien Manga, Franck Mboussou, Kizito Nsarhaza, Olu Oluseun and Vincent Sodjinou.
The regional Office also wishes to acknowledge the contribution of WHO leadership. The conceptualization, development and coordination of writing and production of the report was led by Benido Impouma, engaging the Disease Prevention and Control, Health Systems and Services, Emergency Preparedness and Response, General Management and Coordination clusters, together with other programmes. The Regional Office further acknowledges the Office of the Regional Director and the Director of Programme Management, in particular as regards the contributions of Diallo Abdourahmane, Owen Kaluwa, Yvonne Mburu and Aschalew Workineh.
Abbreviations (91)
Africa CDC Africa Centres for Disease Control and Prevention
AI artificial intelligence
AIDS acquired immunodeficiency syndrome
AMR antimicrobial resistance
ASCEND Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases
AU-IBAR African Union Inter-African Bureau for Animal Resources
AUDA-NEPAD African Union Development Agency–New Partnership for Africa’s Development
AVMA African Vaccine Manufacturing Accelerator
AVoHC-SURGE Africa Volunteers Health Corps – Strengthening and Utilizing Response Groups for Emergencies
BVD Bundibugyo (Ebola) virus disease
CARMMA (Plus) Campaign on Accelerated Reduction of Maternal Mortality in Africa
CCOM Core Country Office Model
CEMAC Central African Economic and Monetary Community
CFR case fatality ratio
COVID-19 Coronavirus disease 2019
DHIS2 District Health Information System 2
DMPA-SC depot medroxyprogesterone acetate – subcutaneous
DTP3 third dose of diphtheria-tetanus-pertussis vaccine
ECCAS Economic Community of Central African States
ECDC European Centre for Disease Prevention and Control
ECOWAS Economic Community of West African States
ECSA-HC East, Central and Southern Africa Health Community
EMRO WHO Regional Office for the Eastern Mediterranean
ENDISA Ending Disease in Africa
EVD Ebola virus disease
EWENE Every Woman, Every Newborn, Everywhere
FAO Food and Agriculture Organization of the United Nations
G7 Group of Seven
GER gender equality, health equity and human rights
GHO WHO Global Health Observatory
GLASS Global Antimicrobial Resistance and Use Surveillance System
GMC Global Management Centre (Pretoria hub)
GPW14 Fourteenth General Programme of Work
HEAT & HEAT Plus WHO’s Health Equity Assessment Toolkit(s)
HIV human immunodeficiency virus
HPV human papillomavirus
IGAD Intergovernmental Authority on Development
IHME Institute for Health Metrics and Evaluation
IHR International Health Regulations
IMST Incident Management Support Team
IPC
JEE Joint External Evaluation
MOPAN Multilateral Organisation Performance Assessment Network
NAPHS national action plans for health security
NCD(s) noncommunicable disease(s)
NTD(s) Neglected tropical disease(s)
OCHA United Nations Office for the Coordination of Humanitarian Affairs
OECD Organisation for Economic Co-operation and Development
PABS Pathogen Access and Benefit-Sharing (system)
PATH A global health nonprofit organization; “PATH” is its proper name and is no longer used as an acronym
PDX preparedness data exchange
PEN-Plus Programme extending the WHO Package of Essential Noncommunicable Disease Interventions to severe noncommunicable diseases at first-level referral facilities
PHC primary health care
PHEIC public health emergency of international concern
PRSEAH prevention of and response to sexual exploitation, abuse and harassment
RBM Partnership to End Malaria
RC76 Seventy-sixth session of the Regional Committee for Africa
REC regional economic community
RMNCAH reproductive, maternal, newborn, child and adolescent health
SADC Southern African Development Community
Integrated Food Security Phase Classification (as cited in a Chapter 1 reference; not to be confused with “infection prevention and control”, which is written in full throughout the report)
Formerly “Roll Back Malaria”; RBM is retained as part of the partnership’s current name
SAFER
SDGs Sustainable Development Goals (United Nations)
SIDS Small Island Developing States
SPAR State Party Self-Assessment Annual Reporting
STEPS surveys STEPwise approach to noncommunicable disease risk factor surveillance
TrACSS Tracking Antimicrobial Resistance Country Self-assessment Survey
UHC universal health coverage
UN United Nations
UN80 United Nations eightieth anniversary reform initiative
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNEP United Nations Environment Programme
UNFPA United Nations Population Fund
UNGA United Nations General Assembly
UNHCR United Nations High Commissioner for Refugees (the UN Refugee Agency)
UNICEF United Nations Children’s Fund
Unitaid Global health initiative that invests in innovative health products, hosted by WHO
USAID United States Agency for International Development
WAHO West African Health Organisation
WASH water, sanitation and hygiene
WCO WHO country office
WFP World Food Programme
WHA World Health Assembly
WHO World Health Organization
WHO PEN WHO Package of Essential Noncommunicable Disease Interventions
WMO World Meteorological Organization
WOAH World Organisation for Animal Health
WUENIC WHO/UNICEF Estimates of National Immunization Coverage
WHO initiative to reduce alcohol-related harm (five areas of action: Strengthen restrictions on alcohol availability; Advance and enforce drink-driving counter-measures; Facilitate access to screening, brief interventions and treatment; Enforce bans on comprehensive restrictions on alcohol advertising, sponsorship and promotion; Raise prices on alcohol through excise taxes and pricing policies)
Regional context
During the reporting year, health services across Africa were kept running despite the deepest cut to international health funding in a generation, while several disease outbreaks were fought at the same time. Results held up far better than the scale of the funding cut alone would predict: eight countries i reached a major disease-elimination milestone, 71% of outbreaks were detected within a week, and emergency responses left lasting infrastructure behind rather than disappearing once the crisis had passed. But the margin was thin, some results went backwards, and of the money pledged to close the remaining gaps, less than half had been supplied at the time of writing. What ministers and partners decide over the next year will determine whether this year’s progress holds or is lost.
A year of change and challenges
International funding for health declined by approximately 20% worldwide in a single year. The WHO African Region absorbed the largest share of that cut of any region, despite bearing the highest global burden of malaria and new HIV cases. These cuts affected a health workforce already operating at less than 50% of required capacity, and their impact was uneven. Countries already dealing with conflict or displacement and those dependent on external funding were the hardest hit. Within those countries, the burden fell disproportionately on the most vulnerable, with women and children accounting for an estimated 80% of the 12.7 million people displaced by conflict in the reporting year in West and Central Africa alone.
The funding cut also coincided with an exceptionally complex operating environment. The Region faced several concurrent disease outbreaks, including Ebola, Marburg, mpox and a record wave of cholera, alongside worsening floods and droughts; and record levels of food insecurity. It was also the first full year in office for the Region’s new Regional Director and of WHO’s current four-year global strategy.
i. Algeria, Burundi, Cabo Verde, Guinea, Kenya, Mauritius, Senegal, Seychelles
The role of WHO and partners
None of these results occurred in isolation. WHO set technical standards and guidance for disease programmes, supported countries to strengthen the detection and emergency-response systems that caught outbreaks faster, assisted in reforming how health financing is raised and managed, and represented the Region’s interests in global decision-making. To this end, WHO restructured itself first. The Regional Office reduced both costs and staffing by 23% during the year, from 2540 to 1948 personnel, and redeployed three quarters of its remaining staff to country offices closer to the ministries and communities it serves. That restructuring freed up more than US$ 8 million annually, now being redirected to country-level operations.
A broad range of partners contributed capabilities beyond those of WHO alone. The African Union and Africa CDC led continental strategy; Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank and other financing institutions supported immunization, HIV, tuberculosis and malaria programmes directly; and United Nations agencies supported the humanitarian response to displacement. Noncommunicable diseases, including mental health, was supported by the Wellcome Trust, and the Leona M. and Harry B. Helmsley Charitable Trust, along with the NCDI Poverty Network.
Additional resources were mobilized. A total of 22 of the Region’s 47 Member States pledged funding to WHO’s first-ever global fundraising round, and 48% of those pledges had been converted into contributions by the close of the period, up from 12% a year earlier. Voluntary contributions to the Region rose to US$ 769 million in 2024–2025, with a growing share now coming from private donors and foundations.
Continuing challenges
Four major problems remain unresolved. First, underfunding threatens core operations. Even after this year’s pledges, WHO’s basic running costs in the Region remain underfunded by US$ 662 million over the next two years. Patients still pay directly, out of pocket, for roughly 33% of all health spending in the Region – a level high enough to push families into poverty in 35 ii of 47 Member States.
Second, public health emergencies continue to escalate. The emergency threat has not passed. The particularly challenging Ebola outbreak described above was still spreading as this report was finalized, and cholera cases reached a regional record of more than 245 000 in 2025, driven primarily by unsafe water and sanitation.
Third, continuity of care remains a critical gap. Services that depend on repeated contact with the health system remain the weakest. Mental health support fell from an estimated 982 000 people reached in 2024 to a projected 207 000 in 2025. Only one country meets the recommended standard of antenatal care for pregnant women, and noncommunicable diseases, already accounting for 37% of all deaths, remain the most difficult health problem to monitor.
Fourth, data gaps obscure and health inequities. The Region still cannot reliably see who is being left behind. Fourty-four of 47 countries have limited data on the actual causes of death among their populations, making it difficult to target the allocation of funds.
ii. Algeria, Angola, Benin, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, Comoros, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Madagascar, Mali, Mauritania, Mauritius, Niger, Nigeria, Republic of the Congo, Senegal, Seychelles, Sierra Leone, South Sudan, Togo, Uganda and the United Republic of Tanzania
What needs to happen next
To close the funding gap, Member States must turn this year’s pledges into actual disbursements on a fixed timetable, bring the remaining countries that have not yet pledged into the fundraising round and set a clear national timetable in each country for reaching the Region’s long-standing target of spending at least 15% of the government budget on health.
To resolve the remaining emergencies, countries need to bring the active Ebola outbreaks in the Democratic Republic of the Congo and Uganda to a complete and safe close and translate the response into lasting local capacity. They must also invest specifically in clean water and sanitation to achieve cholera elimination.
To strengthen services that are falling behind, and to resolve surveillance gaps, countries should fully implement surveillance systems that detect preventable maternal and newborn deaths, protect funding lines so that this year’s elimination gains are not reversed, rebuild mental health support back to its previous levels, and ensure that every country reports basic health data disaggregated by sex and age within two years.
This calls for targeted action from each audience. Ministers should treat health as an investment, rather than a cost, by setting and funding national timetables towards the 15% target, protecting essential front-line programmes that made this year’s results possible from further reductions, and translating existing commitments on staffing and funding into filled posts and disbursed resources. Partners and donors must provide direct, predictable funding to national plans, rather than several separate projects; honour existing financial pledges, and invest in Africa’s pharmaceutical manufacturing capacity.
The WHO African Region has demonstrated what it can deliver, even in its hardest year. Sustaining this year’s progress now depends on adequate funding and honouring these commitments.
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