Adapted from Dr. Ahmed Ogwell’s opening keynote at the 2nd Africa Primary Health Care Forum, held in Abuja, Nigeria, on July 30, 2026.
Across Africa, families are making impossible choices every day.
A mother in northern Nigeria delays taking her child to the clinic because the cost of transportation is more than she can afford. A father in rural Malawi ignores the symptoms of hypertension because missing a day’s wages could mean his family does not eat. A grandmother in Kenya walks for hours to collect medicines that should have been available in her own community.
These are not isolated stories. They represent the daily realities of millions of Africans.
They are failures of access—and they reinforce a conviction that must guide the next chapter of health system development across our continent: The future of Africa’s health will not be decided in specialized and referral hospitals. It will be decided in primary health care settings.
Primary health care is a development imperative
Africa’s population, cities, workforce and innovation ecosystem are changing rapidly. By 2050, one in every four people on Earth is projected to be African. Our cities will be among the fastest growing in the world, our workforce will be the youngest, and our innovation ecosystem will be among the most dynamic.
Yet our greatest demographic advantage could quickly become our greatest vulnerability if primary health care systems do not evolve at the same pace.
Primary health care is therefore no longer merely a health agenda. It sits at the core of Africa’s development agenda.
For decades, global health has largely organized itself around diseases. We have built programs for HIV, malaria, tuberculosis, Ebola, COVID-19 and, increasingly, noncommunicable diseases. These investments have saved millions of lives and deserve recognition.
But somewhere along the way, we became very good at fighting diseases while investing far less in building the systems capable of preventing them.
We built vertical excellence while horizontal resilience remained fragile.
Every major health emergency has reminded us of the same lesson. The COVID-19 pandemic did not create weak health systems; it exposed them. Ebola did not simply reveal gaps in surveillance; it revealed gaps in trust.
Climate change is teaching us the same lesson. Whether the challenge is flooding, food insecurity, malnutrition, an emerging pathogen or mental health, it eventually arrives at the same destination: primary health care.
This is where prevention begins. It is where communities first encounter the health system, where trust is built, and where resilience is strengthened or lost.
An opportunity to build around African priorities
Africa stands at a turning point in its public health history.
International health financing is changing. Development assistance is shrinking, and governments are facing growing fiscal pressures. We have spent considerable time discussing these developments as uncertainties, but they also present an opportunity.
Perhaps for the first time in decades, Africa has both the necessity and the freedom to redesign its health systems around African priorities rather than external funding cycles.
This is our opportunity to move:
- From projects to systems.
- From fragmentation to integration.
- From dependence to capability.
- From implementation to institution-building.
Resilience cannot be donated. It cannot be imported. It must be built—by us.
As we build that future, there are four Ffrontiers we must embrace:
1. Prevention must become our greatest investment
Health systems should not be judged only by how effectively they treat illness or by how many patients they process. Health systems—not disease systems—should be judged by how successfully they prevent illness.
Every child vaccinated, every pregnant woman receiving antenatal care, every family accessing good nutrition, every adolescent protected from preventable disease, every case of hypertension diagnosed early, and every community empowered with reliable health information represents progress toward a more resilient society.
These are not small victories. They are the foundation of resilient communities and prosperous nations. The strongest health system is not the one that treats the most patients. It is the one that produces the fewest preventable illnesses. Let us not only chase disease. Let us produce health.
2. Technology must strengthen people—not replace them
Data can revolutionize decision-making. Digital platforms can transform surveillance. Digitally enabled supply chains can improve the availability of health products, and artificial intelligence can support more informed, timely and responsive health care.
But technology alone cannot create trust.
Technology can process data, but it cannot comfort an anxious mother waiting for news about her sick child.
It can generate reminders, but it cannot build the trust that gives a parent confidence to vaccinate their child.
It can support clinical decisions, but it cannot replace the wisdom, compassion and lived experience of a community health worker who understands the people they serve.
Technology is therefore not the destination of primary health care. It is an enabler of a better and more efficient primary health care system.
The future we seek is not one in which health care is simply digital. It is one in which health care is digitally enabled, human-centered, community-driven and unwaveringly focused on equity.
Technology must make it easier for health workers to do their jobs. It must reduce rather than add to their workloads. It must help governments identify emerging needs, strengthen supply chains, anticipate outbreaks and direct limited resources where they will have the greatest impact.
Innovation matters, but only when it improves the experience and outcomes of the people the health system exists to serve.
3. Communities must become co-architects
One of the greatest mistakes we continue to make is designing health systems for communities rather than with them.
Too often, we organize health services into separate programs and expect communities to navigate that complexity. But communities do not experience health in silos.
A mother does not separate her child’s immunization from good nutrition. A family does not distinguish maternal health from the management of chronic disease, or mental health from infectious disease.
To the people we serve, health is one continuous experience. Our systems must be designed to reflect that reality.
At VillageReach, we have learned over more than 25 years that the most sustainable solutions are those shaped alongside the communities they are intended to serve.
When communities become co-designers rather than passive recipients, they develop a sense of ownership. Ownership builds trust. Trust encourages people to seek and use health services. And when people use those services consistently, we achieve what matters most: lasting impact.
Community engagement should not be treated as a final step in implementation or as a communications exercise after the important decisions have already been made. Communities should help define the problem, shape the solution, evaluate whether it is working and hold systems accountable for responding to their needs.
4. Sustainable financing must become political, not merely technical
We also need to change the way we think about financing primary health care.
Too often, discussions about health financing are confined to health professionals, economists, budget analysts and ministries of finance. But sustainable financing is not merely a technical exercise. It is ultimately a political choice.
It is the choice to invest in prevention before paying for a crisis. It is the choice to strengthen community health today rather than bear the far greater social and economic costs of illness tomorrow. Primary health care is not simply a recurring expense on a government balance sheet. It is one of the smartest investments a nation can make.
Every investment in strong primary health care yields returns:
- Healthier children who are better able to learn.
- Healthier adults who are more productive.
- Stronger communities that are more resilient to shocks.
- Economies that are better positioned for sustained growth.
Health is not in competition with economic development. It is one of its most powerful drivers.
Countries do not become prosperous and then invest in health. They invest in health and, in doing so, create the conditions for lasting prosperity.
Leadership must evolve alongside innovation
The final frontier—and perhaps the most important one—is leadership.
Technology will continue to evolve. Artificial intelligence will become more powerful. Medicines will become more effective, and diagnostics will become faster and more precise.
But these advances will not deliver their full promise unless our leadership evolves alongside them. The future of primary health care will ultimately be shaped not by the pace of technological innovation, but by the quality of the decisions we make.
It will require the courage to integrate where we have duplicated. To invest in resilient systems rather than short-term projects. To trust communities as co-creators and partners rather than treating them only as beneficiaries. And to make decisions that look beyond election cycles and deliver generational impact. It will also require the courage to recognize that no country can build resilient primary health care in isolation. Diseases do not stop at national borders.
Africa’s future will increasingly depend on our ability to work together through stronger regional cooperation: sharing surveillance systems, strengthening local manufacturing, exchanging knowledge and innovation, and holding one another accountable for the health of our people.
On an interconnected continent, resilience is not something we achieve alone. It is something we build together.
Building health systems worthy of the next generation
Imagine an Africa where every child begins life connected to a trusted primary health care system: where every community health worker has digital tools that improve—not complicate—their work; where no woman dies while giving birth simply because quality care was too far away; where nutrition, immunization, mental health, chronic disease management and emergency preparedness all function through one integrated system; where governments use real-time data to anticipate outbreaks rather than merely respond to them; where communities trust the health system because they helped build it; where primary health care becomes an engine of Africa’s prosperity.
This future is not a dream. The science exists. The technology exists. The evidence exists. The institutions exist. The talent exists. The partnerships exist.
The remaining question is whether our collective ambition is equal to the opportunity before us.
History will not remember us for the eloquence of our discussions. It will remember whether the decisions we made transformed the lives of ordinary Africans.
The next chapter of Africa’s health story will not begin in a laboratory, in a parliament nor in a boardroom. It will begin in primary health care.
Because when we build primary health care systems well, we do far more than improve health. We unlock Africa’s greatest asset: its people.