Dr Munya Saruchera, Director: the Africa Centre for Inclusive Health Management, Stellenboch University
Global Health Ecosystems: Africa’s Decolonial Opportunity Amid U.S. Withdrawal from the WHO In a move reflecting the Trump administration’s "America First" policy, the United States has formally withdrawn from the World Health Organization (WHO), ceasing its significant funding contributions and raising concerns about the efficacy of global health coordination.
While the ramifications of this decision are deeply concerning, particularly for vulnerable health systems in the Global South, this moment also presents an opportunity for Africa, and others, to reassert our leadership in health ecosystem management, firmly rooted in decolonial praxis.
Implications of U.S. Withdrawal for Global Health
The WHO has been a cornerstone of global health security and policy, driving equitable access and inclusion, progress in disease control, pandemic response, and the universal health coverage agenda. The U.S. withdrawal and its sudden cessation of nearly 18% of the WHO's annual budget destabilise these gains made and initiatives, risking disruptions to vital health services worldwide. Programmes combating malaria, tuberculosis, and HIV/AIDS, which disproportionately impact Africa, are particularly vulnerable and bound to regress.
Jennifer Nuzzo, Director of the Pandemic Center at Brown University School of Public Health, underscores the WHO’s irreplaceable role in inclusive global health governance that is levelling the playing field under difficult conditions as witnessed during the recent Covid-19 pandemic. The technical expertise, emergency response capabilities, and ability of WHO to align global health goals remain unmatched. However, the funding gap created by the U.S. withdrawal could stymie coordinated efforts to address health inequities, particularly in regions like Africa, where historical dependencies on external aid have framed the development discourse.
Decolonial Pathways: Africa’s Leadership in Health Management
Amid these challenges, Africa’s emerging decolonial epoch provides a framework for re-imagining health management and financing for the continent. Decolonial approaches reject the prescription of hegemonic and Western-centric solutions, emphasizing instead local agency, innovation, indigenous knowledge systems, and regionally defined priorities informed by local context and needs. The decolonial approach and accompanying principles align with the strategic vision of the Africa Centre for Inclusive Health Management at Stellenbosch University, which calls for an equitable, sustainable and inclusive health ecosystem for the continent that is driven by African leadership.
Africa has already demonstrated remarkable leadership in health systems management with the following examples:
* Rwanda’s Mutuelles de Santé that achieved over 90% health insurance coverage through a decentralized health system.
*South Africa’s HIV/AIDSanti-retroviral treatment led by the Treatment Action Campaign (TAC) and its Ritshidze initiative — the world’s largest community-led monitoring system, that remain the world’s largest and most successful response programmes.
*The African Union’s Africa CDC, which has spearheaded regional health responses, from coordinating Covid-19 campaigns to strengthening laboratory networks.
Climate Health: Navigating New Challenges
The U.S. withdrawal from the Paris Climate Agreement further complicates global health dynamics. Climate change exacerbates health issues, including the spread of vector-borne diseases and food insecurity. Africa, with its diverse climates and ecosystems, is particularly susceptible to these challenges.
Despite these setbacks, African nations are proactively addressing climate-related health impacts. For example, the Africa Centres for Disease Control and Prevention (Africa CDC) has developed robust frameworks to monitor and respond to climate-sensitive diseases. Additionally, countries like Ethiopia have implemented climate-resilient health strategies, integrating environmental considerations into public health planning.
Artificial Intelligence and E-Health Initiatives: A Digital Revolution
Artificial intelligence (AI) and the digital revolution present unprecedented opportunities for strengthening Africa’s health systems. AI and E-health initiatives, which leverage data, information and communication technologies (ICT) for health, are transforming healthcare delivery across the continent.
The WHO Regional Office for Africa emphasizes the use of AI and e-health in health governance, treatment of patients, conducting research, educating the health workforce, tracking diseases, and monitoring public health. For instance, eHealth Africa, a non-profit organization, has developed data-driven solutions to improve health outcomes in unserved and underserved communities. Their initiatives include digitizing health records, enhancing disease surveillance, and supporting vaccination programs.
Opportunities in Crisis: Building Resilient Health Futures
The withdrawal of the U.S. highlights the risks of over-reliance on external actors in global health. For Africa, this moment reinforces the need to further invest in and advance decolonial frameworks that prioritize sovereignty, self-reliance, and regional collaboration.
The Africa Centre for Inclusive Health Management envisions this as an opportunity to:
1. Strengthen regional health systems by investing in frameworks like the Africa Health Strategy 2016-2030 and Africa CDC.
2. Leverage indigenous knowledge by integrating traditional healing practices with modern medicine.
3. Promote South-South cooperation by equitably sharing inclusive innovations and resources with other Global South nations.
A Call to Action: Rethinking Global Health Governance
The Trump administration’s disengagement from the WHO underscores broader critiques of international health governance, including its failure to fully empower Global South actors. Africa’s decolonial moment offers an alternative vision - one that values inclusivity, equity, innovation and localized solutions over top-down aid models.
The Africa Centre for Inclusive Health Management calls for renewed global solidarity, one that acknowledges Africa not as a passive recipient of aid but as an active leader in shaping sustainable health futures. By embracing its decolonial path, Africa can navigate the challenges of today and illuminate a new paradigm for global health governance.
Email: msaruchera@sun.ac.za
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