KITUU: Reimagining public health in a gendered and uncertain world

Across Africa, a silent crisis brews beneath the radar of global headlines. Health systems, already strained by climate-induced disasters, economic volatility, and fragmented governance, now face an additional threat: precipitous declines in global health funding.

According to The Lancet, recent cuts to Official Development Assistance (ODA) could contribute to over 14 million preventable deaths by 2030.

This isn’t merely a funding gap; it’s the symptom of a fractured model that treats global health as charity rather than collective security.

Even before recent funding cuts, Africa’s health systems faced intensifying pressure from a convergence of escalating outbreaks, chronic underinvestment, and fragmented governance.

Cholera, malaria, measles, and Ebola surge through communities where clinics lack essential staff, medicines, and equipment, not due to inherent vulnerability, but decades of strategic neglect.

Treating these crises as isolated "anomalies" ignores the undeniable pattern: outbreaks and preventable diseases proliferate where health infrastructure is starved of sustained investment, where skilled workers emigrate for opportunity, and where policies crafted far from frontline realities fail communities.

The result is preventable mortality that transcends any single disease: every two minutes, a child dies of malaria in Africa; and a mother dies globally. This is not misfortune; it is systemic failure.

We need to realise that the world is changing and global health interventions and funding supply need to change with it. Reimagine public health as strategy; a sovereign system that prioritises local leadership, resilience, justice and equity, rather than a stopgap measure that keeps us just healthy enough to avoid widespread disruptions to economies.

Resilient health systems are the bedrock of economic stability, social cohesion, and pandemic preparedness. At the centre of this strategy must be women. Women aren’t just "participants" in health delivery, they are its architects.

Women are the backbone of public health, making remarkable contributions as specialised clinicians, caregivers, technician, educators, and community health workers.

Given the central role they play, women must be at the helm of designing, delivering and leading a new era of people-centred public health approaches.

The prevailing health landscape calls for more than perfunctory representation in leadership; it demands meaningful and equitable participation of women in decision-making along with their man counterparts.

We already see glimpses of what that future could look like. Women across various disciplines and hierarchy in public health are taking up the mantle of leadership.

From Botswana’s Dr Matshidiso Moeti who made history as the first African woman to be elected as the World Health Organization’s Regional Director for Africa, to Theresa Kachindamoto, a traditional leader in Malawi who has led a nationally recognised campaign to end child marriage, improving reproductive health and educational outcomes for thousands of girls.

Their successes are not isolated; they are a model of inclusion and transformation we can,and should,scale. Expanding women’s leadership in health requires political and institutional will and a new way of thinking.

Building sovereign health systems demands concrete, collaborative action. First, governments should shift from project-based aid to pooled, long-term investments in primary healthcare. Mandate co-creation of policies with local health leaders (especially women) and track outcomes via localised data.

Embed and embrace intersectional leadership in health design. A gender-blind health system cannot serve a gendered world. The experiences of women, girls and other marginalised communities must shape how we design and deliver health systems to advance equity in practice, not just in policy.

Train leaders to address how gender, poverty, and geography compound vulnerability (e.g., ensuring rural clinics stock uterotonics and have ambulance access).

Secondly, global partners must fund African-led research, innovation and manufacturing, prioritising women’s health. While continuing to support regional initiatives to enable rapid and context-specific responses.

Without systemic change, Africa faces a future of perpetual catch-up: scrambling to contain outbreaks while chronic diseases erode human capital and economic growth.

Conversely, investing in resilient, inclusive health sovereignty offers generational returns: healthier populations, stable economies, and a defensive against global health threats. The path forward isn’t charity; it’s shared strategic interest.

For sure, Africa can transform health from a crisis expense into Africa’s most vital infrastructure through developing and empowering local leaders, anchoring systems in primary care and harnessing the expertise of women at all levels. The moment for reimagination isn’t tomorrow; it’s now.

Liberty Kituu is a public health communications strategist and a senior communication manager at WomenLift Health.