“A child born in many parts of Africa has 50 times the chance of dying before the age of five than children in other countries.” – Bill Gates
That sobering fact continues to shape the Gates Foundation’s vision and resolve in Africa. Since the year 2000, we’ve worked alongside African partners to confront some of the continent’s most urgent challenges that are health, education, food security, and more with innovation, partnership, and a commitment to equity at the heart of our approach.
What we’ve learned is simple but profound: innovation doesn’t always mean complexity. Some breakthroughs are cutting-edge, like new vaccines for malaria, HIV, and tuberculosis. Others are deceptively simple reimagining how to organize a primary health care system, training health extension workers, or empowering communities with basic, life-saving health practices.
“Even in places with very limited resources, the kind of field work to get solutions out even in the most rural areas has been incredible.”
Over the past 25 years, humanity has made remarkable progress in global health. One of the most powerful, yet underreported triumphs has been the dramatic reduction in child mortality. Deaths of children under five have fallen from just under 10 million annually to less than 5 million a pace of progress never seen before in history.
Africa has played a key role in this transformation. In Ethiopia, for instance, under-five deaths dropped from 400,000 to 183,000, thanks to targeted investments in health posts, vaccine supply chains, and a dedicated workforce of health extension professionals. It’s a model of what’s possible when governments, donors, and citizens commit to health equity.
Our foundation has been proud to support initiatives like Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These institutions have been crucial in driving down the cost of vaccines like reducing the price of the rotavirus vaccine from $30 to under $2 and helping countries expand coverage to almost every child.
“There are many exemplars in this work, including Ethiopia. For sub-Saharan Africa as a whole, deaths have been cut. Ethiopia has done even better than that.”
The fight against HIV is another story of extraordinary progress. In Zimbabwe, where HIV once reached epidemic proportions, deaths have dropped by over 80%. Today, 95% of people living with HIV know their status, 95% are on treatment, and 95% of them have viral suppression a global benchmark in HIV control.
We now have an HIV preventive shot that lasts six months a game-changing innovation that could accelerate control in the years ahead.
But the road hasn’t been without setbacks. Malaria remains a formidable adversary, particularly as parasites and mosquitoes adapt. Yet new technologies, such as dual-insecticide bed nets and smarter data use in countries like Mozambique, show us that resilience and innovation go hand in hand.
Polio eradication has also seen incredible gains. From 60,000 global cases in 1995 to under 1,000 today, Africa has eliminated the wild poliovirus thanks in part to bold leadership by African champions like Dr. Muhammad Pate and partnerships with figures like Aliko Dangote. We now face the final push against circulating variants, and history demands we finish the job.
Agriculture, too, has become a central focus for us. As I’ve come to learn over the years, it is the backbone of the African economy and central to childhood nutrition, economic opportunity, and climate resilience.
“When we first got started, I didn’t understand how important agriculture is.”
From providing farmers with better weather and market data to introducing improved crop varieties and poultry breeds like the high-yield chickens we helped bring to rural Africa, now numbering over 140 million we’re seeing how the right tools in the right hands can reshape entire sectors.
Looking forward, Africa has the potential to shift from being a net food importer to a net exporter even amid population growth and climate stress.
Digital public infrastructure is another critical opportunity. Today, more than half of African countries are building digital ID systems and payment rails. This leapfrogs traditional banking and brings financial inclusion closer to reality. It will also drive intra-African trade, empower entrepreneurs, and make social protection systems more responsive.
And then there’s artificial intelligence the most transformative technology of our time.
“Now you have a chance, as you build your next-generation healthcare systems, to think about how AI is built into that.”
Already, AI is being used in maternal care. In Rwanda, for instance, we’re using AI-powered ultrasound devices connected to smartphones to predict difficult pregnancies and intervene early something that could save thousands of lives each year. And that’s just one example.
Africa can lead in the equitable application of AI. Whether it’s giving a smallholder farmer in Kenya more accurate crop advice than a commercial farmer in a rich country, or enabling real-time disease surveillance in remote regions—AI must not be a tool reserved for the wealthiest nations. The need here is greatest. So should be the priority.
“If equity were served, it should roll out here first.”
Africa is home to the next generation of scientists, entrepreneurs, and changemakers. It’s essential that we support and amplify their efforts. The Gates Foundation remains committed to walking alongside governments, institutions, and communities to invest in the tools that will shape a healthier, more prosperous, and more just future.
Because when Africa thrives, the world moves forward.
