Remarks at the African Leaders Meeting

Bill Gates
Addis Ababa, Ethiopia
February 9, 2019
AS PREPARED

Your Excellency Mr. President Paul Kagame.

Your Excellency Mr. Moussa Faki Mahamat.

Your Excellencies, Heads of State and Government.

Your Excellency Mr. António Guterres, Secretary General of the United Nations.

Ladies and Gentlemen, it’s an honor to be with you this afternoon.

And to Prime Minister Abiy Ahmed: Thank you for welcoming me to your country.

As many of you know, the words of the African Union anthem were written by an Ethiopian poet, and they include this hopeful line: “Let us make Africa the Tree of Life.”

My background is in software, definitely not in poetry. But I think that over the past twenty years, many of the nations represented in this room have worked hard to realize the dream that poet wrote about: Through tireless effort – and smart investments – you’ve made Africa a place where life is longer, healthier, and more productive.

Since the turn of the millennium, the child mortality rate has been cut by more than 40 percent on this continent. Deaths from malaria have peaked and fallen off. So have deaths from HIV.

In fact, I remember one of the millennium’s first issues of the magazine, Newsweek. It said that in sub-Saharan Africa, “AIDS has been cutting through the population like a malevolent scythe.” Six years after that story broke, annual deaths from HIV reached their highest point. Since then, they’ve fallen by more than half.

These remarkable achievements are worth celebrating. But they’re not enough…

Despite the progress you’ve made, enormous challenges remain.

Africa accounts for 16 percent of the world’s population, 24 percent of its disease burden, and 50 percent of its child mortality – yet only one percent of the world’s health spending. Diseases like HIV and malaria are on the decline, but they still kill a disproportionate number of Africans.

So, this is the crossroads: Will Africa build upon the achievements of the last twenty years?

Or will we see a “lost decade” of stalled progress when it comes to health?

Well, I’m a believer that it will be the former – and I believe that because Africa’s leaders, including many in this room, are taking many of the right steps. The most important one is investing in what economists call, “human capital” – or the education and health of your people.

The nations of Africa have pledged to dedicate at least 15 percent of their budgets to public health. And under the leadership of Chairman Kagame and Chairperson Faki, you’re exploring new ways to track progress on this commitment, using data to hold each other to account.

Just as important: Once you set aside funding for health, you have good examples for how to spend it. In Rwanda, Ethiopia, and Senegal, governments have built high-functioning health systems, where primary care is widespread and the vast majority of children are vaccinated.

The future depends on more nations learning from these examples. It depends on Africa investing well – and investing enough.

Today, more than half of Africa’s population still lacks access to essential health services. Of the 55 AU Member States, only two have met the 15 percent budget goal.

This is unsustainable, not just for citizens, but for economies, too.

If you want more prosperity, the data show that investing roads and bridges and new sources of energy are important. But so is investing in health.

In fact, in many cases health can produce better returns than infrastructure or energy. An example is buying and delivering basic medicines. Every dollar invested in that work, through institutions like Gavi and the Global Fund, creates 20 more dollars in social and economic benefits.

The healthcare math also works in reverse: Even a small cut in government health expenditures costs the economy more than it saves.

Of course, there’s a role for the wider world to play: We need more leaders in Europe and the United States to be like Prime Minister Solberg, who has been a staunch supporter of development aid.

Their support is especially important now, as Gavi and the Global Fund need to be replenished. Sixty-three percent of Gavi’s funding is spent in Africa. The number is closer to 70 percent for the Global Fund. And over the next 18 months, both will need more funding.

I plan on spending much of the next year making sure donor countries provide it. But I will also say: The case for funding much easier to make when the world knows that Africa, too, is investing in its own health.

Which is why my message today is quite simple. The time to mobilize domestic resources for health is now.

The nations of the African Union have set bold, ambitious targets. If governments increase their investments in health, not a decade from now, but immediately, we know it is possible to meet those targets. You can end the epidemics of AIDS, TB, and malaria. You can achieve universal health coverage. And you can grow Africa’s economy in the process.

Choices made in the next few years will determine this continent’s future for decades. Investing in health is the right choice to make. And Melinda and I promise that, as you invest in your people and your countries, we will continue to be with you every step of the way.