Moving Towards Self-Reliance to Achieve Universal Health Coverage and Health Security in Africa: Outcomes of the Public Health Conference in Africa, 2025

The 4th International Conference on Public Health in Africa (CPHIA) was held from 22–25 October 2025, at the Durban International Convention Centre in South Africa, under the theme “Moving Towards Self-Reliance to Achieve Universal Health Coverage and Health Security in Africa.” The conference brought together international government ministers, health leaders, scientists, youth, and civil society actors from across the continent and beyond, reflecting Africa’s growing leadership in shaping its own public health agenda.

During the opening ceremony, the Director General of Africa CDC, Dr. Jean Kaseya, emphasized Africa’s determination to chart its own path, noting that the continent is increasingly defining its priorities and solutions. South Africa’s Deputy Health Minister Dr. Joe Phaahla emphasized the importance of healthy equity and policy achieved through African leadership and global solidarity, calling for health systems that are financed, powered and sustained by Africans themselves. The conference was strategically positioned as a precursor to the G20 Health Ministers’ Meeting under South Africa’s presidency, reaffirming Africa’s role in shaping the global health agenda.

The conference programme was anchored around strategic priorities focused on strengthening Africa’s health sovereignty. Discussions emphasized the need for sustainable and innovative financing to build resilient and efficient health systems that are nationally owned. Considerable attention was given to expanding local manufacturing of vaccines, medicines, and diagnostics as a means of reducing import dependence and strengthening health security. Transforming primary health care was also highlighted, with African-led innovations such as digital health tools, telemedicine, and artificial intelligence showcased as solutions for expanding access and improving quality of care, particularly in underserved communities.

The conference drew nearly 20,000 participants from over 70 countries, featuring multiple plenary discussions, abstract sessions, special sessions, and partner-led side events. These engagements explored cross-cutting themes including climate resilience, One Health approaches, laboratory networks, genomics, governance, sustainable health financing, public health emergency management (PHEM) and pandemic preparedness. A high-level plenary on health sovereignty examined how demand, innovation, regulation, and investment can drive the growth of Africa’s pharmaceutical manufacturing sector.

Health financing emerged as a central concern throughout the conference. Official development assistance for health in Africa has dropped by nearly 70% between 2021 and 2025, while African governments dedicate an average of 6% of their national budgets to health; far below the Abuja Declaration commitment of 15%. Health expenditure accounts for only 1.5% of Gross Domestic Profit (GDP), and out-of-pocket payments by citizens remain high at 37% of total health expenditures, exposing households to financial hardship and limiting access to essential services.

Primary health care (PHC) remains a critical gap with about 400 million people worldwide, lacking access to essential services. The Service Coverage Index for the World Health Organization (WHO) African Region averages 46%, indicating that half of Africans do not receive basic PHC. The WHO recommends that countries allocate 1% of GDP to PHC, yet most African states remain below that threshold. Low insurance coverage (often under 10%) compounds inequities, with millions at risk of catastrophic health spending. Limited investment in primary health care, combined with low health insurance coverage, perpetuates inequities and increases the risk of catastrophic health expenditure, particularly among vulnerable populations.

Local manufacturing capacity was identified as both a challenge and an opportunity. Despite consuming about 25% of global vaccine doses, Africa currently produces only 1% of its vaccines locally. Over 95% of medicines and active pharmaceutical ingredients are imported, along with the majority of diagnostics and laboratory reagents. To address this, continental initiatives led by Africa CDC and the African Union (AU), including the Partnership for African Vaccine Manufacturing (PAVM) and the Platform for Harmonized African Health Products Manufacturing (PHAHM) are working to strengthen regulatory harmonization, expand regional production capacity, and advance the AU goal of producing 60% of Africa’s vaccine needs through local production by 2040.

These interconnected priorities framed the conference’s emphasis on mobilizing domestic resources, revitalizing PHC and building sustainable manufacturing ecosystems as the foundation of Africa’s journey towards health sovereignty.

The conference was concluded on 25 October with the launch of the Durban Promise, a continental call to action outlining commitments to mobilize Africa’s wealth and innovation for health, strengthen governance and accountability, reinvest in primary health care and community systems, promote regional solidarity and pooled procurement, build climate-resilient One Health systems, reframe health as a strategic investment, and consolidate Africa’s leadership in global health

In the closing plenary, Prof. Olive Shisana, co-chair of CPHIA 2025, noted that health is not charity but a matter of sovereignty, political choice, and economic future. The Durban Promise marked Africa’s clear shift from aid dependency towards autonomy and will guide the next phase of Africa CDC’s strategic action under the New Public Health Order. In his closing remarks, Dr. Kaseya announced that the next edition of the conference (CPHIA 2026) will be held in Addis Ababa, Ethiopia, to continue advancing African-led public health leadership.

In conclusion, through its rich exchanges and the launch of the Durban Promise, CPHIA 2025 reaffirmed that Africa’s path to health self-reliance requires sustainable domestic financing, strong and equitable PHC systems, and robust regional manufacturing capacity. By translating these commitments into national policies and implementation frameworks, countries like Uganda are well-positioned to advance Africa CDC’s vision of a continent that is prepared, responsive, and self-reliant in safeguarding public health.

Authors’ Contribution: WN conceived, designed, and led the drafting of the article, participated in the conference as a Public Health Emergency Management (PHEM) fellow. SH, WE, and WM provided technical input, coordination, editorial revisions, and were the technical conference organizers at Africa CDC. All authors reviewed and approved the final version.

Acknowledgement: The authors acknowledge the Africa Centers for Disease Control and Prevention (Africa CDC), the Government of South Africa, and AfricaBio’s BIO Africa Convention for their support in organizing the Conference of Public Health in Africa, 2025.