For Mwalimu Nyerere, leadership meant walking alongside his people and Africa, lending his hand without pretence and advancing collective upliftment over personal aggrandisement.
With Tanzania having marked Nyerere Day earlier in the week, memories return of a leader whose style was defined by service and moral conviction.
For Mwalimu Nyerere, leadership meant walking alongside his people and Africa, lending his hand without pretence and advancing collective upliftment over personal aggrandisement.
It is only fitting therefore that in this era of looming health crises in Africa, we reflect on his ethos and unite through our regional leaders to mirror his servant leadership in shaping Africa’s health future.
Fifty‑one years ago, in 1974, the East, Central and Southern Africa Health Community (ECSA‑HC) was established under the auspices of the Commonwealth Secretariat to harness collective strength across neighbouring states (then British Commonwealth) to tackle shared health burdens.
Its founding objective – to promote cooperation and regional capacity in health – was simple yet profound. Mwalimu was one of the founding fathers of ECSA-HC and his dream was no nation had to confront epidemic threats, resource scarcities, or policy deficits alone.
Over time, that aspiration took root. By 1980, member states formally took over ownership under a Convention signed by their health ministers, giving the organisation a political and legal foundation.
Today, ECSA‑HC encompasses nine full member states (Kenya, Lesotho, Malawi, Mauritius, Eswatini, Tanzania, Uganda, Zambia and Zimbabwe) and offers technical support to over 16 other countries.
But while the vision was noble, the terrain has grown far more complex. Africa’s is now witnessing a health systemic strain characterised by several global vulnerabilities, including:
Underinvestment and funding shortfalls
Despite the critical role of health in societal stability, many African governments fall short of globally recommended thresholds. A recent Human Rights Watch analysis showed that, among African countries, many allocate well under five percent of their national budgets to health.
Donor dependence remains the order of the day, with many countries seeing more than 30-40 percent of their health sector budgets supported by external aid.
Import dependency and fragile supply chains
One of the starkest vulnerabilities in Africa’s health infrastructure is the overwhelming dependence on imports for medicines, diagnostics, vaccines and devices. Estimates indicate that 70–90 percent of medical products consumed in Africa are imported.
In pharmaceuticals, the continent produces only 25–30 percent of what is consumed locally and less than 10 percent of medical supplies.
For vaccines, Africa produces under 1 percent of vaccines used on the continent, making it painfully vulnerable to supply chain shocks.
In Tanzania and Ethiopia, comparative studies of locally produced vs imported medicines reveal nuanced dynamics. In Tanzania, local products were procured at lower relative cost than imports (median price ratio MPR 0.69 vs 1.34), but availability for local products was lower in private outlets and procurement planning often favoured imports.
Going forward, global health financing architecture is shifting: multilateral institutions, donor priorities and development banks are pushing for greater local manufacturing, regional supply chains and “health sovereignty” models.
The African Union’s “New Public Health Order” emphasises strategic autonomy in health, including investment in local production of medicines, diagnostics and technology.
Given this shifting landscape, Africa cannot afford to remain a passive consumer. The motto “Buy Africa, Build Africa” must move from rhetoric to reality, especially for regional bodies like ECSA‑HC.
For this to be attained, we must adhere to Mwalimu’s Servant Leadership codes:
Pooled procurement and regional manufacturing hubs
ECSA‑HC member states should lead in creating pooled procurement platforms for medicines, diagnostics and supplies. By aggregating demand across multiple countries, the region can negotiate better prices, assure predictable volumes and incentivise local manufacturing.
Complementing this, regional manufacturing hubs should be developed in strategic locations (e.g. East Africa, Southern Africa) to produce APIs, fill‑finishing, diagnostics and medical devices.
Countries with nascent capacity e.g. Kenya, Uganda and Tanzania could host scale-up facilities. Such hubs would benefit from economies of scale, cross‑border standards and favourable trade agreements under AfCFTA.
Harmonised regulation, quality and standards
Local manufacturing must be underpinned by strong regulatory systems. ECSA‑HC should coordinate efforts to strengthen national regulatory authorities toward WHO maturity levels, harmonise regulatory frameworks and support the Africa Medicines Agency (AMA). This reduces duplication, lowers entry barriers and enhances trust in locally made products.
Investment and incentives for local industry
Governments must adopt smart investment and procurement policies: tax incentives, subsidies, special economic zones (health clusters) and public–private partnerships targeted at pharmaceutical and diagnostics firms.
Leadership, governance and servant-leadership approach
Africa must adopt servant leadership styles. We need ministers who listen, empower and align across borders. Just as Mwalimu emphasised service above dominance, ECSA‑HC leadership must act as integrators, bridging ministries, the private sector, academia and civil society to design region‑wide strategies.
ECSA‑HC has served for half a century as a regional anchor. But today, amid shifting global health patterns and Africa’s growing demographic pressures, it must lead audacious transformations.
Africa must move from mere passive importers to empowered producers. To attain this, Africa should desist from fragmented systems and move to unified regional platforms. Donor dependency to sustainable at all.
Africa must chart a new and urgent course of health sovereignty. Regional bodies like ECSA‑HC and its member states, guided by Mwalimu’s servant leadership antics and anchored in his shared vision for an independent Africa, must lead the way.
Bryan Toshi Bwana is a Founding Trustee, Umoja Conservation Trust. www.umojaconservation.org
