Africa turns to philanthropists to fill gaps in health funding

The role of philanthropic capital in Africa's health system has come into sharp focus in the wake of massive cuts to international aid. The downturn in external assistance has left fiscally strained African governments with big gaps to fill in healthcare and other sectors, pushing some leaders to turn to wealthy private donors for financial support.

Philanthropists have a long history of financing healthcare in Africa. Working through foundations and other non-profits, they provide grants and technical assistance targeted at both public and private health systems. They also subsidise care for underserved populations and vulnerable groups.

Among the larger international foundations active on the continent, the Rockefeller Foundation has by far the longest track record in healthcare. It opened a regional office in Nairobi in 1966 but its work in Africa's health sector started long before that. As far back as the early 20th century, when much of Africa was still under colonial rule, it was involved in public health campaigns against yellow fever and malaria. It remains one of the continent's most consequential philanthropic partners today.

Gates' parting gift to Africa

At the turn of the new millennium, the spotlight shifted to Microsoft founder Bill Gates, who became the de facto face of global philanthropy in Africa. The Gates Foundation has, since its establishment in 2000, pumped billions of dollars into vaccines, research, and frontline programmes that have helped fill critical gaps in healthcare across Africa.

However, Gates announced last year that the foundation will spend down its endowment by 2045 as part of his commitment to "give away virtually all my wealth". Over the next two decades, the foundation expects to deploy a record $200bn, with the bulk of this earmarked for Africa.

Most of the funds spent in Africa will target healthcare, with Gates pledging to work alongside governments that "prioritise the health and wellbeing of their citizens".

"Our foundation has an increasing commitment to Africa. Our first African office was here in Ethiopia about 13 years ago. Now we have offices in South Africa, Kenya, Nigeria and Senegal," Gates told African leaders during a visit to Addis Ababa in June last year.

Primary healthcare is set to anchor the foundation's work in Africa over the next two decades. "Investing in primary healthcare has the greatest impact on health and wellbeing," Gates said.

The foundation will also prioritise data systems and digital health tools such as AI-driven health services. Gates noted that in countries such as Rwanda AI adoption in healthcare delivery is already showing early signs of success.

"Rwanda is using AI to improve service delivery... [including] AI-enabled ultrasound to identify high-risk pregnancies earlier, helping women receive timely, potentially life-saving care."

African corporates embrace giving

In recent years there has been a notable increase in the number of foundations linked to African corporates, with healthcare routinely featuring as a top priority. Safaricom Foundation in Kenya, for example, invests heavily in maternal health, community clinics, and mobile health initiatives. The Dangote Foundation in Nigeria has made major investments in polio eradication, primary care, and nutrition.

For James Mwangi, group MD and CEO of Equity Group Holdings, corporate giving in healthcare is not only about providing immediate relief to underserved communities. It can also help drive improvements in productivity of marginalised groups, strengthening consumer and labour markets in the continent.

Equity Group Foundation "is the social and sustainability arm of Equity Group, while banking and insurance and technology form the economic arm. The two work together in synergy, complementing each other," he tells African Business.

"Health is an imperative [for the foundation]. We realised we don't address health; 40% of our loan default occurs when a health incident occurs within the family. So we decided to address health in a comprehensive way," he says.

"We today, through the Equity Afia franchise, operate 148 hospitals that see nearly 200,000 patients per month. That has brought affordability, quality and accessibility of health, and we have really enhanced the productivity of the population."

Equity Afia relies on doctors trained through the Equity Leaders Program, an initiative by the foundation that funds undergraduate university education for bright but needy students. Alumni doctors are empowered to run clinics through a franchise model that operates under Equity Afia's brands and standards. The clinics use a high‑volume, low‑margin approach, with low standardised fees that keeps care affordable while ensuring profitability and scalability.

'Grants helped us develop and test our product'

John Paul Otieno, co-founder and CEO of Kenya‑based insurtech startup Maisha Poa, says the rise of philanthropic investment in African healthcare is widening access to grant funding for social entrepreneurs. He argues that such grants are vital for early‑stage innovators working on solutions to complex health challenges. They provide the financial runway needed to develop a concept before commercial launch and revenue generation.

Maisha Poa offers mobile‑based health insurance tailored to low‑income informal workers, with a focus on small entrepreneurs and taxi operators. The company partners with licensed underwriters, including APA Insurance and AAR Insurance, to give members access to around 400 facilities nationwide. It works with mostly low‑cost private and missionary hospitals located near its customers.

"The covers we issue are very comprehensive. They take care of both in- and out-patient cases. In some instances, the cover extends to take care of maternity, dental and optical as well. We've also incorporated unlimited telemedicine for all covers," Otieno tells African Business.

Since its inception in 2022 the company has sold about 2,800 policies, impacting some 10,000 lives, Otieno says. Cover can cost as little as 20,000 shillings ($154) annually, with those that offer more protection costing slightly more. Moreover, payment plans allow for small premium instalments rather than annual lump sums.

Otieno says that grant funding helped the company develop and test its product. "So far, we've largely benefited from grants. We haven't gotten any venture capital yet. The largest grant we've gotten has been about $50,000, which is still okay for a small company like us."

While this level of funding can support product development and market testing, it is nowhere near enough to support expansion. For this, Otieno says the company is considering raising large-scale commercial capital from external sources. "Our target is to raise $2m in equity or debt over the next two years," he says.

Limitations of philanthropy

Grant funding and philanthropy more broadly has its limitations. Critics argue that reliance on private donations can entrench dependency and give wealthy individuals excessive influence over health policy and local companies. The Gates Foundation's health and agriculture programmes and policies in Africa, for example, have been the subject of extensive debate and occasional criticism.

Moreover, contrary to the popular view, the money that foundations give is sometimes not enough. Foundations involved in healthcare often simultaneously back competing priorities such as climate action, education and gender. This means that, even for foundations with large endowments, the money actually available for individual healthcare programmes is sometimes far less than hoped.

While philanthropy will continue to play a vital role in African healthcare, particularly in the absence of foreign aid, domestic resource mobilisation and service delivery is likely to play a determining role in the success or failure of Africa's health response.