Africa CDC chief on health agency’s past problems and promising future

The Africa Centres for Disease Control and Prevention has grown into an influential player on the global health scene. If Dr. Jean Kaseya, the director-general of Africa CDC, has his way, his agency will become the dominant health player representing a continent of 1.4 billion people where health is both an opportunity and a challenge. “We are the convening power in Africa,” he said. “No one can come today again to work in Africa without Africa CDC. It doesn’t make sense.” But Kaseya’s agency — including the director-general himself — has had a rocky road navigating various constraints and controversies since its establishment in 2017 — which he addressed in a sweeping Devex Pro briefing on Aug. 1. Africa CDC’s explosive growth since the COVID-19 pandemic has come with growing pains, particularly as it settles into its still-evolving role as an autonomous arm of the African Union — though Kaseya insists the agency’s future is “brilliant.” But that future is further being tested by massive foreign assistance cuts, driven primarily by the United States but also European donors and others. Kaseya was candid that “surely, some people will die because of the aid cuts,” and many of those deaths could’ve been preventable if it weren’t for the suddenness of the cuts. But he believes the impact can still be mitigated if Africa takes collective action. “I visited some countries in Africa. I see clinics locked. I see even data gone. And I said to my leaders, now it’s time to come together, and Africa CDC is playing a major role. We managed to bring heads of state together. We managed to bring ministers together. We developed a vision called ‘rethinking Africa and financing in a new era,’” he said. “Yes, we are suffering from these aid cuts, but it’s a major wake-up for us now to take back our sovereignty.” In fact, he said he saw the writing on the wall even before U.S. President Donald Trump’s aid purge. Kaseya, a Congolese medical doctor who worked with his government on health care strategies, said the manifesto he wrote for his candidacy for the Africa CDC director role addressed this very issue. “We need to stop with dependency. We need to start to think how Africans can invest in their health system. But I think I was not very well understood by people, by our leaders, because some of them, they were still thinking that [aid] money will continue to flow.” Then, as director-general of Africa CDC, Kaseya said he met with Rwanda’s president, Paul Kagame, in February to discuss ways to boost domestic financing, among other issues — prior to the full effects of the U.S. aid cuts. “Africa was proactive,” he said. Today, the continent needs to be even more proactive in attracting innovative finance, devoting more of its national budgets to health care, joining forces to act as a single continental market, and tackling bad governance, including corruption and fraud, he said. In particular, Kaseya insisted that rooting out inefficiencies in the system would yield tremendous cost-savings that could negate the need for external assistance. That includes HIV programming long underpinned by PEPFAR, the landmark U.S. global HIV/AIDS initiative. Kaseya argued that HIV programming needs to be integrated into primary health care systems to create greater efficiencies. “Some countries are understanding that it’s the primary health care that must be the driver. We don’t want to be a continent led by programs,” he said. “I was talking to a minister who was telling me, ‘In my country, we have 22 strategic plans, not speaking to each other. We want a country with one plan, HIV being part of that.’” Interestingly, Kaseya had hefty praise for Rwandan President Paul Kagame, despite Kagame’s initial opposition to Kaseya’s appointment to lead Africa CDC, citing a selection process he claimed was excessively secretive. “Rwanda managed to bring one system in place and to put in place the community health insurance. And Rwanda is one of the countries where inefficiencies are not like in other African countries,” Kaseya said, noting that the country devotes more than 15% of its national budget to health. “It means Rwanda can be a model. We don’t have to fly to other continents. We can use just our own models, like Rwanda and others, to see how by putting in place a strong planning process, by putting in place a strong alignment, by putting in place a system that avoids corruption and fraud, we can have a huge impact in the health sector,” he added. Africa CDC is working on improving its own alignment — with donors, partners, and the African Union, under whose umbrella it still falls. That’s because up until fairly recently, the young agency didn’t have the internal financial systems to manage funds directly, so funds were primarily channeled through implementing partners. Kaseya said that’s gradually changing as Africa CDC takes more of the financial reins. “We are getting more funding … but what was happening [was that] money was not coming to Africa CDC,” he said. “It means we didn't have oversight on the financial system, on the procurement system, and we had to provide reports to donors about funding we don’t control.” Kaseya said Africa CDC has embarked on reforms to instill more confidence in donors so that money goes directly to the agency. That included clarifying its mandate to ensure it didn’t duplicate other organs of the AU. Kaseya also noted that the agency has had seven audits done since January to show donors it is a “world-class organization that is accountable, transparent.” That’s critical because the agency has been dogged by persistent questions about staffing, whether Africa CDC is spending donor money efficiently, and Kaseya’s own leadership style. Among a raft of whistleblower complaints were allegations that Kaseya misspent funds, flouted rules, exhibited favoritism, and spent too much on travel. An African Union audit found evidence to disprove some accusations, but had inadequate access to fully examine others. Kaseya pointed out that, among other things, he has installed an open system for complaints and exercises to create a more “conducive working environment.” “Strong leadership invites also scrutiny, especially when it’s challenging established systems,” he said, noting that the agency is implementing “massive changes … in terms of putting in place the accountable system, putting in place a system that ensures transparency, [so] yes, there will be some frictions.” On hiring, Kaseya said that when he came on board over two years ago, many positions, such as human resources, finance, and administration, were held by junior staff, and he has since recruited senior staff with more experience. But that doesn’t mean Africa CDC’s workforce is expanding. “Yes, we’ll cut some positions, but we’ll cut positions for two reasons,” Kaseya explained. The first is because Africa CDC was built during COVID-19 and is in the process of restructuring now that the pandemic is over. The second is aid cuts around the world. Because of these dynamics, he estimates around 20% of staff positions will be cut. “I know there can be rumors,” he added. “Yes, like other organizations, you can have still 5% or less than 5% of people who can continue, for some reasons, to say things. But the majority of Africa CDC staff is well-informed … so motivated,” he said. “It’s the 500 people in Africa CDC, running every day, making things done. I'm proud of them, and I'm proud to be the leader of these people.”