Africa CDC's rocky road to stability

Elevating the health of 1.5 billion people is the driving mission of the Africa Centres for Disease Control and Prevention. Ever since it was granted autonomy from the African Union more than three years ago, the Pan-African public health agency has plowed ahead with greater responsibilities, a larger budget, and heightened visibility. “Yesterday, Africa CDC was a small player. Today, Africa CDC is a big elephant in the room,” the organization’s director-general, Dr. Jean Kaseya, said during a Devex event. “We are the convening power in Africa.” But with rapid growth often come growing pains, and Africa CDC — including Kaseya — has had its fair share. The agency needed to build internal systems and confront emergencies such as the COVID-19 pandemic and the mpox outbreak. Other challenges include staffing and control of finances. There’s been praise of Africa CDC’s handling of some challenges — for example, increasing surveillance and championing local pharmaceutical manufacturing — but also concerns, including questions about the agency’s spending. And there are questions around leadership. Kaseya had pledged to improve transparency and create a “new management culture.” Now, more than two years into the job, his own management has been scrutinized, including, previously, through a series of whistleblower complaints. Devex conducted interviews with former and current Africa CDC staff and public health experts, including from organizations working on the continent, as well as obtained internal documents — such as audits, recordings, and emails — painting a picture of a young agency carrying enormous expectations and a mixed track record of living up to them. “Africa CDC is in a period of transformation, and transformation can be uncomfortable,” the agency told Devex, while also defending Kaseya’s tenure and touting the agency's successes. World Bank’s spotlight on spending One challenge the agency has faced is implementing a $100 million World Bank grant. According to a May internal email from Shanelle Hall, Kaseya’s adviser on management and operations, the bank expressed concerns about reputational risks of what could be perceived as “extravagant” spending with “immense amounts of funds for travel and meetings.” She wrote that, given decreases in official development assistance, the bank is “looking to ensure efficiencies on all of their financing facilities.” “They implied on several occasions, if funds are not being used efficiently or optimally, grants will be reduced,” she wrote. “At one point [bank employees] said if we looked at our expenditures on trips and per diems, it could look like Africa CDC could be a travel agency.” She added that the bank questioned certain expenses, such as “shelter for cars in the parking lot” and “cars to deliver protocol papers to embassies.” The World Bank declined to comment for this story. Inefficient spending is a problem Kaseya said he’s worked to reverse. In a March email, he wrote that about 70% of Africa CDC’s funding goes to “extensive travel for meetings and trainings, and the continuous development of documents that often remain unused and unimplemented.” But the agency has also made notable progress. Last August, the bank ranked Africa CDC’s grant implementation as “moderately unsatisfactory” — which the agency said was an analysis of implementation in 2023 — but upgraded it this year to “moderately satisfactory.” The bank’s “moderately unsatisfactory” rating triggered internal conversations on “cost-effectiveness and prioritization,” the agency told Devex, including a “deeper cultural shift” toward results-based management. For example, the agency said since March 2024, it’s reduced nonessential travel by over 40%. Africa CDC also told Devex the bank has praised Africa CDC in areas such as expansion of surveillance, workforce development, and emergency response readiness. Nevertheless, its ratings have stirred anxiety. In November and December 2024, Kaseya wrote internal emails about Africa CDC staff detained in the Democratic Republic of Congo after entering with $200,000 in cash without declaring it. “It will be extremely challenging to explain this incident to our partners — especially against the backdrop of performance concerns already flagged in the World Bank program,” he wrote. Africa CDC told Devex there’s an AU practice of having finance colleagues fly with cash, especially in locations where banking access is limited, but since then, they’ve issued “a strict zero-cash policy” with exceptions granted on rare occasions, including when no alternatives exist. Autonomy in practice The implementation of the World Bank grant highlights one of Africa CDC’s growing pains. When the Africa CDC was launched in 2017, it was a specialized technical institute of the AU. But during the pandemic, Africa CDC was granted autonomy from the AU so it wouldn’t be weighed down by bureaucracy and could be nimbler in emergencies. But there wasn’t a clear path forward on how autonomy would be achieved and perceptions about who’s in charge — Africa CDC or the AU — have been problematic, a former employee said. While Africa CDC isn’t part of the AU Commission, it reports to its chairperson and political leaders. But some partners were under the impression that autonomy meant independence from the AU, even though Africa CDC is still subject to AU rules, this person said. “It created confusion with the partners and gave them the impression that Africa CDC wasn’t bound by the AU’s regulation — which is not a good message,” this person added. The agency told Devex that while there “may have been early misconceptions among some partners about what autonomy meant in practice,” it has worked to clarify this. When it launched, its financial management, procurement, and grant-making systems were also reliant on the AU. Because of this, donor funding has been funneled through implementing partners. As part of efforts to become autonomous, Africa CDC has worked to build up internal systems to manage funds directly. Africa CDC now has direct funding agreements with donors such as the European Union, Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the World Bank, among others. But some funds are still managed through implementing partners. Funders that continue to rely on this arrangement include Mastercard Foundation, Gates Foundation, and Novo Nordisk, for example. Africa CDC told Devex that this approach is “often due to the design of their existing programs or fiduciary arrangements, rather than any limitation on Africa CDC’s capacity to receive funds directly,” adding that it’s working with partners towards direct financing agreements. “It is true that operationalizing Africa CDC’s autonomy required a transition period, which is normal when a new institutional status is granted,” it said. Moreover, in February, the AU formally approved Africa CDC as “the public health agency of Africa” tasked with managing “all aspects of public health in Africa” — but doing so in partnership with other AU entities. This, according to the agency, shows African governments confirmed trust in its “institutional maturity.” A ‘coalition’ against Africa CDC There have also been fissures between Africa CDC and implementing partners — who receive overhead from donors. During an internal call — a recording of which Devex obtained — Kaseya said he requested that implementing partners give Africa CDC a portion of the overhead they receive from donors because it was his agency writing proposals and bringing in funds. “We didn't win this fight. They came together — amazing how they managed to have a coalition of implementing partners against Africa CDC,” he said. “I will not allow that again, again, and again. This is slavery.” Kaseya said he will now choose implementing partners himself and divide the overhead. “The time for people to dictate us is over,” he said. Africa CDC told Devex Kaseya’s remarks were focused on “equity and institutional sustainability, not confrontation.” It said that while the agency plays roles such as conducting negotiations for funds and managing implementation, it can face criticism if programs don't meet expectations — meaning implementing partners receive overhead yet don’t assume those responsibilities. But it added that the agency continues to collaborate with all implementing partners. Financial risks In July, Kaseya sent an internal email noting an investigation by Africa Field Epidemiology Network, or AFENET, into “serious allegations of fraud” involving three staff members found to have committed “acts of misconduct.” “Fraud, corruption, and any abuse of position or resources have no place in our institution,” he wrote. The agency dismissed the staff members. More broadly, Kaseya said during the internal staff call that “something that is making me worried every single day: potential financial management risk for Africa CDC.” But while he’s internally noted concerns, externally he’s exuded confidence. During the Devex event, he said the problem is “Western countries not trusting African institutions and countries.” “Africa CDC [is] a world-class organization … that is accountable, transparent, that is delivering,” he said. There's evidence to support this, such as the improvement in the World Bank’s ranking of its grant implementation. Additionally, Gavi signaled confidence in the agency when it granted $12 million directly last year, and rated “low” risk to 63% of funds and the rest as “medium.” Their rating was due to supply chain players and activity locations, not the Africa CDC’s capacities. A Mastercard Foundation audit also didn’t find grant misuse. A Gavi spokesperson said that while implementation of its agreement is in early stages, it’s so far “satisfied with the progress and partnership” and they have “successfully collaborated” on several important efforts, such as containing mpox and cholera outbreaks. Africa CDC told Devex it launched a risk management policy in February, and it has “robust controls to detect irregularities early, take corrective action, and report transparently to partners.” “Africa CDC takes fraud and corruption extremely seriously,” the agency said, adding that seven audits this year “found no evidence of systemic fraud.” Sustainable staffing Sustainable staffing has also been a challenge. The staff makeup has included a limited number of long-term, AU-funded positions — with donors supporting the bulk of roles. When Africa CDC launched, it had 11 staff, but that has scaled to 512, of which 70% are seconded with support from partners. This includes 210 staff connected to the Mastercard Foundation’s Saving Lives and Livelihoods program, which is set to wind down next year. According to a Gavi report from last November, only about 15% of finance, procurement, and human resource staff at Africa CDC had long-term employment; the rest were fixed-term or consultants. In the report, Gavi acknowledged that short-term contracts can be cost-effective and allow emergency scale-up, but adequate levels of long-term staff ensure stability. Gavi also noted a Mastercard Foundation audit found up to 40% of candidates selected for their program weren’t consistent with recruitment panel recommendations, “with no justification.” Africa CDC told Devex it took Mastercard Foundation’s findings seriously, and an internal recruitment review followed. It noted 95% of these staff members were recruited before Kaseya took office, and said recruitment processes have since improved. Compounding staffing issues are recent foreign aid cuts. The agency told Devex that next year it plans to cut its workforce by 20%, but then increase staffing in 2027, to preserve “long-term viability.” Leadership questions Some current and former staffers allege Kaseya has an intimidating management style and have told Devex they have feared speaking up. Additionally, in 2023, whistleblower complaints accused Kaseya of "ill-management and maltreatment of staff." For example, in an internal April email, Kaseya wrote, “we are collectively under increased pressure due to lapses by a few of us who are … finding reasons not to do their job while being proactive to run to staff association, member states and partners to tarnish [Africa CDC’s] reputation rather talking about their laziness, misbehaviors and weaknesses.” During the internal call, Kaseya warned against sending anonymous complaints and said he’s aware — and has recordings — of staff organizing late-night calls. “If you send a letter to [the AU Commission], to ambassadors … everything is coming back to me,” he said. “What is the respect I will have vis-à-vis you?” “I don't micromanage people. If I start to follow you, it means you are weak,” he said. In a separate internal call, he spoke about the three staff members he dismissed after the AFENET investigation that found misconduct, saying people told him, “Some of them, they are threatening to kill themselves.” “My answer was: ‘They have to kill themselves, because if you are using fraud, you are using corruption, you are doing that in purpose: You know that it's killing the organization,’” Kaseya said. “If our donors, like EU, they are aware of this practice in Africa [CDC] — they will not give us money internally,” he added. The agency told Devex that “leadership during the transformation of an African institution into a world-class organization is inherently demanding.” Kaseya’s statement that “everything is coming back to him,” Africa CDC told Devex, “was not meant as intimidation, but rather to reinforce transparency and direct engagement: that issues will be heard, escalated properly, and resolved fairly.” “[Director General] Kaseya openly acknowledges that his style is direct and results-focused, with a strong emphasis on accountability and responsibility,” the agency added. On the suicide comments, Africa CDC told Devex that while the agency takes staff well-being “extremely seriously,” Kaseya’s “foremost responsibility” is protecting the organization and “fraudulent practices are a grave matter that undermines trust in our institution and jeopardizes continued support from partners.” “He has refused to be swayed by threats, including the reported statement from one dismissed staff member that they would harm themselves if action were taken,” the agency said. “Invoking suicide in connection with disciplinary action for fraud is deeply concerning, as it risks minimizing the very real mental health challenges that individuals face.” A former international non-governmental organization employee — who used to partner with Africa CDC — told Devex that he’s observed “quite a bit of turnover” since Kaseya took office. “What sometimes tends to happen is you lose good people because of leadership,” he said. Africa CDC told Devex that when Kaseya took office in 2023, there were 498 staff, and since then, there’ve been 11 departures. But there have also been 87 merit-based promotions and 26 new appointments, it said. The head of a public health organization, who wished to remain anonymous given sensitivities, told Devex it’s frustrating that Africa CDC isn’t living “up to its full potential” because “the cause is extremely valuable.” This person added that decisions at what’s intended to be a scientific agency seem more political — energy spent on publicity and attending mostly political meetings rather than scientific discussions, for example. “This whole aura around leadership style, politics, and indecisiveness is really holding the organization behind. I think it needs to come out from under that cloud, because there's some really good people in it that are really committed,” this person said. “As long as it's not free to run full speed without all of these things that are slowing it down — all the politics — I think we're doing the continent a disservice." But the agency told Devex that while science is “core” to its “entirely technical” mandate, political engagement isn't “a distraction” but helps secure policies, resources, and partnerships. “[Director General] Kaseya often reminds staff: ‘Public health cannot succeed in isolation from politics,’” it said, adding that its work requires government buy-in. And others, externally, have offered praise. In the wake of U.S. aid cuts and the country’s withdrawal from the World Health Organization — Kaseya estimates he’s visited Washington, D.C. five times, including the State Department. In the U.S., Kaseya presented a finance paper with a “solid vision” that includes leveraging blended finance for funding health care, said Stephen Morrison, senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies. “I was very impressed,” he said. “He saw the crisis in Africa of the Trump administration and others cutting their support radically — and I think he saw this crisis as an opportunity for Africa CDC to step forward with a new look and put forward some new ideas.” Sunsetting partnerships Some current and former staff told Devex that the agency finds itself in a fragile financial situation, as most external grants are ending, and some are concerned that donors are reluctant to work with Africa CDC. A recent donor grants report shows that out of 43 grants, 33 have either expired or will by year’s end. The Gates Foundation, for example, had 11 grants, but only two will continue beyond 2025. While the agency had a balance of just over $99 million from all of the grants, about 40% is tied to grants that have already expired or will soon expire, according to the report. “This means Africa CDC needs to really pull up its socks in resource mobilization and getting more money to replace the money that is expiring. But the challenge is funders are not coming to the table,” a former staffer said. While the global health funding environment, more broadly, is challenging, some of Kaseya’s critics allege funders have lost interest in working with the agency since he took office due to his leadership — and have said they’ve witnessed partners spoken to in a disrespectful tone. Sources added that some partners choose to work instead with the AU Commission and NEPAD — the AU’s development arm. For example, the Susan Thompson Buffet Foundation, which has provided Africa CDC with three grants amounting to over $27 million, according to the internal document, has partnered with AU-NEPAD on primary health care programs, the sources said. Sources said major donors such as Mastercard Foundation — Africa CDC’s largest funder — and the Gates Foundation are scaling back partnerships. They said that while the Mastercard Foundation pledged $1.5 billion in 2021, its Saving Lives and Livelihoods program is winding down before some $800 million in potential funding can be accessed. "It was money that if Africa CDC had actually maintained the relationship, it could tap into and continue to receive,” one source said, adding that since signing the partnership, only about $700 million was disbursed, and with the program ending, those remaining funds aren’t expected to be disbursed. Gates Foundation, Susan Thompson Buffet Foundation, and the AU didn’t respond to Devex’s requests for comment for this story. Mastercard Foundation declined to comment. The head of a public health NGO said that when deciding partnerships, choosing the AU Commission provides broader access across AU agencies and greater policy influence, but this doesn’t rule out targeted partnerships with entities such as the Africa CDC. “I still believe that despite the alleged management issues and financial issues, Africa CDC was established for the good of Africa, and this is a platform that will continue to convene member states,” this person said. Africa CDC told Devex the Saving Lives and Livelihoods program was always time-bound but considered one of their “greatest successes.” It added that it continues to engage with the Mastercard Foundation on future collaborations. It disputed the figures in the internal donor grants report and said it manages an active portfolio of over $150 million this year, with over $400 million directly intended for Africa CDC in the pipeline for next year, which would include new donors. This includes funds “formally committed,” the agency said, but declined to share a breakdown, saying details are confidential. “​​Far from donors ‘not coming to the table,’ Africa CDC is preparing for major partnership announcements,” the agency said. “Africa CDC is not in retreat — it is in transition: moving from short-term COVID-19 emergency funding toward long-term, Africa-led financing solutions. Our partnerships with Mastercard Foundation, Gates Foundation, and others have delivered historic results and continue to evolve.” And partnerships are still being launched. In July, the European Commission announced a nearly €9.4 million agreement with the Africa CDC and another partner. According to Kaseya, “the future of Africa CDC is brilliant — believe me.”