US philanthropist and Microsoft co-founder Bill Gates has praised Burkina Faso, Mali, and Niger for maintaining relatively stable and effective healthcare systems despite military rule, while urging Nigeria, particularly its northern states, to urgently strengthen its public health response.
Speaking during a recent roundtable with The Africa Report, Gates highlighted that although political situations in these military-led governments vary, their health sectors in stable regions have remained intact and functional.
“Some of those countries run, within the areas of stability, pretty decent health systems,” Gates said.
“Burkina Faso also runs a good health system. That has not changed,” he noted.
In sharp contrast, Gates expressed serious concern over healthcare in northern Nigeria, especially Sokoto State, which he said trails behind Niger in vaccination coverage.
“I wish that Sokoto, which is a state up here, could have nearly the vaccination rate that Niger has. It’s much worse, much lower. More children die because the primary healthcare system is not as well run as it is in Niger,” he explained.
Gates emphasized that northern Nigeria suffers from the lowest vaccination rates in Africa, lower even than Somalia, despite having a larger child population than several conflict-affected countries combined.
“The Sahel is tough, but more children live in northern Nigeria than in all those other countries combined, and that’s where we have the lowest vaccination rates in Africa. Even lower than Somalia.”
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While other African nations like the Central African Republic, South Sudan, and the Democratic Republic of Congo continue to face challenges in healthcare delivery, Gates noted northern Nigeria stands out due to the sheer number of children affected.
Also participating in the roundtable, Dr. Paulin Basinga, the Gates Foundation’s global director for policy, advocacy, and communication, explained that military regimes in Mali, Burkina Faso, and Niger have generally not disrupted existing health leadership.
In Burkina Faso, for instance, the military retained the same health minister, contributing to continuity in healthcare delivery. “It’s actually more stable than many other places,” Basinga said.
He credited the Foundation’s close work with local partners for building trust in these regions and cited Mali’s former health minister, Sambo Sow, as a key figure in maintaining the resilience of Mali’s health system during political transitions.
Gates acknowledged some positive steps by Nigeria’s Health Minister Ali Pate, including a recent $200 million increase in the federal health budget for 2025 aimed at averting a looming crisis after significant US foreign aid cuts under the Trump administration.
However, he stressed that this funding falls far short of what is needed. “There’s no way the government can cover all of that shortfall. I mean, they’ll fund some things. They’ve got an extra $200m, but that’s nowhere near enough to replace the money that’s disappearing.”
Gates warned that the situation may worsen as cuts to funding for UNICEF, Gavi the Vaccine Alliance, and other multilateral health organizations by the US take full effect.
He also expressed concern over similar aid reductions by other Western countries such as the United Kingdom and Germany, which have cut foreign aid by around 40% to increase security spending, moves he said will have deadly consequences.
“But, you know, I’m very upset about it, and we’ll see more HIV deaths, more malaria deaths, more maternal deaths. There’s just no denying that the money was being well spent and there’s no alternative source that comes close to what was previously available,” Gates stated.
Despite being Africa’s most populous country and a regional economic leader, Nigeria continues to struggle with significant healthcare gaps, especially in its northern states.
Gates’s message was clear: while political instability has not destroyed public health systems in neighboring countries, Nigeria’s lack of commitment has allowed its healthcare crisis to deepen.
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