There is a huge mismatch at the heart of global health, and it’s time we talk about it openly.
Think about this for a second. Africa carries roughly 25% of the global disease burden, yet our continent consistently generates less than 2% of the world’s research output.
As the Democratic Republic of Congo battles yet another exhausting Ebola outbreak, the world is reminded that sub-Saharan Africa is the front line for global health security. Yet, the data driving the interventions, the clinical trial designs, and the post-outbreak analyses are still largely coming out of institutions housed elsewhere around the world. This isn’t just an academic issue; I see it as a critical flaw in how we protect our people.
For the East, Central and Southern African Health Community region, where I work, I believe the time has come to stop being the world’s premier data source and start becoming its premier data author.
For decades, our region has been home to brilliant, highly qualified scientists. But let’s be honest about how the system usually works: it’s an extraction model. External experts fly in with pre-funded protocols, look at our epidemiological gaps, publish the findings in high-impact international journals, and leave. This creates a massive misalignment.
External investments have been instrumental in advancing research and improving health outcomes across Africa. As we look ahead, greater investment in country- and region-led research agendas is essential to complement global priorities, strengthen health systems, generate locally relevant evidence, and deliver sustainable, high-impact solutions that respond to the continent’s evolving needs.
The real issues, like implementation research on local supply chain bottlenecks, cross-border health surveillance during regional outbreaks, social, cultural, and behavioral factors that influence community engagement and health-seeking behaviors often remain underexplored and insufficiently documented. If we don’t systematically put our own gaps in writing through a formal, region-led research agenda, those gaps remain invisible to the literature. We simply cannot fix what we haven’t professionally documented.
The true cost of outsourcing our science is felt right at the policy level. When a Ministry of Health receives a stack of recommendations generated by an international consortium, that report usually just sits on a shelf. The path to actual policy implementation is painfully slow.
There is an undeniable, practical value in local ownership. I have observed that when research is conceptualized, cleared, and led by local scientists within ECSA-HC member states, governments actually trust the data. They show a significantly higher willingness to adopt and fund the recommendations because local generation of data fosters political trust. Local leadership also radically speeds up timelines. Navigating ethical clearances, getting community consent, and dealing with local administrative protocols is inherently faster when led by local principal investigators who know the terrain, rather than external teams.
The good news is that the global funding landscape is shifting. Major international donors are finally realizing that top-down research doesn’t last. There is a growing, explicit demand for grant applications to be country-led and sub-Saharan Africa-based. But here is where we hit a roadblock. When these massive, multi-million-dollar calls for protocols are announced, our regional teams often feel incapacitated. We have the qualified experts, but they lack sustained exposure to the rigorous, high-stakes grant architecture required to design a protocol from inception to complex financial management.
By coming together under a unified ECSA-HC research agenda, we can change the game fundamentally. First, we explicitly lay out exactly where information is missing and decide whether we need implementation research, clinical trials, or health systems evaluation. Second, we move away from isolated country teams and act as a formidable regional bloc capable of winning complex grants. Finally, we ensure that financial resources are mobilized by regional institutions, allowing us to build up our own laboratories, data systems, and administrative muscle for the long haul.
To get where we need to be, the ECSA-HC is taking an unapologetic lead. It is high time we document our own gaps, write our own protocols, manage our own resources, and author our own solutions. Only when we truly own our research agenda will we close the gap between the health burdens we carry and the science we create.
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