The health workforce crisis on the African continent is not simply a numbers problem – it is a structural one. Our work supporting the development of the African Union Health Workforce Compact, which engaged all 55 AU Member States, revealed that while 21 Member States have dedicated health workforce strategies, critical gaps persist across the continent in both specialist availability and workforce retention. Career development pathways remain insufficiently defined in many countries, driving demotivation and attrition among key cadres including midwives, anaesthesiologists, and medical specialists. Meanwhile, in countries with high maternal mortality, severe shortages of skilled midwives and emergency obstetrics specialists continue to cost lives – a pattern that demands urgent, coordinated continental action.
The findings on specialist shortages extend well beyond maternal health. Across the continent, critical fields including paediatrics, cardiothoracic surgery, psychiatry, orthopaedics, and geriatrics face widespread deficits. Perhaps most strikingly, the shortage of biomedical engineers is so acute that some countries are flying in engineers from high-income countries simply to maintain existing equipment — an unsustainable and inequitable arrangement that underscores the need for long-term domestic capacity investment. These are not peripheral challenges; they sit at the heart of health system resilience.
Our 2025 work also took us inside the regulatory processes shaping access to novel TB diagnostics across five African countries, in a project funded by The Gates Foundation. In Ethiopia, TB in vitro diagnostics classified as priority IVDs can move from application to marketing authorisation in under a month through a fast-track process — a model that demonstrates what is possible when political will and regulatory design align. In Kenya, a full IVD evaluation can take up to two years, though expedited pathways of four to seven months exist. Understanding and documenting these timelines is essential: faster, more predictable regulatory processes are not a technical nicety — they are a matter of equitable access to life-saving tools.
Our 2025 work also took us inside the regulatory processes shaping access to novel TB diagnostics across five African countries. The contrast between pathways was striking. In Ethiopia, TB in vitro diagnostics classified as priority IVDs can move from application to marketing authorisation in under a month through a fast-track process – a model that demonstrates what is possible when political will and regulatory design align. In Kenya, a full IVD evaluation can take up to two years, though expedited pathways of four to seven months exist. Understanding and documenting these timelines is essential: faster, more predictable regulatory processes are not a technical nicety – they are a matter of equitable access to life-saving tools. This urgency is underscored by WHO’s March 2026 recommendations on near-point-of-care molecular tests for TB diagnosis – the first of their kind – which introduce new testing technologies and sample types designed to reach patients at the community level. As these tools move from global guidance into country implementation, the regulatory groundwork we mapped will matter more than ever.