In what was his first visit to Nigeria after he announced plans to give away $200 billion to end preventable deaths of mothers and children, eradicate deadly infectious diseases, and lift millions of people out of poverty, Bill Gates, Chair of Gates Foundation, last month, reiterated his call for innovative African-led solutions to drive health, equity and economic impact in Nigeria and Africa. Speaking to ThisDay and a select crop of reporters, the Gates Chair, in a recent media roundtable which took place ahead of the first ever Lagos edition of the Goalkeepers event, harped on the transformative power of AI and innovation to tackle health and economic inequalities in Nigeria and across Africa. writes that he also tackled questions on innovation, global hunger, health access and equity, partnerships, Primary Healthcare, vaccine coverage and the distrust around it, maternal deaths, and most importantly, why the 200 million dollars he pledged to donate for the next decade will have a large portion of that focused on the African continent

What really drove me was the data I encountered. The statistics were alarming. For example, attendance at primary care was barely 10 per cent. Access to both primary and secondary care was just around 25 per cent, far below the expected 90 per cent. Immunisation coverage was at 14 per cent and in some areas, as low as 3.5 per cent. Meanwhile, the number of out-of-school children was around 580,000. 

When I looked at those figures, it became clear that I needed to prioritise both health and education. I knew we had to reach people in underserved areas. That’s what led me to commit to upgrading the primary healthcare system.

Initially, I set a target to commission one primary healthcare centre per week. We managed to scale that up — we now commission two centres per week. We’ve rehabilitated close to 150 centres, and we’re still expanding. This was a deliberate decision because I knew that without access, we wouldn’t achieve meaningful results.

The outcome has been promising. Today, immunisation coverage has increased to about 50 per cent and access to primary care is now between 40 per cent and 45 per cent. We’ve also improved maternal and child health outcomes. Mortality has declined, absenteeism among health workers has reduced, and we’ve motivated staff better. But of course, challenges remain — and we’ll get to those shortly.

The Gates Foundation began in 2000 with the belief that all lives have equal value. I started by asking: Why are children dying? What do they die of? Where do they die?What I found was shocking. For instance, in northern Nigeria, a child is 50 times more likely to die than in a high-income country. And that’s without war — it’s one of the worst places in terms of child and maternal survival.

I looked around and asked, are medicines being made cheaper? Are they being tailored for the people who need them most? Are we investing in new tools for malaria or child survival? Back then, the answer was mostly no. That motivated us. Over 70 per cent of the $100 billion we’ve spent in the past 25 years has gone to global health. We’ve built strong partnerships across Africa, including Nigeria. We work with governments, because they are ultimately responsible. Our role is to help accelerate progress.

Improved health drives economic growth. You see that in Asia — when countries invest in health, they grow faster and become self-sufficient. We believe African countries are heading in that direction. So our focus is to help speed up that journey, identify local challenges, and find solutions through partnership.

In 25 years, childhood deaths have dropped from nearly 10 million to under 5 million globally. I believe we can cut that in half again. Yes, foreign aid is shrinking — unfairly so, in my view — but the gains we’ve made are incredible.

Tools like cheaper vaccines for rotavirus and pneumococcus, malaria treatments, and prevention of mother-to-child HIV transmission — all that has made a huge difference. We also track vaccine coverage closely. Some African countries now outperform the U.S. in that regard. If we can spread best practices across countries, we can do even more.

 Yes, performance is critical. In some places, health workers were not even showing up to work regularly. That’s why we introduced biometric systems to monitor attendance and improve accountability. But beyond that, the issue of funding was also key. When we came in, the budgetary allocation to health was only around 3.5 per cent. We’ve scaled that up significantly — to between 20 per cent and 40 per cent in some areas.

This has allowed us to align resources properly and give our workers the support they need. It’s not just about having money, it’s about how you spend it — and we’ve tried to ensure that every bit of energy and funding is used effectively.

Absolutely. Even with tight budgets, when countries focus on workforce performance and primary healthcare, we see results — fewer childhood and maternal deaths, better nutrition rates. AI is also playing a role. Not just global AI, but local African entrepreneurs are developing AI solutions tailored to their own needs.

Africa is getting richer. Rich countries will return to offering support, and new tools — like those for sickle cell disease — are emerging. So, when you combine innovation and growth, I believe the next 20 years can outperform the past 25.

It must be. Look at what we’ve done in other sectors. In petroleum, we built a refinery with a capacity of 650,000 barrels, the largest of its kind. In May alone, we exported 400,000 metric tonnes of petrol. If we can do that in oil, we can do the same in health. We must stop medical tourism. We must produce our own drugs. If any of us fall sick — myself included — we shouldn’t have to go abroad for treatment. We also need strong partnerships to get this done.

Yes, our partnership has covered everything — from fighting polio to improving primary health care. We’ve worked not just in Nigeria but in neighbouring countries too. Having leaders who understand their country deeply helps us tailor solutions that work. That’s what makes the work fun and impactful.

I’d say, understand yourselves and your environment. Recognise your challenges and find homegrown solutions. We have the talent. Use your government role to unleash it, use innovation like AI, and engage with global partners. But the will and the sustainability must come from us.

What’s amazing about Africa is its youth. This continent will account for more than half of all births this century. Cities like the one we’re in will be the largest in the world. That youth is Africa’s power. Whether it translates into real progress depends entirely on the decisions we make in the next 20 years — especially around health and education. If we get those right, the future is extraordinary.