"Africa’s ambitions for universal health coverage will depend on its ability to invest in the people who deliver healthcare, strengthen primary healthcare and build sustainable, African-led health systems."

This is what Professor Sheila Tlou told delegates at the University of Cape Town’s (UCT) 2026 Global Health Lecture.

Former Botswana Minister of Health and Chancellor of Botswana Open University Professor Sheila Tlou delivered the keynote address at the lecture, held at UCT’s Neuroscience Institute on 10 September under the theme Enhancing Our Healthcare Systems to Better Serve Africa’s Healthcare Needs.

Hosted by the Pan-African Health Sciences Forum (PAHS), the event brought together health leaders, academics, practitioners and students to consider what it will take to build more equitable and resilient healthcare systems across the continent.

For Tlou, the starting point is clear: “There is no health without a workforce.”

Putting Africa at the centre

Opening the lecture, programme director Dr Moses Isiagi traced the origins of the forum to the COVID-19 pandemic and a desire among African health academics and practitioners to create a platform centred on the continent’s priorities.

The objective, he said, was to create a space where Africans working in global health could engage with issues affecting the continent and pursue “African solutions for African problems”.

Over the years, the forum has convened conversations on global health equity, research and education and the development of health strategies from an African perspective. At its heart is a determination to ensure Africa and African expertise “take centre stage” in conversations about global health.

Introducing Tlou, Professor Graham Fieggen highlighted the combination of academic, political and public health experience she brought to the conversation, particularly her leadership during Botswana’s response to HIV.

He reflected on her tenure as Botswana’s Minister of Health from 2004 to 2008 and the impact of health policies implemented during that period.

Health systems begin with people

Tlou’s keynote examined the pressures African countries face as they work towards universal health coverage and the Sustainable Development Goals (SDGs).

At the centre of her argument was the health workforce.

Building resilient health systems, she emphasised, requires sustained investment in the people delivering care – from doctors and nurses to community health workers and other health professionals – and careful consideration of how they are trained, distributed, supported and retained.

Her emphasis on the workforce was closely connected to another priority: strong primary healthcare.

Health systems must be capable of reaching people where they live and responding to their everyday health needs, rather than concentrating resources only at higher levels of care. Drawing on lessons from Botswana and her wider public health experience, Tlou highlighted political commitment, investment in healthcare personnel and community-based approaches as essential ingredients for stronger primary healthcare.

These systems must also contend with increasingly complex pressures. Persistent communicable and non-communicable diseases exist alongside emerging biological threats, epidemics, climate change, conflict and displacement – placing additional strain on already stretched healthcare systems.

Building sustainable systems

Tlou also turned attention to one of the continent’s most pressing questions: who pays for Africa’s health priorities?

Heavy dependence on external funding can leave essential programmes vulnerable when global priorities and funding flows change. Strengthening health systems therefore requires African countries to increase sustainable domestic financing while protecting gains already made.

But financing alone is not enough.

Tlou called for stronger research and data to understand population needs, implementation of continental and global commitments, strengthened community systems, and policies grounded in equity, human rights and participation.

The COVID-19 pandemic reinforced the urgency of this agenda. While demonstrating how interconnected global health has become, it also exposed stark inequalities in access to essential health products and resources.

For Africa, the lesson is not to retreat from global collaboration, but to strengthen the continent’s own capacity to respond – including through greater self-reliance, local capacity and African-led solutions.

Turning policy into better care

A panel discussion chaired by Mr Sayuran Pillay extended the conversation from health policy to the realities of delivering care.

The discussion reinforced that health-system strengthening cannot be achieved by one profession, institution or government department alone. It requires collaboration between healthcare professionals, communities, policymakers, researchers and other partners – and, crucially, an understanding of how decisions made at policy level are experienced by patients and practitioners.

The conversation brought Tlou’s central argument into sharper focus: a health system is ultimately judged not by the strength of its policies on paper, but by its ability to deliver equitable, accessible care to the people it is intended to serve.

From conversation to action

In his closing remarks, Faculty of Health Sciences Dean Professor Lionel Green-Thompson reflected on the responsibilities of institutions such as UCT within this wider health landscape.

Universities occupy an important position at the intersection of health professions education, research, healthcare and society. Their role extends beyond generating knowledge: they can convene different voices, prepare the health workforce and help translate evidence and ideas into solutions that respond to communities’ needs.

For a Faculty training future generations of health professionals while contributing to health research across Africa, the discussion therefore poses an important challenge – to ensure that conversations about stronger African health systems are accompanied by action.

It is a challenge closely aligned with the purpose Isiagi described at the beginning of the evening.

Reflecting on the forum’s journey, he described it as a space for Africans to celebrate African expertise while remaining committed to finding “African solutions for African problems”.

At the close of the event, Isiagi thanked Tlou for being a “flag bearer”, particularly for Botswana, and for demonstrating leadership that continues to resonate beyond her country.

The message from the evening was ultimately less about identifying a single solution than about recognising what makes solutions possible: people, political commitment, sustainable investment and African leadership.

For Africa’s health systems, the task is to turn those ingredients into better care.