Africa’s New Public Health Order Needs Women at the R&D Top Table
By Prof Nothando Ngwenya (South Africa), Julie Muriuki (Kenya) and Marième Gueye (Senegal)
Africa is talking a lot about sovereignty right now. The Accra Reset initiative launched during the 2025 UN General Assembly centers health sovereignty in a broader effort to move away from aid-first development towards African-led investment, coordination and delivery, with stronger public health institutions, local manufacturing and domestic financing as core pillars. Health sovereignty is also a core pillar of the Presidential Declaration on Advancing Local Manufacturing of Health Products in Africa made during the 39th AU Summit in February 2026. But there is a missing piece in this vision – we cannot build health sovereignty while sidelining half our scientific brainpower.”
Women form the backbone of Africa’s health systems: WHO estimates that women make up around 70% of the global health and social care workforce, a pattern reflected in many African countries, yet they occupy only a fraction of leadership posts. At the same time, recent analyses of African universities suggest that roughly half of STEM graduates are women – among the highest shares in the world, but a 2024 analysis of African women in research finds that women still make up only about 33.5% of researchers in sub-Saharan Africa, and far fewer of those who serve as principal investigators, heads of institutes, funders or regulators. In other words, even where the pipeline is strong, we remain a minority in the spaces where R&D priorities and budgets are decided.
We have a systems problem – not a pipeline problem.
In Kenya, we have gender-aware policies and strategies, and a visible cadre of women in health service delivery and across the research pipeline. But the structure of research careers still assumes a “perfect worker” with no childcare or eldercare duties. Women who step back briefly for motherhood or caregiving pay a long-term penalty in eligibility, networks and visibility. Domestic funding for health R&D is still too small to anchor women-led, locally relevant research agendas; we are often at the mercy of external priorities that may not match our communities’ needs.
In South Africa, women are close to numerical parity in research: we make up about half of all researchers, and we are strongly represented in health and biomedical fields. Yet when you look at who leads major trials, sits on powerful committees, or directs big institutes, women suddenly thin out. Policies and funding instruments exist, but everyday systems – grant rules that punish career breaks, promotion criteria that reward uninterrupted publishing, care responsibilities that fall disproportionately on women – quietly push us out of the fast lane.
In Senegal, women carry much of the health and social sector on their shoulders, including community health work, yet are under-represented along the health R&D pipeline and in high-responsibility roles. Studies show that women are concentrated in the least secure, least remunerated community health positions, even as their labour is central to service delivery. In universities and research institutions, women make up under a third of academic staff and are scarce in governing bodies; leadership in the Ministry of Health and Social Action has improved but remains largely male at the top.
Different contexts, same message: women are not asking to be invited into a system that stays exactly as it is. We are offering to help redesign it.
The recently developed “Beyond Participation” framework and the emerging women’s health R&D scorecard developed by Speak Up Africa, Gawani Africa and Africa Center for Health Systems and Gender Justice, give Africa a practical way to do this. Instead of merely counting how many women are “in the room”, they ask three harder questions: Who actually leads? Who gets the grants, the lab space, the protected research time, the leadership training? Whose caregiving realities, safety, mentorship and mental load are recognized in how institutions are designed?
That is why we are calling on African leaders to make three shifts.
First, adopt a women’s leadership in health R&D scorecard as a companion to existing continental health and STI scorecards. That means tracking harmonized indicators at continental level and reporting progress using standard templates; discussing results in AU Specialized Technical Committees and similar governance meetings; and posting an annual continental brief on women in health R&D, co-issued by the AU Commission and Africa CDC, that names where progress is happening and where it is stalling. What gets measured gets debated – and what gets debated can finally get funded.
Second, move from donor dependence to domestically anchored, women-led R&D. We cannot talk about sovereignty with health R&D budgets that depend almost entirely on external partners. We are asking national treasuries, parliaments and ministries of health and science to create and protect health R&D budget lines, with explicit recognition that women-led, locally relevant research is a public good; to set medium-term targets for the share of clinical trials fully funded by domestic resources – and track how many of those are led by women principal investigators; and to make “researcher” a high-status public service career, with promotion pathways that recognize leadership and mentoring, and with transparent, gender-responsive criteria that do not punish maternity or caregiving breaks.
Third, fix institutions so women can stay, progress and lead. Universities, institutes, hospitals and regulatory bodies need the following key reforms: protected research time, especially for those juggling teaching, clinical work and family care; anti-harassment policies and safe reporting mechanisms that are actually enforced, not just filed; gender-responsive grant rules that factor in career breaks, offer return-to-research fellowships, and allow childcare costs in budgets; and minimum thresholds for women’s representation – at least 40% – on ethics committees, grant panels, trial steering committees and boards, with public disclosure of their membership and gender balance.
From South Africa, we have seen how national women-in-science awards and mentorship schemes can boost visibility and confidence – and how much more powerful they could be if extended to district level and coupled with serious institutional reform. From Kenya, we know that without domestic funding and flexible, care-aware career structures, even the most talented women will keep dropping out of leadership tracks. From Senegal, we see the cost of not joining up gender equality strategies with concrete health R&D reforms and STEM pipelines for girls.
If Africa is serious about health sovereignty, women cannot remain the invisible backbone of the system. We must be recognized, resourced and trusted as its architects.
