Every September, the world’s leaders descend on New York for the United Nations General Assembly (UNGA). Lofty speeches fill the halls, cameras flash, and declarations are signed with solemn ceremony. Yet for too many in Africa, these moments leave a bitter aftertaste. Grand promises made in New York rarely translate into tangible change in Nairobi, Lagos, Kinshasa, or Cape Town. Instead, the cycle of rhetoric repeats, and the gap between global ambition and lived reality on the continent widens.
This year, the 80th session of the UNGA cannot be another ritual of words without action. The stakes are too high, the crises too deep, and the costs of delay too devastating.
September 2025 offers a defining test for Africa. On 25 September, heads of state will adopt a new political declaration on noncommunicable diseases (NCDs) and mental health conditions during the Fourth High-Level Meeting on the issue. This gathering, set against the theme “Equity and Integration: Transforming Lives and Livelihoods Through Leadership and Action”, is an opportunity for genuine transformation. But it will only matter if Africa comes prepared—not as scattered national delegations with competing priorities, but as a unified bloc that insists on fair financing, equity in global governance, and genuine space for African leadership.
What global health needs in 2025 will not be satisfied by another glossy declaration. The test ahead lies in whether financing will finally be tied to accountability rather than empty pledges, whether equity will be placed at the centre so the Global South is no longer treated as a guest at decisions about its future, whether urgency will extend beyond pandemics to include Universal Health Coverage, maternal health, and the workforce crises, and whether clarity of leadership can replace the fragmentation that weakens the UN system and the WHO alike.
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The question is simple: will Africa continue to be a spectator at the global stage, or will it assert itself as a decisive player shaping the future?
The global health agenda has long promised equity. Yet Africa’s realities tell a different story. Health systems remain fragile, with underfunded infrastructure and chronic shortages of health workers undermining access to care. Essential medicines and technologies remain out of reach for millions. Climate-driven health shocks—from deadly floods to heat-related disease—are intensifying, while recovery from COVID-19 is far from complete.
Universal Health Coverage, maternal health, and workforce crises are no less urgent than pandemic preparedness, yet they consistently receive less political attention. Without mechanisms to tie financing to accountability, declarations risk being nothing more than political theatre. Too often, leaders pledge billions in New York, but when the spotlight fades, delivery on the ground falters. For communities across Africa, these failures are not abstract—they are measured in lives lost, livelihoods destroyed, and futures diminished.
The international landscape has grown even harsher. Traditional funding streams are shrinking as donor fatigue sets in, while geopolitical tensions redirect attention and resources elsewhere. The recent executive actions of the United States to withdraw from the World Health Organization have further destabilised multilateral health financing and created uncertainty about the future of global health leadership.
Meanwhile, conflict zones stretch international capacity to respond, leaving fewer resources for Africa’s pressing needs. Within the UN itself, fragmentation across agencies erodes effectiveness, with overlapping mandates weakening collective impact. Unless Africa articulates clear, coordinated demands, decisions about the continent’s future will continue to be made without its meaningful input.
For Africa, the costs of passivity are existential. Climate change is already eroding health gains, driving food insecurity, and displacing communities. Youth unemployment threatens to become a generational crisis, locking millions out of opportunity. Mounting debt burdens undermine the ability of governments to invest in health, education, and social protection.
If Africa arrives at UNGA 2025 without clear priorities, others will define the agenda. If Africa fails to demand climate justice, fair financing, and equitable health governance, the continent risks another cycle of promises without progress. The time has come to move beyond dependency and claim ownership of solutions. Africa cannot remain a guest at decision-making tables where its future is negotiated.
None of this diminishes the symbolic value of the United Nations. Eighty years ago, from the ashes of war, the UN was founded on the promise of peace and collective action. As António Guterres reminded the world this June: “Eighty years ago, from the ashes of war, the world planted a seed of hope. One Charter, one vision, one promise: that peace is possible when humanity stands together.”
But symbolism is not enough. From Gaza through the Democratic Republic of Congo to Sudan, the link between peace and health is painfully clear. There can be no health without peace and no peace without justice. For Africa, standing together at UNGA 2025 means rejecting the old cycle of per diems, photo-ops, and empty speeches. It means coming to New York not as beggars but as builders of global solutions.
The time for games is over. The 80th UNGA must not be a ceremonial trip for selfies and soundbites. It is a strategic battlefield where the future of Africa’s health, climate resilience, and youth opportunities will be contested. Africa’s leaders must treat it as such.
We must arrive with evidence-based solutions, coordinated priorities, and the courage to demand reforms that matter. We must speak with one voice, leveraging our collective strength to secure climate justice, fair financing, and equitable health governance. Anything less would be a betrayal of the millions whose lives depend on decisive leadership.
This decisive leadership must come from the AU.
If Africa walks into this UNGA “unprepared”, which most likely is going to be the case, we will leave with nothing. But if we rise together—with clarity, urgency, and unity—we can transform this anniversary into a turning point.
Africa does not lack frameworks for health. The African Union has adopted strategies, created the Africa CDC, and even launched the African Medicines Agency to harmonise drug regulation. These institutions show that the continent can design collective solutions. During COVID-19, the Africa CDC proved Africa could act as one—coordinating surveillance, negotiating vaccine access, and pushing for local manufacturing. That moment revealed what is possible when Africa rises above national silos.
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Yet the truth is sobering. Too many AU health commitments have gone the way of the Abuja Declaration, where governments pledged 15% of their budgets to health but rarely delivered. Fragmentation across Regional Economic Communities slows progress, and heavy reliance on donor financing keeps Africa dependent on external agendas. The African Medicines Agency, launched with fanfare in 2021, still lacks the ratifications and resources to function fully. Without consistent investment and accountability, Africa’s health coordination remains a patchwork rather than a united front.
This is exactly why UNGA 2025 matters. If Africa repeats the old pattern—arriving with declarations but no financing, fragmented voices, and vague priorities—others will define the agenda for us. But if leaders use the AU’s structures to align evidence-based proposals and push for fair financing, climate justice, and equitable health governance, then coordination can shift from rhetoric to power.
This is Africa’s chance to prove that it is not a guest at the table, but a force shaping the future.
Luchuo Engelbert Bain is Head of International Programs at the African Population and Health Research Center (APHRC), Nairobi, Kenya, with keen interest in health politics, science communication, diplomacy, and advancing meaningful decolonization of global health knowledge systems through African-led leadership and innovation.
