The Third Wave: Why African Governments Can't Afford to Ignore AI Philanthropic Capital

Who sets the terms?

The question is no longer whether philanthropic capital will shape Africa's health systems, because it will, but who gets to set the terms.

This article is not about African countries positioning themselves to receive the assumed AI money. It is about governing that capital. It moves in three steps: the financing break that is pulling philanthropy into the space aid is leaving, the decision logic of the newest philanthropic money, and the institutional response African governments and intermediaries are already building. I anchor on health and wellbeing.

The financing break: aid is shrinking, and philanthropy is stepping in

Official development assistance (ODA) from DAC members fell to $174.3 billion, a real-terms decline of 23.1% from 2024. This is the largest single-year contraction on record and returns ODA to roughly the level it was when the 2030 Agenda for Sustainable Development was adopted (OECD, 2026a; OECD, 2026b).

The decline was concentrated. Five donors (France, Germany, Japan, the United Kingdom and the United States) accounted for 95.7% of the total fall, with the United States alone responsible for about three-quarters of it after cutting its ODA by 56.9% (OECD, 2026a). The effect on the continent has been disproportionate. Bilateral ODA to sub-Saharan Africa fell by roughly 26% in real terms (OECD, 2026a), and The ONE Campaign put the decline in core bilateral aid to Africa at 23.9% for the year (ONE Campaign, 2026).

This is not a routine cyclical dip. It is a structural break in a financing model that many African health and education systems have depended on since independence.

Even before this contraction, ODA had ceased to be the dominant external financial inflow to the continent. It has been dwarfed for years by remittances (over $90 billion annually), foreign direct investment and, in countries with functioning tax administrations, domestic revenue itself. What makes this moment different from earlier aid contractions is what is rushing in to fill the vacuum, and of the available sources, one behaves differently from all the others: philanthropic capital.

Where philanthropy sits, and why that matters

Philanthropic capital occupies a strange middle ground. It moves like a grant, the way ODA does, but it answers to no electorate and no diplomatic counterpart. In the language of development finance, it is often classified as private development assistance: private money, deployed for public purposes, accountable to a board of trustees rather than a parliament or a foreign ministry.

ODA, philanthropic capital and FDI are three distinct forms of external capital, shaped by different actors, motivations, instruments and accountability structures.

That difference in accountability is the whole story. ODA, for all its paternalism, forces a degree of institutional alignment: projects are negotiated against national development plans, within a government-to-government framework that can be renegotiated, criticised or withdrawn from. Philanthropic capital rarely carries an equivalent obligation. It can fund a health ministry's stated priority in one grant cycle and pivot entirely away from it in the next, sometimes on nothing more than a change in a founder's interests or a foundation's internal data model.

Three roles philanthropy now plays

•         Catalytic, risk-tolerant capital. Where commercial investors see African infrastructure or health-tech as too risky, foundations increasingly provide first-loss capital or guarantees, absorbing early risk to draw hesitant FDI into a sector.

•         A growing domestic layer. African-led foundations are funding entrepreneurship and local economic ecosystems rather than emergency relief, a genuinely different posture from the "aid" model.

•         An ODA substitute. As Western aid budgets shrink, philanthropic money is increasingly asked to plug fiscal gaps in basic healthcare, education and climate adaptation, sectors that used to be the near-exclusive domain of government-to-government aid.

The third role should concern African governments most, because it changes how development happens, not just who pays for it.

Why the substitution isn't neutral

ODA, whatever its flaws, is slow because it is deliberately encumbered. Legislative cycles, government-to-government negotiation, and alignment with national plans all act as friction. Philanthropic capital has none of that friction. A foundation can deploy tens of millions of dollars on a single board decision, with no requirement to answer to the country's own development strategy.

The old development model assumed philanthropy would pilot ideas and fund health interventions that domestic budgets would not prioritise, while ODA or domestic finance scaled the ones that worked. That handoff depended on ODA still being there to receive the pilot. With ODA in structural decline, the second half of that model has largely disappeared, forcing existing public systems into triage.

The logic of the machine: a different decision rule

The newest and fastest-growing pool of philanthropic capital comes from technology and AI wealth, much of it organised around Effective Altruism (EA). EA applies quantitative, utilitarian reasoning to maximise measurable welfare gains per dollar spent. That is a materially different allocation logic from either traditional bilateral aid or conventional philanthropy, shaped by a donor class trained to think in terms of scalability and provable return.

The 2026 GiveWell–AMF grant

A concrete, current illustration is GiveWell's August 2026 announcement of a $276 million grant, its largest single grant to date, co-funded with Coefficient Giving, to the Against Malaria Foundation (AMF). The grant funds procurement and distribution of approximately 92 million insecticide-treated nets across all 26 provinces of the Democratic Republic of the Congo (DRC) between 2027 and 2029 (GiveWell, 2026a, 2026b).

It is the largest grant in a long series. Cumulatively, GiveWell has directed approximately $430.5 million to AMF for bed-net campaigns in the DRC over roughly the past decade. That steady escalation has made GiveWell the dominant funder of malaria prevention in the country, underwriting roughly two-thirds of its universal net-distribution network.

The system holding the grant

The DRC's health system is not simply a system with a malaria problem. It operates under severe financial and institutional constraints. World Bank analysis has estimated total health expenditure in the DRC at around $21 per person, with only about $2 per person coming from government. The same analysis identified low public spending, high household expenditure, dependence on external financing, and weak budget execution as major constraints (World Bank, 2024). Plainly put, the system has a major financing problem.

The ODA cuts described above are not simply a reduction in the money available. They change the environment in which philanthropic interventions operate. For decades, vertical programmes existed alongside a broader ecosystem of bilateral aid, government expenditure, multilateral financing and humanitarian funding. The results were often imperfect and fragmented, but the pieces collectively kept the system functioning. What happens when several of those pieces contract at once?

Verticalised, metric-bound giving

GiveWell's cost-effectiveness methodology answers one question: if we have a fixed amount of money, where can it produce the greatest measurable health benefit compared with simply giving people cash? That is a defensible question for an individual donor choosing between charities. It is a strange question to ask of a country whose entire health system runs on a tiny fraction of what multilateral institutions consider the minimum viable investment.

Every dollar in the DRC grant series is earmarked for a single commodity and its delivery, not for any part of health systems strengthening. GiveWell has been explicit that part of the rationale for structuring the funding this way is to observe how AMF, an external implementing organisation, manages logistics in a market that its own core budget largely bypasses. I do not claim access to the detailed thinking, modelling or allocation decisions behind the grant. But on the information GiveWell has made available, the methodology explicitly filters out horizontal health-systems-strengthening spending.

Interestingly, the grant expects the DRC to draw on its existing Global Fund allocations to cover local distribution costs in eighteen provinces, so it leverages existing systems. This is consistent with AMF's organisational footprint: the "direct campaign control" budget functions less as an in-country payroll and more as a fund to contract independent operators.

The debate between vertical financing and horizontal health-system investment is longstanding, and I will not linger on it here. The case for horizontal investment becomes considerably more complicated in fragile settings such as the DRC. But there is a danger that if we systematically favour what can be measured most cleanly, we underinvest in the very capabilities that make the measurable interventions possible.

Why African governments should care

Large pools of external capital can shape a health system even when they are not intended to.

•         National priorities. When external funders decide which diseases, populations, or interventions receive significant resources, those priorities can influence the health agenda alongside, and sometimes outside, national planning processes.

•         Talent. It can pull scarce talent out of public systems.

•         Parallel systems. Separate funding streams, reporting requirements, procurement arrangements, data systems and implementation structures make it harder for governments to build one coherent health system.

•         What counts as impact. What funders choose to measure becomes what is most visible as "impact."

•         Domestic reform. It can crowd out domestic reforms.

There is also a broader economic reason to care. Where money flows, capabilities can follow. A large health investment can strengthen domestic manufacturing, supply chains, logistics, research institutions, health-worker capacity and local organisations, or it can primarily finance externally procured goods and internationally managed delivery systems. These choices have different implications for a country's long-term economic and institutional capacity. Money is not just a resource. It is also a mechanism through which priorities, incentives, institutions and power are shaped.

GiveWell's internal pivot

GiveWell's research team has publicly acknowledged health systems strengthening as a necessary area of focus to prevent vertical investments from failing on the ground as supply chains and data systems erode. The organisation has begun accepting higher levels of structural uncertainty in order to fund technical-support work aimed at helping fragile states manage aid contractions.

In this reading, treating a single commodity as a standalone solution is an analytical flaw in a rapidly deteriorating ecosystem. When general system funding recedes, even well-designed vertical interventions are left stranded on a beach of broken infrastructure.

What are funders willing to trade off?

Beyond the commendable transparency around uncertainty and limitations, what are EA funders and the wider EA community actually willing to give up?

•         Some degree of allocative efficiency, for greater local decision-making power and agency?

•         Greater uncertainty, where an investment may strengthen the systems and institutions on which future health outcomes depend?

•         Some immediately measurable impact, in exchange for capabilities that keep producing value long after the grant ends?

Ultimately, what are we willing to give up to build stronger systems, institutions and local agency, and who gets to decide? I was encouraged by Prof. Mohamed Janabi's insights at UNGA81 on designing the next global health financing architecture, particularly his argument that countries must remain at the centre of decisions about what gets financed and how, and that primary health care should be central to these investments.

Saviorism, legibility and accountability

A structural analysis of allocation logic is incomplete without engaging the older critique it sits on top of. In 2012, the Nigerian-American writer Teju Cole coined the term "White Savior Industrial Complex" in an essay for The Atlantic. He argued that a certain mode of Western humanitarian intervention is oriented less toward the structural causes of need than toward the emotional and reputational needs of the donor, and that it typically proceeds without meaningfully consulting the people it is meant to help (Cole, 2012).

Applied to AI-era philanthropy, this critique points to two concerns beyond the efficiency-versus-equity tension already discussed.

1.       Psychological orientation. A donor model built around clean, quantifiable proof of impact, a fixed number of deaths averted or a fixed cost per net, gives funders a legible, defensible account of their own effectiveness.

2.       Structural continuity, regardless of intent. Because large foundations are accountable primarily to their own trustees or boards rather than to any electorate or treaty body, decisions that functionally set health priorities for entire countries carry none of the contestability of a comparable domestic budget decision.

Does the source of capital matter?

A further dimension specific to the AI-wealth cohort concerns the relationship between the source of the capital and the geography receiving it. The DRC supplies roughly 72 to 73 percent of the world's mined cobalt, a mineral central to lithium-ion batteries and, more indirectly, to the data-centre and computing infrastructure underpinning the broader technology economy (Cobalt Institute, 2026).

This is not a claim that any specific grant is causally linked to mineral-extraction conditions, nor that the individual donors involved bear direct responsibility for mining practices. It is a more modest observation about the wider economic relationship: capital generated substantially within a global technology economy that depends on Congolese mineral exports is, in part, being returned to the DRC as "charity" whose scope, timeline and metrics were set mostly outside the country. Whether that return is best understood as generosity or as a partial and informally negotiated form of reciprocity is a normative question this article does not attempt to resolve.

As a personal reflection: an allocation method optimised for provable, quantifiable impact, evaluated by a body accountable only to itself, will tend to produce interventions that are legible and defensible from the donor's side of the relationship, whether or not they reflect the priorities recipient governments and communities would have set given equivalent resources and equivalent authority.

Three reasons to act now

1.       Protect policy sovereignty from algorithmic decision-making. Capital organised around cost-effectiveness models tends to flow towards interventions that are relatively easy to quantify and demonstrate. That can favour commodities, digital applications and narrowly defined health outcomes over less visible but essential investments in workforce development, institutional capacity and resilient public systems. Cost-effectiveness analysis is an important tool for allocating scarce resources. The problem arises when a particular model of value becomes a substitute for public deliberation and national priority-setting. When governments lack the capacity or institutional authority to shape these decisions, agenda-setting power shifts to those who design the models, select the outcomes, and determine what counts as impact, often beyond the jurisdictions in which the consequences are felt.

2.       Stop the uncompensated drain on public infrastructure. Donor-funded campaigns, however "tech-native" or state-bypassing, still depend on public roads, cold chains and, critically, public-sector health workers. Without a mechanism that compensates the state for that borrowed capacity, a successful campaign can subsidise itself at the expense of routine services such as immunisation and antenatal care. The question is not whether philanthropic actors should use public infrastructure; they often must. It is whether the full cost of doing so is recognised, financed and incorporated into national health plans.

3.       Break the cycle of engineered dependency. Capital optimised for short-term, provable wins rarely funds local manufacturing, workforce training or institution-building. When the grant cycle ends, the fiscal gap it filled reopens, and the state has spent scarce administrative capacity managing someone else's pilot instead of building its own.

The continental response is already under way

African institutions are not starting from a blank slate. Over recent years, continental initiatives have begun to build the financial, procurement and policy architecture through which African countries can exercise greater collective influence over health financing. Three developments are particularly significant.

•         Direct fiduciary status. In June 2026, the Pandemic Fund's Governing Board accredited Africa CDC as an Implementing Entity. It is the first African Union institution, and only the second African institution after the African Development Bank, to hold that status, following a review of its governance, fiduciary systems, and operational capacity (Africa CDC, 2026a; Devex, 2026). Accreditation gives Africa CDC direct authority to receive, manage and deploy resources rather than channel them through external intermediaries.

•         Pooled purchasing power. Following a February 2024 African Union Summit decision, Africa CDC has been operationalising the African Pooled Procurement Mechanism (APPM), which aggregates member-state demand to negotiate as a single buyer (Africa CDC, 2025a; UNECA, 2024). Its first completed tender, covering ten priority reproductive, maternal and newborn health products across ten member states, achieved price reductions of 30–90% against national benchmarks (Africa CDC, 2026b). The mechanism is designed to favour African-manufactured products, supporting the continental goal of producing at least 60% of vaccine doses used in Africa by 2040.

•         A shared donor rulebook. The Lusaka Agenda, the product of a fourteen-month multi-stakeholder process, sets out five shifts for the major global health initiatives, including the Global Fund, Gavi, the Vaccine Alliance and the Global Financing Facility (GFF). They are toward primary health care integration, sustainable domestic financing and pooled rather than fragmented funding (Center for Global Development, 2024). It works alongside Africa CDC's New Public Health Order, which prioritises domestic pharmaceutical manufacturing and stronger public health institutions (Center for Global Development, 2025).

Sovereignty is not achieved through rhetoric alone. It requires institutions capable of receiving resources, setting conditions, aggregating demand, and holding partners accountable. The existence of these mechanisms does not mean all philanthropic capital is governed through them; their significance lies in the institutional possibilities they create and the opportunity for governments to build on them. The common thread is that each mechanism changes who sets the terms. The donor still brings the money, but the African institution decides the channel, the price and the priority.

African intermediaries: from conduits to institutions of accountability

Between continental architecture and the individual funder sits a growing layer of African-led collaborative funds, venture philanthropy networks and regional foundations. They perform three functions a foreign donor is poorly placed to perform alone.

•         Converting trust into flexibility. They turn large, unrestricted grants into flexible, trust-based funding for community-accountable organisations, replacing rigid external metrics with contextual judgement.

•         Gatekeeping technology. They insist that AI and digital-health tools interoperate with national health registries and respect data sovereignty, rather than build disconnected parallel systems.

•         Structuring blended finance. They design deals in which philanthropic capital absorbs early risk to crowd in domestic commercial capital, so a one-off grant becomes a sustainable local industry rather than a cliff-edge dependency.

There is an important caveat. An intermediary is not inherently more accountable simply because it is African-led, and intermediation can reproduce the same concentration of power it is meant to address. Its legitimacy must rest on its governance, transparency, decision-making arrangements and accountability to local actors, not merely its geography. The opportunity is to build institutions that translate capital into locally determined priorities without becoming another layer of control.

A practical policy checklist

For governments seeking to move from passive recipients to active stewards of philanthropic capital, three areas of reform deserve attention.

1.       Structural and administrative intermediation. Amend NGO/NPO legislation to distinguish direct foreign implementers from indirect funders. Consider requiring grants above a defined threshold to route through an accredited domestic or Pan-African intermediary, mirroring the logic Africa CDC already applies to Pandemic Fund resources. Consider a stabilisation levy on large vertical, disease-specific grants, directed to the system costs those campaigns rely on but rarely fund: health-worker salaries, clinic power and water.

2.       Labour, local industrial content and productive capacity. Tie tax and duty exemptions on donor-funded goods to minimum local-procurement thresholds. This turns distribution campaigns into a source of domestic manufacturing demand, the same principle behind the APPM's preference for African-made products. Public procurement, tax incentives and other policy instruments can also support African manufacturing, workforce development and local technical capacity. Where exemptions are offered to philanthropic programmes, governments could attach transparent local-content and capacity-building conditions, consistent with applicable law and procurement commitments. The objective is not to exclude international expertise or necessary imports. It is to ensure that external funding also builds the long-term capabilities African health systems need.

3.       Data, AI and capital governance. Require data localisation for AI and digital-health pilots handling patient or biometric data, with open, interoperable, state-compatible systems as a condition of operating. Require large philanthropic inflows to be escrowed through domestic financial institutions rather than held offshore, so that big grants also support local financial-market stability.

Guardrails: how these tools could go wrong

A sovereignty checklist is only as good as the government wielding it. Three risks deserve naming.

•         Turning the tools on domestic civil society. NGO legislation across the continent has often been used to restrict local organisations that monitor elections, corruption and rights abuses. Any new rule must apply to large foreign funders first, and must not become a back door for tighter control of domestic civil society.

•         Chilling the funding that communities need. Thresholds, levies and escrow rules that are badly calibrated can push out small and mid-sized funders and slow money to organisations already starved of it. Design should be proportionate, consulted on and phased.

•         Replacing donor capture with state capture. Intermediaries and pooled mechanisms need transparent governance, published data and community voice. Otherwise the gatekeeper simply changes address.

The test for every tool above is whether it shifts power toward the communities and institutions that carry accountability for outcomes, or merely toward whoever holds the pen.

The regulatory asymmetry, and two unkept pledges

One gap this checklist cannot resolve alone is well documented in Kenya. In October 2024, the government gazetted Legal Notice No. 157, granting the Bill & Melinda Gates Foundation privileges and immunities under the Privileges and Immunities Act, typically reserved for diplomatic missions and intergovernmental organisations, including tax exemptions and protection from certain legal proceedings (allAfrica, 2024; Citizen Digital, 2024). After the Law Society of Kenya petitioned that the notice undermined constitutional accountability, the High Court issued a conservatory order in November 2024 suspending the privileges pending a full hearing (Nairobi Law Monthly, 2024). The Foundation withdrew its host country agreement in April 2025 (People's Dispatch, 2025).

The Kenya case reflects a wider pattern: large foreign philanthropic and technical actors frequently secure, through host country agreements, derivative immunity via multilateral vehicles or bilateral co-financing arrangements, protections resembling those of sovereign states, while remaining accountable to boards of trustees rather than an electorate. Part of the explanation lies at home. Only a handful of states, among them Rwanda, Botswana and Cabo Verde, have consistently met the 2001 Abuja Declaration target of allocating 15% of national budgets to health (WHO, 2023, as cited in allAfrica, 2025). Fiscal dependence weakens bargaining power, and weak bargaining power invites exemptions.

That is why this asymmetry cuts both ways. Governments cannot credibly demand accountability from donors while underfunding their own health systems. Meeting Abuja is part of the sovereignty agenda, not a separate one.

What keeping the pledges could return

African governments have made two pledges that bear directly on this argument: 15% of budgets for health (Abuja, 2001) and 1% of GDP for research and development (African Union, 2007). Continental R&D spending averages about 0.45% of GDP, against a global average of 1.7%. Fewer than ten African countries spend more than 0.6%, and South Africa, Nigeria and Egypt account for almost two-thirds of the total. Africa holds nearly 19% of the world's population but only 1.1% of global R&D investment. The Africa CDC and Team Europe report notes that health research on the continent remains heavily dependent on foreign donors and exposed to shifting priorities. That is the policy-sovereignty problem from the start of this article, applied to science: whoever funds the research shapes what counts as a priority.

The same report models what keeping the R&D pledge could return. Under a scenario in which Africa invests 1% of GDP in R&D and directs 15% of that to health, the cumulative GDP gain over 20 years (2025–2044) reaches US$668 billion. GDP growth runs about 0.4 percentage points above baseline by 2030 and nearly one point by 2035 (Africa CDC & Team Europe, 2026). On the Abuja side, the African Union Commission's health commissioner told finance ministers in October 2025 that every US$1 invested in health yields up to US$10 in economic return (African Union, 2025).

These are modelled projections from institutions that advocate the investment, and the report counts economic returns only. They are best read as the order of magnitude of the case, not a forecast.

Where this leaves us

Holding a $200 million foundation grant to the same regulatory standard as a domestic advocacy NGO is arguably the highest-leverage reform available to African governments facing the next wave of AI-driven philanthropic capital. The institutional tools exist and are maturing quickly. What remains unresolved is the political will to apply them consistently to every donor, regardless of size or apparent efficiency, and to apply the same standard of openness at home.

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