Josephine Barasa was the woman girls in her corner of Kenya turned to when nobody else would help. They called her a “mother mentor”, though her actual job was community health worker and gender-based violence champion. She walked young women, many barely out of childhood themselves, through pregnancy, fear and the confusion of early motherhood, teaching them when to vaccinate their babies, how to breastfeed and when a fever meant a trip to the clinic rather than a wait at home. 

Then, one afternoon in January, an email arrived just after 2pm. It was brief: “We are sorry. We no longer need your services.” Barasa describes freezing, then going silent for four days. For a woman whose entire working life had been built on being able to speak, to guide, to help, losing her funding felt like losing her voice entirely. 

Her story is not an isolated setback. It sits inside a set of figures captured by the Gates Foundation’s 2025 Goalkeepers Report, We Can’t Stop at Almost, which shows how fragile progress in maternal and child health has become across the region Kenya belongs to. For the first time this century, child deaths are set to rise. In 2024, 4.6 million children died before their fifth birthday. In 2025, that number is projected to climb by just over 200,000, to an estimated 4.8 million. 

Kenya: a mother mentor’s silence becomes a warning sign for maternal health 

Five days after her funding ended, Barasa and her team were brought in for a debrief. Surrounded by the wreckage of a programme that no longer existed, she found the words slowly returning, and with them, a realisation that they could take away the money, but they could not take her away from her women. 

In February, she went back to work anyway, unofficially and unpaid. She still screens women for gender-based violence and offers basic health education to their children. The support systems may have disappeared, she says, but the need has not, and neither has she. Her team has been going door to door, to churches, mosques and community centres, asking for small donations or simply a place to meet. 

The Goalkeepers data puts numbers to that strain. The global maternal mortality ratio stood at 188 deaths per 100,000 live births in 2024, having improved by just 4.6 per cent since 2015, a sharp slowdown from earlier decades. Sub-Saharan Africa carries by far the heaviest burden, with 387 maternal deaths per 100,000 live births, more than double the global average. Reaching the Sustainable Development Goal target of 70 by 2030 would require a 15 per cent annual rate of reduction, roughly thirty times the pace achieved since 2015. 

Kenya’s government has, in Barasa’s account, begun stepping in where it can. “It is a start,” she says. But the pattern she describes, women and children falling through gaps left by sudden funding withdrawal, echoes across the wider region and sets the tone for the rest of this scoreboard. 

East Africa: from a brother’s fever to a gene drive built to outrun malaria 

Travel north-west from Kenya into Uganda and the story shifts from maternal health to malaria, though the underlying theme, fragile progress threatened by funding cuts, remains the same. 

Krystal Mwesiga Birungi’s earliest memories are of her younger brother convulsing with fever while their mother tried desperately to cool his body. He had malaria. The family knew treatment existed but could not afford it. She herself caught malaria as a child, and the pain was so severe she sometimes wished it would simply end. Even mosquito nets were out of reach for her family. Her mother once told her, “Nets are for rich people.” 

Everything changed when the Global Fund to Fight AIDS, Tuberculosis and Malaria arrived in Uganda. Birungi was fourteen, and suddenly nets and medicines were distributed free of charge. That intervention gave her a future and a purpose. She is now an entomologist with Target Malaria at the Uganda Virus Research Institute, developing gene drive technology, a method of spreading a genetic trait through a mosquito population far faster than nature would normally allow, so malaria-transmitting mosquitoes become less able to reproduce or pass on the parasite. A year before her account was written, her own son turned five. In Uganda, one in twenty-five children dies before that birthday, most from malaria. When he blew out his candles, she says, all she could think was, “he is alive, he made it.” 

On the Goalkeepers scoreboard, Sub-Saharan Africa recorded 194.5 malaria cases per 1,000 people at risk in 2024, more than twenty times the next closest region. Malaria is the one indicator among the eight tracked that has moved backwards since 2015: global incidence has risen 3.2 per cent, and the 2030 projection of 33.3 cases per 1,000 people misses the target of nine by a wide margin, even as a better-case scenario shows a possible fall to 22. 

Dual-insecticide bed nets, used across seventeen African countries, are credited with preventing more than 13 million malaria cases, for a little over a dollar per person. New tools include single-dose cures capable of clearing certain types of malaria with just one pill. Taken together, the report’s modelling suggests that a broad portfolio of new malaria tools, deployed effectively, could save 5.7 million children’s lives by 2045. 

Africa: ghost workers, real budgets and a continent choosing resourcefulness over rescue 

In Nigeria’s Gombe State, Governor Muhammad Inuwa Yahaya inherited a historic budget deficit in 2019. The health system received only 3.5 per cent of the state’s total budget, and trained staff were often absent. Rather than waiting for outside rescue, Yahaya’s government focused on the basics: primary health, education and trust. Today, Gombe has 114 renovated or newly built primary health centres, one in every ward, and more than 300,000 people are enrolled in the state’s health insurance scheme, all funded from the existing budget. Introducing biometric attendance for health workers uncovered 500 “ghost workers” on the payroll who did not exist. Addressing this saved the state ₦2.8 billion, roughly $1.8 million (Ksh232m) reinvested into training, hiring and expanding care. His conclusion is that governments do not need perfect conditions to make progress, only clarity and the courage to stick to it. 

Further west, in Senegal, Dr Awa Marie Coll Seck, a former two-time Minister of Health, remembers hospital wards filled with children suffering from measles, some left with permanent brain damage. With support from Gavi, The Vaccine Alliance, Senegal strengthened its routine immunisation system, and measles cases fell from a high of 24,000 in 2000 to just hundreds in recent years. Her story illustrates a broader point: every dollar spent on immunisation returns $54 (Ksh6, 966) to countries, yet that progress remains fragile, because any slip in routine coverage allows diseases to return at a cost far higher than staying on track. 

These accounts sit against stubborn continental disparities. Sub-Saharan Africa tops the burden ranking on almost every indicator tracked: under-5 mortality at 66.9 deaths per 1,000 live births against a global average of 36.1, neonatal mortality at 23.6 against 16.0, tuberculosis incidence at 260 new cases per 100,000 people against a global rate of 111 and neglected tropical disease prevalence at 28,674 cases per 100,000 people, more than double the global figure. On HIV, the region records 1.087 new infections per 1,000 people, against a global rate of 0.246. 

Neglected tropical diseases are what the report calls “the quiet success story”, with Sub-Saharan African prevalence having fallen 37 per cent since 2015, the largest sustained reduction of any indicator tracked. Tuberculosis incidence has dropped 28 per cent since 2015, even though the region’s burden remains many times higher than the global 2030 target of twenty cases per 100,000 people. 

Global: Bill Gates’s warning that falling aid could cost 16 million more child lives 

The Gates Foundation worked with the Institute for Health Metrics and Evaluation at the University of Washington to model what happens if health funding continues to fall. A 20 per cent cut in official development assistance for health, the scale some major donors are considering, could cause an estimated 12 million more child deaths by 2045. A 30 per cent cut could push that toll to 16 million. 

Global HIV incidence fell to a record low of 0.246 new infections per 1,000 people in 2024, a 23.1 per cent improvement since 2015. Yet the report says disruptions to funding have already turned that decline around, with incidence projected to rise again to 0.268 by 2030, more than ten times the target of 0.02. Against that trend, the report also describes innovation: Lenacapavir, a twice-yearly injection offering long-acting HIV prevention, already exists, and a once-yearly version may arrive as soon as 2028. Expanding twice-yearly coverage to just four per cent of high-incidence areas could prevent up to 20 per cent of new infections. 

Nearly half of all child deaths occur within the first month of life, often too quickly for standard immunisation schedules to help. Maternal vaccines against respiratory syncytial virus and Group B streptococcus immunise pregnant women so antibodies pass to the baby before birth, described in the report as fitting a newborn with a suit of armour. RSV vaccine rollout has begun in high-income countries and is being extended through Gavi to lower-income countries, where most deaths occur. Scaling these RSV and pneumonia-related immunisation products, the report estimates, could save 3.4 million children’s lives by 2045. 

Text by: Yvonne Kawira 

Data visualisation: Stanley Njihia