The rumba band paused for a moment as the presidents of the Democratic Republic of Congo and South Africa walked down a red carpet together to lunch in a garden pavilion in Congo’s presidential residence.
Watching with satisfaction a few yards away was Dr. Jean Kaseya, the director general of the Africa Centers for Disease Control and Prevention, known as the Africa C.D.C. A Congolese physician with a punishing work ethic, a PowerPoint presentation for seemingly every occasion and a taste for shirts embroidered with his own name, he had convened the presidents to discuss the Ebola epidemic, which so far has killed more than 3,300 people in eastern Congo.
On a continent long accustomed to Western agencies and foreign donors driving emergency responses, Dr. Kaseya is pushing for a major shift — one made increasingly urgent by shrinking Western aid budgets. Jetting around Africa, he is pushing the continent’s presidents to take financial and political ownership of public health. He says it is a question of African sovereignty.
“This response is led in Africa by Africans, for Africans, with support from our partners,” he told the two presidents — and some of those Western “partners,” or donors — at a meeting after the fancy lunch in July. “It’s not the reverse.”
The devastating 2014 Ebola outbreak in West Africa convinced the African Union that the continent urgently needed its own C.D.C. It was launched in 2017. Dr. Kaseya, who took office in 2023, is only the second person to hold the leadership position.
His leadership has split opinion in global health circles. To supporters, he has a clear vision for the continent and the ability to see it through, and he has elevated the Africa C.D.C. into a formidable political force.
To critics, his tenure has been turbulent and his style abrasive. According to investigative reporting last year by Devex, a news outlet covering global development, extravagant spending on travel and meetings has raised some funders’ concerns, and some donors no longer want to work with the Africa C.D.C. because of Dr. Kaseya’s leadership. Dr. Kaseya said that in response to some of the earlier Devex reporting, he launched institutional reviews that ultimately did not substantiate its accusations.
As proof of his success, he pointed to the Africa C.D.C.’s rapid growth in funding and spending; 12 recent audits, with all problems resolved on schedule; and an official African Union evaluation this year that recently rated his performance as “Outstanding.”
But there has been turmoil on his staff.
This year, Dr. Kaseya ordered three of the agency’s five regional directors, whom he had appointed, back to headquarters, saying they had been rejected by their host countries. They fought the decision, complaining to an African Union tribunal, which ordered them reinstated. The standoff ended in July when a top African Union official backed Dr. Kaseya and recalled the directors.
Still, trust in his leadership appears to be building. The World Bank, for example, upgraded one of its rankings of the agency from “moderately unsatisfactory” two years ago to “satisfactory” last year. Observers have described several of his recent hires as impressive.
In an interview in his hotel suite in Kinshasa, Congo’s capital city, Dr. Kaseya acknowledged that he has a “strong personality” and does not tolerate weakness or “misbehavior” on his staff.
“If I find any kind of misbehavior, I’ll help you to be out of the organization,” he said.
Dr. Kaseya, 55, said that his mother, a nurse in a Kinshasa hospital, inspired his medical career. He described how at age 6 or 7, he saw a 1-year-old die of measles, and watched his mother weep because she could not save the child.
“Me, I need to save life,” he remembered telling her. “I will become a nurse.” Her reply, he said: “You can even become more than that. You can become a doctor.”
And so, he resolved to be a doctor — until, at 15, his ambitions turned to music. After watching a performance by the Congolese rumba star and international heartthrob Koffi Olomide, he said, he approached the singer and told him he wanted to be a musician. “OK, sing,” he recalled Mr. Olomide saying. After the impromptu audition, Mr. Olomide told him to stick to medicine.
“You see how he managed to kill my passion,” Dr. Kaseya said, smiling on the hotel sofa as night deepened and his staff brought him takeout for dinner.
Working late at night is imperative because that is when you talk to presidents on the phone, he said. He wakes every morning at 3 to have an hour to himself to think, he said, before launching into the workday. He and his team said he broke only to spend an hour or two every evening cooking Congolese dishes.
Dr. Kaseya’s wife and daughters are in Canada, so they have no claim on his time. While on the two-day trip to Kinshasa, he wanted to visit his mother, but said he could not break away.
The many pictures of him with politicians posted on social media have earned him some side eye. For Dr. Kaseya, though, playing the role of a high-level diplomat is key to getting the Africa C.D.C. respected — and funded by African governments.
He picked up his phone and opened his contacts. “If I just put ‘president’ here, you’ll see a number of them are connected with me by WhatsApp. At least 40. I’m talking to them directly.”
Dr. Kaseya has built on the work of John Nkengasong, who established the Africa C.D.C.’s credibility during the Covid-19 pandemic and leveraged it into greater autonomy from the African Union.
Dr. Yodi Alakija, a prominent global health leader, said it was long past time Africa had power over its own public health. Global health organizations failed Africa during the pandemic, she said, and would do so again because many were built during colonialism, with colonial aims.
“If we don’t look after ourselves, the world will leave us behind,” she said.
But only 21 percent of the agency’s funding comes from African governments, Dr. Kaseya said, leaving it reliant on foundations and other donors.
Dr. Boghuma Titanji, a Cameroonian physician and infectious diseases expert, said, “You cannot claim to have ownership and sovereignty of every decision you’re making when still there is a funding gap, and you’re relying on external funders who are still going to dictate to some degree the agenda that you’re able to pursue.” This, she said, put the organization in a “fragile and vulnerable situation.”
In the interview, Dr. Kaseya said changing this paradigm was a major focus. He described making Congo confirm how much money it would provide for the Ebola response before he would approach donors for funds, arguing that it was primarily Congo’s responsibility.
In the meeting with the Congolese president, Félix Tshisekedi, and the South African president, Cyril Ramaphosa, in July, Dr. Kaseya said he was “so proud” of them for their countries’ financing — $50 million from Congo and $13.5 million from South Africa.
Later, he said that $90 million of the $120 million African countries had promised for the response had been disbursed so far. “This is amazing, from African countries,” he said.
Paying for its own public health is one way for Africa to take charge of its own future, he said — an exhortation he said he frequently heard from African presidents.
“You know, sometimes to have a broad vision implemented, we need to look for entry points,” he said. “And health is a major entry point today.”
His own “broad vision” for the Africa C.D.C. appears to encompass much more than public health. He wants to use the immediate Ebola crisis to solve longer-running problems in the affected area of eastern Congo, and send home many of the hundreds of thousands of people living in camps there. That would stamp out cholera and bolster the economy, as well as stop Ebola, he argues.
To achieve this, Dr. Kaseya nearly tripled the amount of money he said the Ebola response plan needed, from $518 million to $1.4 billion.
Some global health veterans accuse him of adding unrealistic responsibilities to Africa C.D.C.’s plate. He acknowledged that managing displaced populations is not part of the agency’s mandate, but that he sees a role for it in lobbying and raising funds for humanitarian work.
“There is a category of people who still think that Africans are not hard workers,” he said. “I will not fight with them, but I will show them.”
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