"The real challenge is no longer technical. It is about building robust governance structures and legal frameworks that ensure AI serves patients rather than exploits them."
The world looks even more different today than we could have predicted a year ago. Political alliances have shifted, economies struggle, and the financing of global health has been fundamentally redrawn. Besides real challenges, change also creates opportunities. For an organization built to challenge how healthcare systems work, that reality is exactly what our mission was made for.
For the NGO sector, 2025 was an earthquake. A changing political climate led to the dramatic reduction, and in some cases disappearance, of bilateral funding. PharmAccess, like so many organizations financed this way, was not spared. It forced us into the difficult decision to downsize and reshape ourselves into a more resilient, future-proof organization.
This global change came far faster than would have been ideal, but change itself was necessary. Long-term dependency on donor funding had created a crowding-out effect, often holding back the very market-based solutions we and our partners build. Remaining donors, meanwhile, often want to fund single solutions, while we are driving systemic change. The transformation to innovative models requires investment, but governments in Africa understandably only finance the scaling of innovations that are already proven. Developing innovative care models requires financing of small-scale labs where new ideas can be tested, proven, and then scaled through public and private partners. The decline of donor funding threatens exactly this early-stage investment. Finding new ways to finance innovation is now a shared responsibility for everyone who believes healthcare systems can work better.
Amid this turbulence, one development represents our biggest opportunity going forward: AI technology. AI has become ubiquitous, in business, in daily life, and increasingly in healthcare. Throughout this report you can read how our programs are putting it to work, from the MomCare to the Data Cooperative and pandemic preparedness.
As AI models evolve, the technology itself will become easier, faster, and cheaper. The real challenge is no longer technical. It is about building robust governance structures and legal frameworks that ensure this technology serves patients rather than exploits them. AI and data sovereignty are at the core. That is where our focus was in 2025, and what we will continue to work on.
At the heart of this challenge lies data. To receive care, people must share information about themselves. Many would allow their anonymized health data to help other patients, but they are never asked. Their data is simply taken by the companies behind the AI models. The defining question of this moment is: how do we manage and use health data without handing it to tech giants who monetize it for profit, without solidarity and consent?
This is a question that unites Africa and Europe, and we are glad to share a learning agenda with partner Amsterdam Health and Technology Institute (ahti) to see how the Netherlands and Africa can work more closely on this.
Looking back on 2025, we can be proud of being an early adopter of AI-driven technology and of recognizing its potential to give patients more control over their care and their data. And we can be especially proud of being an organization that is firmly rooted on the ground, sees what happens, and learns from it, even when we don't yet know how something will work.
The landscape has shifted beneath us, but our resolve has not. We will keep innovating, keep demonstrating what works, and keep scaling it with partners who share our conviction: that everyone, everywhere, deserves access to quality healthcare.
None of this would be possible without our funders and partners. I want to especially thank the Dutch Ministry of Foreign Affairs and the Dutch Postcode Lottery, whose trust and long-standing support are fundamental to everything we do. And finally, a heartfelt thank you to the amazing PharmAccess colleagues, the people who turn ambition into change, every single day.
I wish you happy reading, and I look forward to what we will achieve together in 2026.
Nicole Spieker, PharmAccess CEO