Gates Foundation and OpenAI test AI in African healthcare

Primary health care systems across Africa are under increasing pressure, caught between rising demand, chronic staff shortages, and shrinking international aid budgets. In this context, AI is being tested in healthcare not so much as an advanced technology but as a means of keeping essential services running.

According to what I reported ReutersThe Gates Foundation and OpenAI are supporting a new initiative, Horizon1000, that aims to introduce AI tools into primary health care clinics in several African countries. The project will start in Rwanda and aims to reach 1,000 clinics and surrounding communities by 2028, supported by a total investment of $50 million.

The timing is not accidental, as global development aid for health fell by just under 27% last year compared to 2024, according to Gates Foundation estimates, after cuts that began in the United States and spread to other major donors such as Britain and Germany. These declines coincided with the first rise in preventable child deaths this century, increasing pressure on already overstretched health systems.

Rather than focusing on diagnostics or advanced research, Horizon1000 pivots around time-consuming, everyday tasks in under-resourced clinics. Artificial intelligence tools under the program are expected to help in receiving patients, triaging them, keeping records, scheduling appointments, and accessing medical guidance, especially in places where a single doctor can serve tens of thousands of people.

The Gates Foundation and OpenAI are focused on supporting AI in healthcare

“In poor countries with massive health worker shortages and a lack of health system infrastructure, artificial intelligence can be a game-changer in expanding access to quality care,” Bill Gates wrote in a blog post announcing the initiative. talking to Reuters At the World Economic Forum in Davos, Gates said technology could help health systems recover after aid cuts slowed progress.

“Our commitment is that this revolution will happen at least as quickly in poor countries as it does in rich countries,” he said.

The focus, according to the partners, is to support healthcare workers rather than replace them. OpenAI is expected to provide technical expertise and AI systems, while the Gates Foundation will work with African governments and health authorities to oversee deployment and alignment with national guidelines.

Rwanda was selected as the first pilot country in part because of its existing efforts in digital health. The country established an AI health center in Kigali last year, positioning itself as a testing ground for health technology projects. The goal is to reduce administrative burdens while expanding access, said Paula Ingabire, Rwanda’s Minister of ICT and Innovation.

“This is about using AI responsibly to reduce the burden on healthcare workers, improve the quality of care, and reach more patients,” Ingabire said in a video statement issued in conjunction with the launch.

Within Horizon1000, AI tools can also be used before patients arrive at clinics. Gates said Reuters Systems can support pregnant women and HIV patients with guidance before visits, especially when language barriers exist between patients and providers.

What are AI tools expected to handle?

Once patients arrive, AI can help link records, reduce paperwork and speed up routine processes.

“We believe a typical visit can be about twice as fast and with much better quality,” Gates said.

These projections highlight the promise and limitations of this approach. While AI may help streamline workflows, its impact depends on reliable data, stable power and connectivity, trained staff, and clear oversight. Many previous digital health pioneers in low-income settings have struggled to scale beyond initial pilots once funding or external support declined.

Horizon1000’s designers say they are trying to avoid this pattern by working closely with local governments and health leaders rather than deploying one-size-fits-all systems. The tools are intended to be adapted to local clinical norms, languages ​​and models of care. However, questions remain about long-term maintenance, data management, and who bears responsibility if systems fail or errors occur.

The initiative also reflects a broader shift in how AI is positioned in global health. Rather than headline-grabbing claims about medical breakthroughs, the focus here is on narrow operational use cases that address staffing gaps and administrative overload. In this sense, AI is being treated less as a cure for weak health systems and more as a temporary support amid declining resources.

OpenAI’s involvement comes as the company expands its presence in healthcare, following previous work in health-related applications. At the same time, it faces increasing scrutiny over how its systems are trained, deployed and managed, especially in sensitive sectors such as medicine.

A test of the limits of artificial intelligence in healthcare systems

For African health systems, the risks are practical, not symbolic. Sub-Saharan Africa faces an estimated shortage of six million health care workers, a gap that training alone cannot fill in the near term. If AI tools can help doctors see more patients, reduce errors, or manage workloads more effectively, they may provide some relief. If they add more complexity or require constant external support, they risk becoming another layer of dependency.

Horizon1000 is located at this intersection. As aid budgets tighten and demand for healthcare rises, the project offers a test of whether AI can play a useful, limited role in primary care without overstating its reach. The result will depend not so much on the technology itself as on its suitability for the systems intended to use it.

See also: SAP and Fresenius to build a sovereign AI backbone in healthcare

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