Africa Is Burying Its Dead Without Counting Them

Think about a death that nobody records. No certificate, no cause, no entry in any ledger. The family buries the person, the village moves on, and the state pretends it never happened. Multiply that by millions and you have the real health crisis in Africa, one that rarely makes the front page because the people it claims are never counted.

This week the World Health Organization released a report that should shame every health ministry on this continent. It finds serious gaps in how African countries record deaths, collect health information and interpret what they collect. Dr. Mohamed Janabi, the WHO regional director for Africa, put the danger plainly: when we do not know why people are dying, which children are missing essential services, or where communities face the greatest risk, we overlook the very people who most need us. The report was launched at the First African Health Data Forum in Nairobi, where health ministers and senior officials gathered to discuss a problem they have known about for years.

Here is the number that should keep every African minister awake tonight. Only 18 percent of countries on the continent report having a dedicated budget for health information systems. Eighteen percent. That means four out of five African governments are running their health data on goodwill, borrowed funding and hope. You cannot plan a vaccine rollout, track a cholera outbreak or decide where to build a clinic when your basic records are unreliable. Every decision made on bad data is a decision that can kill.

The report points to weaknesses across the system. Coordination between agencies is poor. Routine checks on data quality are rare, which means errors go uncorrected and bad numbers travel upward into policy. And there are not enough trained professionals to collect, clean and analyse the information in the first place. This is not a mystery. It is what happens when a government treats data as a luxury rather than the foundation of every public service it claims to provide.

Now look at what is happening in Kenya, where the consequences of blind governance are already arriving. The Meteorological Service Authority has warned that a super El Niño is coming, with heavier rain expected from October to December and November forecast as the peak. The Kenya National Disaster Operations Centre estimates that 1.5 million people are at risk and has told residents in flood-prone areas to move to higher ground. Scientists say this may be the most intense El Niño on record.

Yet the flood risk in Nairobi is not simply a matter of the weather. A 2026 report from the World Resources Institute found that the city is growing more vulnerable because of decades of failed urban planning, the continued loss of wetlands and weak enforcement of land-use rules. In other words, the water is not the main enemy. The enemy is the approval of buildings on drainage paths, the filling of wetlands for speculative development and the officials who look away. Rainfall does not bribe inspectors. People do.

Nairobi County says it will work with Safaricom to send timely alerts to residents before disasters strike. That is a sensible step, and we should say so. But a text message is not a plan. An alert sent to a phone in a house built on a riverbed is a warning with nowhere safe to run. The county must pair early warnings with enforced zoning, functioning drainage and a public record of who approved what, and who will be held to account when the water rises.

This is the thread that connects the hospital ledger and the flooded street. A government that cannot count its dead cannot protect its living. A government that does not know where its people are, or what illness is spreading among them, or which neighbourhood sits in the path of a flood, is governing blindfolded. And blindfolded governments tend to serve the people who benefit from their blindness: the contractors who build without permits, the officials who collect bribes for ignoring the rules, and the political class that prefers a population it cannot measure.

We have seen what the alternative looks like. Botswana built a reputation for disciplined public finance and institutions that, for much of its independent history, kept faith with its citizens. Mauritius has invested steadily in administrative capacity and transparent governance. Rwanda, whatever we think of its foreign military adventures, has built a health information system that many countries cite as a model for tracking patients and services at community level. Success in these places was not an accident. It came from treating data as public infrastructure, funding it reliably and holding officials responsible for its accuracy.

So here is what must happen. Every African government should legislate a ring-fenced, multi-year budget line for health information systems and civil registration, so that counting the dead and the living does not depend on a donor's mood. The African Union and Africa CDC should set binding benchmarks for death registration and data quality, and publish country scorecards so that every minister knows exactly where they stand. Parliaments should demand audits of health data and land-use enforcement as routinely as they demand audits of ministerial spending. Private firms, including telecoms like Safaricom, should be partners in data systems and early warnings, with clear rules protecting citizens' privacy and their right to information. And county and municipal officials who approve construction on wetlands and floodplains should face consequences, not promotions.

Now the call to action, and it is addressed to you. If you live in Nairobi, Kisumu, Lagos, Accra or Kinshasa, ask your local officials a simple question: how many deaths in this district were registered last year, and what caused them? If they cannot answer, that is your evidence. Demand the budget. Demand the audit. Demand the published data. Write to your representative, file the request under your country's access to information law and make it public.

We are the ones who bury the dead and we are the ones who must now refuse to let them vanish from the record. Africa does not lack the intelligence to solve this. It lacks the will to fund the boring, unglamorous machinery of accountability. Our children deserve governments that can see them. Our cities deserve planners who respect the water. And our leaders must understand that a nation which refuses to count its people has already decided not to take care of them.

Based on reporting by ACSS-EMAIL