Weaning off Foreign Aid with Catherine Kyobutungi

This week's conversation dives into the implications of the US's withdrawal from WHO and the halting of USAID funding. Our guest, Dr. Catherine Kyobutungi, shares her insights on the disbelief surrounding these actions, the false narratives that have emerged regarding aid, and the responses (or lack thereof) from African leaders. The discussion emphasizes the need for a critical reevaluation of global health systems and the dependency on aid, framing it as both a challenge and an opportunity for change. In this conversation, Catherine Kyobutungi discusses the complexities of African leadership, the nuances of aid dependency, and the need for accountability in health systems. She emphasizes the importance of rethinking health priorities, balancing infectious and non-communicable diseases, and the role of civil society in demanding accountability from governments. 

Read Catherine's article: After USAID: what now for aid and Africa?

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Follow us on X (@unfiltered_gh), LinkedIn, Instagram, and TikTok.

Transcript

Global Health Unfiltered (00:02)
Hello friends and welcome to the Global Health Unfiltered Podcast. A podcast about the unspoken realities of global health in Africa and the world. I'm your host Desmond Jumbam and I'm here with Ella Amoako. Hi Ella.

Catherine Kyobutungi (00:17)
Hi,

Ella. Hi, Beth. So in our last episode with Shia Mimbolla, we touched briefly on shifting donor priorities with the US halting US aid funding and threatening to pull out of the WHO. Today, we will explore the full implications of these recent policy changes.

Global Health Unfiltered (00:23)
So in our last episode with Shia Mimbolla, we touched briefly on shifting donor priorities with the US halting US aid funding and threatening to pull out of the WHO. Today we will explore the full implications of these recent policy changes and

what they mean for the future of healthcare in Africa. And we have just the perfect guest for that.

Catherine Kyobutungi (00:44)
and what they mean for the future of healthcare in Africa. And we have just the perfect guest for

that. Today's guest is Dr. Catherine Chabutingui, a returning guest to the show. I think I believe this is Catherine's third time to the show, so it shows how much we love having you on the show. Dr. Catherine Chabutingui is the Executive Director of

Global Health Unfiltered (00:53)
Today's guest is Dr. Catherine Chobutingui, a returning guest to the show. I believe this is Catherine's third time to the show, it shows how much we love having you on the show. Dr. Catherine Chobutingui is the Executive Director of the Africa

Catherine Kyobutungi (01:11)
the Africa population and health research center. Catherine, welcome back to Global Health

Global Health Unfiltered (01:11)
Population and Health Research Center. Catherine, welcome back to Global Health Unfiltered.

Catherine Kyobutungi (01:19)
Unfiltered. Hi, Des. Hi, Emanuela. Thanks for having me.

Global Health Unfiltered (01:25)
So, perhaps we just jump straight into it. This news has been around for a couple of weeks now, Trump pulling out of the WHO or threatening. I don't know if they've pulled out yet, but USAID has been mostly disbanded. All the aid global health programs have been paused or ended. So I'd love to hear your initial reactions to this news from the Trump administration.

Catherine Kyobutungi (01:26)
So, Catherine, perhaps we just jump straight into it. This news has been around for a couple of weeks now, Trump pulling out of the WHO, threatening, I don't know if they've fooled out yet, but USAID has been mostly disbanded. All the aid global health programs have been paused or ended. So I'd to hear your initial reactions to.

this news from the Trump

administration. How did you feel? did you react?

Global Health Unfiltered (01:55)
How did you feel? How did you react?

Catherine Kyobutungi (02:01)
I mean, I think it was like, disbelief, like most people. I mean, I think he did something which until now was unthinkable. I don't think anyone ever thought that this could happen. So it was that, like really disbelief. can't believe he's doing this. And, and of course it kept on coming. So it was a trick or, know, there's been suspensions, stop work orders, there's a review.

The review is days and then actually it was done in 30 days. Then there was another review. it was that whole confusion and disbelief that we cannot believe he's doing this. And you're just watching like almost like history unfold in front of your eyes. And you have your friend sit, you know, watching all this. So I think that that was mostly like a sense of disbelief. And then, of course, because there was this time to absorb

what was going on is to start seeing the

you know, the narrative and then for me stepping back and saying, just imagine like this guy is so far away. He knows nothing about how any of this works. And he sat there and said, I don't think this is a good thing. I'm just going to dismantle it and, have all these mostly false narratives really about the rationale for doing it. And yeah, don't ask anyone, just sit there like a

an expert in every single thing in the world and just make these very drastic, radical decisions without consulting the people that have been in this space for years and years and decades. And just feeling that I know, I know what's good and I'm going to do it anyway. So for me, that's one of the things which is quite amusing to watch how much Trump thinks he understands global health and global development.

Global Health Unfiltered (03:56)
Hmm.

Catherine Kyobutungi (03:56)
and sitting

there in Washington and signing letters and then creating pandemonium across the world. Mostly based on really misinformation and misguided beliefs about certain things and how the world works. Yeah, for me that's been quite amusing. Can you expand a bit more on the, you talk about false narratives for the rationale for doing it. Right, can you expand a bit on that?

Global Health Unfiltered (04:14)
Can you expand a bit more on You talk about false narratives for the rationale for doing it. Can you expand a bit on that?

Catherine Kyobutungi (04:25)
Yeah, I mean, I think this whole thing like, know, the global aid has not helped. It has not been addressing US interests. And all these things are so wasteful. Look at all these things just happening. Can you imagine they gave $4 million for this and that? Can you imagine? my God, look at this. They gave, I don't know, $50 million for condoms for Gaza and it was given to Hamas. You know, there are all these things that are not, that are apparently false about, you know, maybe the scope and the magnitude.

So while it may be true, yes, there were some grants which were interesting to see, but cherry picking those grants and then creating this whole narrative about how wasteful yesID was and forgetting the big ones. So I'll give an example, I come from Uganda and I'm here in Kenya sitting on social media and I don't know, doing my own things. And I'm constantly bombarded with this screenshot of a...

graphic from Fox News. I don't watch Fox News. I yeah and then I am bombarded by this. It's circulated in WhatsApp. It's on this and this. my god. Look. Look at all this. What does the screenshot show? It shows four million dollars that went to some NGO that was working on LGBTQ rights in Uganda. And that's being used as as a I don't know as the poster child of how wasteful yes ID was. But

what we don't see is that the government was receiving about half a billion dollars every year from us id and they're going on government sums my god can you imagine you they were they were using this money for this kind of thing they don't even acknowledge that they are receiving a hundred times more money every year than the four million dollars which was given to this particular thing so it's that creating this whole narrative about how yes i was being used for nefarious intent and it was not aligned with us ideology

Okay, it may not be aligned with the government's ideology of the government of the day, but USAID has always been aligned to US ideology. So it's just that you don't agree with that ideology, but to pretend that it's not aligned to US interests. I think that's what I'm saying. Like it's sort of based on this, you know, some things which are not true. USAID has always been about US interest. It's just that the interests of the current government are different from the interests of previous governments, but it's disingenuous to say.

that it was being used for things which are not aligned with the SID, with the S government interests. And it's pursuing ideology. Even the disagreement with one type of ideology is ideological. So you just don't agree with that ideology, but even what you're pushing is also ideological. So it's those things. And to see how this is packaged and lapped up by audiences both in the US, but also across the pond.

Yeah, that has been interesting to watch.

Right, thank you. It's quite interesting to zoom into that picture of this information, like what the poster child, they're actually using to say that the money is being used for other things, that aid is being used for behavior. But I mean, I guess beyond everything, they would, I mean, they do have the right to say it's their money.

side what it should be used for. Now, on the receiving end is most African leaders. And I would want to ask, how do you judge the response of African leaders to this withdrawal of the USD? What's the sense that you get amongst African leaders so far? Yes, I'll first speak to them. They have the right to withdraw.

Yes, of course they do. that's actually for me, that is my biggest gripe with this whole thing. Yes, they do have a right, but at end of the day, that's what I'm saying. You don't fully understand really how the world works. You don't understand what the aid has been used for. don't understand how aid is used. Things like you cannot use the money for administrative costs. You can't run an institution without administrative costs. You can't use money for HIV programs on transport.

Of course, transport is needed to go somewhere. It's not like people are just going to the beach and then the HIV, like deliverable services is something separate from transport. You can't use it for meetings. You can't run a program for $200 million without meetings. So it's those things like how do you think HIV drugs are delivered? They don't just drop from heaven and drop into people's hands. There's a whole apparatus to deliver aid. So yes, of course you have the right to do that, but

That is, I say that's my biggest cry. That there was no thought of the fact that after how many years, I don't know, 40 years of, I don't know, 50 or 70, however long USID has been there, it has set up an infrastructure, it has set up an apparatus. And dismantling that apparatus overnight is cruel and irresponsible. And I don't even know, I can't even know how anybody thinks a normal person thinks like that. It's cruel.

But having said that, that's the question, how did we get here? And it takes me to the question of the African government. And I think, I mean, when we started, talked about the withdrawal from WHO. I've only seen the statement of the AU chairperson who said it's unfortunate and it's going to create all these problems and they would urge the US government to reconsider. That is the only official statement I've seen from the African continent. There may be others which I've missed.

But for me, actually, the withdrawal from as a continent, which by all means, I think, benefits the most from WHO. You'd have expected to see a little bit more of people saying, oh, this is like this and this is like that. But the EU's chairperson gave a statement and everybody kept quiet, almost as if WHO doesn't matter to the continent. And yet I think it matters to some extent. Or maybe...

Maybe I'm misinformed about how important WHO is. I was asked in one interview, and I said, maybe the way WHO sees itself and maybe the way we see it being in the global health community, maybe it's not how governments on the ground see it. Maybe they don't see WHO as important as we think it is, because it's quite puzzling to see the silence about WHO. Speaking out may not bring WHO back, may not bring the US back into WHO. Speaking up may not.

you know, re-instates the funding that the US government has withdrawn. But at least it reassures WHO that what they're doing is useful. But if everybody's silent, it's almost like, yeah, we can do without these guys. It doesn't matter. And maybe we can, but I don't think so. I don't think we can. So there's been like this two-year silence from African politicians, the political class, about all this.

Of course, they've been asked questions, you what does this mean? What does this mean for? So you see this smattering of statements, especially with regards to the funding. I think there was a statement from Botswana which says, no, we're going to look after our people. There was a statement from South Africa. I think there was one from Nigeria which says they're going to put $200 million in health. But the lost amount is like five times for Nigeria, maybe four times. They are going to replace 25 % of that.

The others have been this, you know, once in a while, somebody is ambushed and they say something, but not like a coherent, sustained position of African governments about what all this means. And I can't speculate about why this is the case. First of all, we've had endless stories of imperialism and, you know, self-sufficiency and sovereignty. So I think maybe governments don't want to admit that actually they're in the pockets of imperialists and that their health budgets

I depended to extent, maybe to significant extent, on foreign funding. Maybe they don't want to admit that. Maybe in their hearts they know that aid was great, but they can't do without it. So why should they cry? They just forfeit some luxuries and then they're able to meet their budgets. I really don't understand it. It's quite puzzling to see how silent African governments are about all this.

And maybe it's fear. I was told some people are afraid. I said, what are you afraid of? my God, you never know. You know, if I make a statement, I said, do you think Trump is putting statements made by some obscure minister in some countries he never heard of in the algorithm to decide which programs to terminate or what? I don't really know. I don't understand. Maybe, yeah, but I was told that people are afraid. I said, what are you afraid of?

You think Trump is going to make a line and say, this person said this, so which grant, which number terminate that one? No, they have AI. They just put gender, sex, what, don't know, bias, equality, and everything is gone. So it doesn't matter whether you speak or don't speak. But at least when you speak, maybe there's somebody else who's listening who says, okay, now we can really appreciate. But we've left the crying and the distress, really. Most of this has been left to the global north.

Global Health Unfiltered (13:53)
Right.

Catherine Kyobutungi (13:57)
That's where most of the narratives around, my God, what's going to happen? People are going to die. These are dominant in the North, but not really in the South, which is again puzzling. All right.

Global Health Unfiltered (14:08)
Right. So

it's interesting. mean, so many things are on the there. Trump, in his statement to Congress a few weeks ago, talked about Lesotho. And I think that's the Lesotho way he said it. Some obscure, like nobody has ever heard of Lesotho or something crazy. Again, showing the point that he really doesn't care about the quote unquote obscure countries.

Catherine Kyobutungi (14:18)
statement to Congress a few weeks ago talked about Lesotho.

Global Health Unfiltered (14:38)
I also wonder about the audience. Last time with Shay, we talked about the audience. The silence is indeed deafening for African leaders not to say anything to their own people. You can say maybe they need to make a statement to the US government or make a statement to the WHO or make a statement to the international bodies or whoever.

It seems to me that the fact that they're not even making a statement to their own people has a lot more to say about how they feel about healthcare being a priority, the health of their own people, the devastation that the aid is going to matter. Just the fact that they're not even addressing their own people, not to talk about the international community.

I believe says a lot, right, in all of this.

Catherine Kyobutungi (15:45)
Yeah, I would agree. And I say that's what I feel like. It's an acknowledgement that we've been very dependent in spite of our public posturing about, you know, sovereignty and independence. Or that actually our governments don't care at all.

Global Health Unfiltered (16:03)
Yeah.

Catherine Kyobutungi (16:03)
And they

know that they can keep quiet and there are no consequences. And they will just keep on business as usual. And that's part of the sad thing that any consequences, you see, it's unlikely that there will be such publicly noticeable death and suffering. Death happens in silence. The death of poor people happens in silence. Poor people die all the time without, it's only their close relatives and neighbors that notice that the poor person has died.

So if in one village they were losing three people in a year and they lose seven, that's more than double, but that will not register. That's the problem. And politicians know that the consequences, however terrible they are, even though it's a doubling of mortality from, I don't know, HIV or whatever it is, can still be unnoticeable by the public and life will go on and they can get away with it. So that's part of the thing that...

I think they are hoping that this will happen. There will be narratives, know, AERAV is out of stock, know, people are doing this and this and the other. will be studies which come three years later talking about maybe an increase in mortality. Maybe there will be a new government by then. So who cares? Yeah, so I think, I don't think we have accounted enough leaders for them to care about what even their own population think.

I think that's one thing which has been, I would say, encouraging from all this. The voices from the African continent have almost been unanimous.

seeing this as an opportunity to rethink global health, to rethink health systems. It's quite, it's actually quite surprising and very encouraging to see that. And we are trying to compile them actually so that we have everything that we can find in one spot and come up with what are those emerging things. And I've looked around, I've checked, you know, media, whether it's international media or whatever media in other parts of the world.

whether it's on LinkedIn, people are putting statements, whether it's on blogs, every opinion I've come across, every post I've come across, every position I've come across is almost unanimous. And I think that's a great thing that the public health leaders who are not in government and who have decided they want to speak are speaking with one voice that this is an opportunity. It's a crisis. And in a way, it's almost like saying, if we cry about it, all this and what, it's unlikely

that Trump is going to present any African voice about how this is a terrible decision. So rather than keep on crying about it, say, okay, you know, the horses have bolted, so how do we bring some of them back? And I think what we need right now is a bit more concreteness, not just from speaking, but trying to sing some actions about.

What does this mean for the continent? And how can we support a rebirth, I would say, a rebirth of health systems on the African continent? And of course, this does not mean that everybody's leaving. There are donors and funders who are still there. But I think it's important for us to...

say loudly and clearly that yes you're still you're still staying around but let's do business differently. Maybe not 2025 but 2026 2027 we need to see like some shifts in how how donors engage with African governments how they fund what they fund who they fund

And really, there things which are like non-negotiable. We need to start seeing like efficiency put into all these discussions. You want to see things like sustainability. We want to hear transitions of things. You see, I don't know that there's a fear that if you solve HIV, then you'll become irrelevant. I'm sure if you solve HIV, will be cervical cancer. You can deal with cervical cancer by the time you're done. I'm sure there will be brain cancer or something. So it's impossible to solve all problems, but let's solve some problems and put them aside and then solve others.

and not try to solve problems for eternity. So I think that's the thing. We'd hope that the remaining development partners or donors are paying attention and that all these opinions are not going to not, but that we're also meeting people halfway and being constructive about the future that we see and the future that we want. So.

Global Health Unfiltered (20:58)
Yeah.

Catherine Kyobutungi (21:12)
That's my hope. And then of course we have our government that they're also going to step up and do things differently, but also demand different from development partners.

Global Health Unfiltered (21:24)
So Catherine, it seems like we're really at a crossroads, and we can see it as either a challenge or an opportunity. But if it's truly an opportunity, in order to grasp that opportunity, it's important to take a step back to understand the purpose of in the first place and why it existed.

Catherine Kyobutungi (21:25)
So Catherine, it seems like we're really at a...

Global Health Unfiltered (21:51)
I think that aid only goes to African countries or to low and middle income countries, but there's aid that in the past went to the Europeans, for example, after World War II because the entire place was devastated. The US provided, I think it was a martial, some kind of martial aid to Germany and other countries, and they were able to use that aid from the US.

to develop and they're less dependent on aid. Today when we talk about aid, people understand it in very different ways. Not everybody understands it to be the same thing. Some people see it as charity, USAID from the American people. It's a gift from the American people. Some people see it truly as a gift. Some see it as reparations for colonial injustices.

Others see it as soft power that is to be wielded for political and economic gains. And when Trump disbanded USAID, interestingly enough, a lot of global health, American global health advocates were making this case that it is soft power that the US is letting go of, which was interesting to see. So how do you see aid and its role in development?

on the consonants.

because it's important to understand this if we are to really take advantage of this opportunity.

Catherine Kyobutungi (23:24)
if we are to really.

I mean, all three. Maybe it's the question of what proportion is charity, what proportion is soft power, and what proportion is reparations. And maybe I think reparations are the, it's almost like the historical basis of aid. And I don't think when aid is being given right now, I think it's reparations at the back of the mind, or the poor giving it. I think it's more soft power.

You know, so among all the three things, it plays those different roles. It exists because there's a historical context of why this aid is necessary. And I think maybe there's even a future context of why it exists. It creates this, I think someone has made the case and I don't think it's far-fetched.

you create this level of dependency that people feel, in our political class, feels like there's no way we can survive without this. And so they reach a point where they are so dependent, they are hooked, and it's hard to disentangle themselves from that hooking that has happened. Whether that was intentional or not, it may not have been intentional, but it has happened where our politicians feels like, our political class feels like they are hooked to this system.

that they cannot disentangle themselves from. And so while perhaps aid started as reparations, I think now it has reached the point where it's actually something that sustains this whole colonial power structure. And it's part of that. So you give this little carrot and people are happy looking at this beautiful carrot.

while they don't pay attention to everything else. And if they want to pay attention to everything else and you say I'll take away the carrot, then they're like, my god, if you take away the carrot, you're going to die. So we don't have time to like focus on those things, which have brought us to this place where we need your carrot, the first place. So that's part of the thing. And for me, it has been also quite interesting to see like the very open discourse, my god, we're going to lose soft power, we're going to lose soft power. Aid was one of the most effective soft power tools. This has

been quite dominant in the narratives around, know, in the aftermath of this. And then I've been asked many, many times, do you think China will step in? I'm like, my God, why would I care whether China stepped in? Is Africa this football that everybody looks at when there's a crisis? my God, who's going to get the ball? How do we make sure the other person doesn't get the ball? We are being passed around like a football.

and we're here and for me that's the frustration I have with the political class. How do you think this is okay? Trump has done something and immediately Europe is saying, oh, we can't step in. Then people are like, oh my God, China. And you're here, you're Africa, like your whole continent, 1.5 billion people. And we're like this political football that is passed around.

to for geopolitical aims. And I've seen some memorandum about the new US ID, some, I don't know, some outfit called whatever it is called. And it is in there that the main purpose is to counter the China. What is that? Silk and belt? my God. And then, and we're here and we ask and we allow ourselves to be hooked to this thing, which is being set up to counter China influence.

So that is the thing. you know, aid, whatever it is, I think what we should disabuse of ourselves is the notion that people sit down and like, you know, we are very good people and there's so much suffering in the world and we want to stop suffering. And that that is the motivation for aid. No.

I ultimately, as I said, the middle part, the geopolitical power, the soft power is the main consideration. And if you want to do that, then you say, okay, what's the best way to do it? Because you could take our politicians and take them for, you know, luxury cruises and maybe get the same outcome, but that wouldn't look good, maybe cheaper. So you try to do something that is palatable to your own constituents, but also the constituents across the pond so that people feel like, yeah, these people are doing a good thing and these are good people.

But ultimately, the rationale for aid is not good. It's not to solve problems. It's not to alleviate suffering. It is to get your political power in a way that is palatable to constituents in both sides of the world. And so that's how we end up. And for me, the frustration is that we don't see through this and our political class gets so dependent.

that you find that you have critical parts of your sector, your health sector, are dependent on aid.

Global Health Unfiltered (28:29)
We

have an issue. will pause briefly, Catherine, because Ella actually joined as a producer, which interestingly doesn't record her. So she's going to join back in as a guest. So we'll take maybe a two minute or one minute break as Ella joins back in. Sorry about that. One of those days.

Oh my, it's crazy. The whole A thing.

Yeah, it's just disappointing how we're not taking charge of our own healthcare development.

Catherine Kyobutungi (29:22)
Yeah. I mean, this, this. No, go ahead. Well, I was going to say, I guess the next question that I will probably ask you is, you said we're hooked. Who is responsible for the hooking? Right? Who's to blame? Do we blame the people who are given for decades?

Global Health Unfiltered (29:24)
and let us

Well, I was going to say, I guess the next question I will probably ask you is, you said we're hooked.

Who is responsible for the hooking? Who is to blame? Do we blame the people who are given for decades

all this funding? It has saved lives, but maybe it has resulted in us being hooked. Or do we blame ourselves for allowing our leaders to let us get hooked?

Catherine Kyobutungi (29:51)
all this funding in our lives, it has saved lives, maybe as a of us being hooked? Or do we blame ourselves for allowing our leaders to let us get

hooked? I guess you can maybe think of it as, I don't know, an addiction problem, right? Do you blame the doctor who's overprescribing?

Global Health Unfiltered (30:07)
I guess you can maybe think of it as an addiction problem. Do you blame the doctor who's overprescribing?

Emmanuella Amoako (30:15)
Thank

Catherine Kyobutungi (30:21)
right for a condition that you can say is valid right because there's there's HIV epidemic there are all these issues right and the prescription was aid but then after

Global Health Unfiltered (30:21)
For a condition that you can say is valid, because there's HIV epidemic, there were all these issues, and the prescription was aid. But then after a while...

Catherine Kyobutungi (30:37)
a while we the patients or whatever we want to call ourselves have become hoped even in places where we don't need the prescription anymore

Global Health Unfiltered (30:37)
we the patients or whatever want to call ourselves have become hooked even in places where we don't need the prescription anymore.

So what do you think? I don't know if that's the best analogy but maybe aid is like a drug that we can't get ourselves off of.

Catherine Kyobutungi (30:50)
So what do you think, I don't know if that's the best analogy, but maybe it is like a drug that we can't get ourselves

off of. Yeah, I mean, I don't know. I think that's actually a good analogy when you think about dependency. And, you know, you have to ask who bears the greatest responsibility for someone who gets dependent, for instance, on prescription painkillers. First,

there's a doctor that does a prescription and maybe does not keep this at the back of their mind that somebody is likely to get hooked. And then of course, once this is understood, are different mechanisms within the system that try to prevent it from happening. But then still, people still slip through the cracks, much as there's a lot of control who prescribes, you know, there's all this. But even in the best system, people still manage to get hooked.

So that's the thing. So if you're trying to put this on AIDS, that's the question. Who is the doctor? And which systems exist to try to prevent people from getting addicted? I think the systems don't exist. And maybe that's because the people who would have put in the systems are the doctors. And they've not put in any of those systems. And that's what I'm saying.

like, AIDS started as reparations, but then I think the people that give AIDS have realized that it's actually a very powerful tool.

You get people hooked and once they are hooked, then you can dangle carrots and sticks over their heads. And it's quite effective. You can get a lot of things. You can say, vote this way at the UN General Assembly. You can say, vote the other way. You can say, don't support this country. Don't do this. There a lot of things you can get as a powerful nation. You get your way by dangling aid or the threat of withdrawal of aid.

And so that's what I'm saying. think there's a doctor patient analogy, but I think the doctor and the health system in this case, which was supposed to put in place safeguards is run by the same doctor who's prescribing painkillers. So they have no interest in the patient not getting hooked because I don't know, maybe they get a lot of reimbursements from.

these pills or the patient is going to come up with kidney failure and they can treat the kidney failure at some point. So they have no interest and there are no incentives for them to put in place the safeguards. And that's the question that if you again, if you try to this analogy, it's like trying to blame and expect the patient to unhook themselves. I think it's a tall order because even in addiction.

I don't think people can just say, okay, I'm just going to stop being addicted and they stop it. So I think that's the quagmire that we face. But I think maybe the good thing is that as a continent, we are not one patient. And I think if we take a population of patients, I think there will be a few patients who maybe will get some kind of exposure and they can try to figure out.

how do they extricate themselves, also how do they extricate everyone else? And I think if you continue pushing, if the doctor has said, okay, that's enough, I've just realized that maybe I can get better returns by doing something different. So I'm cutting off the stash and the supply.

and the patient has to quit cold turkey. I think that's where we are. We're in the cold turkey phase of ESID withdrawal of aid. And so I think we have to figure out, we look for another doctor who's going to hook us? Or is this a chance to say, finally, I have like a window, perhaps in which I can stop this. And I think maybe that's where we are. That we have a window of opportunity to see whether we get hooked again completely.

we unhook ourselves from these apparatus.

Emmanuella Amoako (35:05)
I love the doctor-patient analogy. I'm just wondering in the doctor-patient analogy, where does the African leader fall? Because we are assuming that the patients are the people of the continent, but then that leader of each country or leaders in the continent, where did they fall in this analogy?

Catherine Kyobutungi (35:06)
I love the doctor-patient analogy. I'm just wondering, in the doctor-patient analogy, where does the African leader fall?

They are the patients. Because we are assuming that the patients are the people of the continent. But then that leader of each country or leaders in the continent, when did they fall in

this another? No, the leaders are the patients. They are the ones who are hooked. And for us, so I think it's those things like the consequences of getting hooked. Maybe the person is very high and very productive and they produce nice music when they are high.

or they dance and they entertain people. that's the benefit to us as civilians who are powerless in this whole equation. So the patients really are the people are hooked to the political leaders, the political class. And yeah, it's not a perfect analogy, I think.

Global Health Unfiltered (36:10)
Yeah, it's far from perfect because part of the weakness of that knowledge is it assumes that the patients are powerless. Because when it comes to something like...

Catherine Kyobutungi (36:11)
Yeah, it's far from perfect because part of the weakness of that knowledge is it assumes that the patients are powerless, right? Because when it comes to

something like addiction, know, initially there's a need, you you have a pain that needs to be relieved.

Global Health Unfiltered (36:25)
addiction, initially there's a need, you have a pain that needs to be relieved. But

once a certain amount of that pain is relieved, you need to be weaned off the aid. And if the doctor keeps prescribing this aid, what power do the African leaders, because I worry sometimes that we

Catherine Kyobutungi (36:35)
But once a certain amount of that pain is relieved, you know, it needs to be weaned off the aid. And if the doctor keeps prescribing this aid, what power do the African leaders, because I worry sometimes that we

paint ourselves as being completely powerless when that is not always the case, because if we...

Global Health Unfiltered (36:53)
think of ourselves as being completely powerless, when that is not always the case. Because if we

keep this narrative that we are victims, we're going to remain victims, and we're going to remain dependent on aid forever. Again, you have to look at the nuances, I think. Not all countries are the same. There are certain countries that

Catherine Kyobutungi (37:03)
keep this narrative that we are victims, we're going to remain victims and we're going to remain dependent on aid forever. Again, you have to look at it nuances, think, right? Not all countries are the same. There

are certain countries that absolutely need the aid, and they're going to be significantly more devastated by this USAID pulling out.

Global Health Unfiltered (37:20)
absolutely need the aid, you know, and they're going to be significantly more devastated by this USAID pulling out, right?

And like, even if the government commits to investing, I don't know, 25 % or a significant majority of their GDP into health, it's still going to be a challenge to address and to do what USAID was doing.

Catherine Kyobutungi (37:31)
Right? Even if the government commits to investing, I don't know, 25 % or a significant majority of the GDP into health, it's still going to be a challenge to address and to do what the USAID was doing.

Global Health Unfiltered (37:49)
There are countries that should have been weaned off a long time ago. I would put Nigeria and South Africa and

Catherine Kyobutungi (37:49)
But there are countries that should have been weaned off a long time ago. Right? I would put Nigeria and South Africa.

Global Health Unfiltered (37:59)
Kenya into those buckets. yet, Nigeria is the biggest receiver of USAID funding in Africa.

Catherine Kyobutungi (38:00)
and Kenya into those buckets. But yet, Nigeria is the biggest receiver of USAID funding in

Africa. Right? So are we totally powerless? That's the question. I think narratives are powerful.

Global Health Unfiltered (38:17)
Are we totally powerless? That's the question.

Catherine Kyobutungi (38:27)
And if you pitch yourself like, yeah, you know, we are poor. I mean, I see all these arguments. Yeah, yeah, African countries, their economies are like this and they have a lot of debt to pay. yeah, I agree. Yes, there's an issue. But the question is, is this ever going to be solved by continuing aid? And I don't think the answer is no. I don't think that continuing aid is the only is going to get us out of debt.

What is going to get us out of debt? Number one is that either the debt is forgiven because the terms are not fair or that we ask ourselves, why do we need debt? Why are we the only continent where every single country is dependent on debt? And as I've said, when you have this carrot downing in your head and you have a stick that says, if you don't jump, then the stick will land on your head. Then you don't ask the hard questions about reparations, about

the high debt and the unfavorable terms, you don't ask about the illicit financial flaws. You don't ask about even the whole aid architecture and whether it actually benefits you. Because you're just fixated on this little carrot that is dangling over your head. So yes, there's an issue. Final economies are not strong and there are all these issues. But if I was to narrow it down on health.

and our priorities. Again, I think there's a way out. Number one, I don't think every country needs to replace the amount of money which was lost from USID. I don't think so. First of all, the amount which was lost is from the perspective of the money which was allocated by the US government. Only maybe a third of that money actually comes to the continent. So when they say that they gave $1.5 billion to Nigeria,

In essence, you might find it's like $600,000 that came to Nigeria. So they don't need to replace 1.5 billion. They need to replace 600,000, at most 700. So that's the first thing. A lot of the money was not leaving the US. It was staying there, paying US farmers and all this stuff. then a lot was, so there's that. Secondly, what was the money being used for? Let's go into the health sector.

For instance, in HIV programs, where you set up these beautiful parallel structures. They are like islands in a sea of dysfunction. So the HIV clinics are running very well. They are well-stocked. They have laboratories. They have data systems. They have laptops. They have computers. They have drugs. They have well-trained nurses. They are clean. There's AC. They are nice clinics that run in the midst of everything else is falling apart.

So if we are to put money for HIV, we can't put money to sustain these Rolls-Royce in the midst of like potholes. We need to have a car that fits the roads that we have. And so we have an HIV prevention program and treatment program that is not the Rolls-Royce that was being supported by foreign aid. So there's that. then, the other thing is, okay, there are things which you cannot...

There are not ways about them. Yes, we need to keep people on treatment. We need to make sure that women get tested so we don't have babies being born with HIV. Those things stay. But then there many other things in the health system that we've packed aside because the development partners have not talked about them. They have not deemed them important. African leaders are saying NCDs, non-communicable disease, non-communicable disease. They've been talking about them. And who are they? They are talking about them to development partners.

We've been raising the alarm for like the last 10 or 15 years. NCDs, NCDs, NCDs. Every single report says NCDs are rising. Mental health is rising. Road traffic crashes, violence. All these things are rising. And actually they are displacing infectious diseases as the major causes of ill health and death on the continent.

But we are telling people outside, we're not asking ourselves what can we do about NCDs. And we explain that the same development partners whose interests are infectious diseases because infectious diseases can cross borders and infect people elsewhere. And we are appealing to their senses that, know, we should also invest in non-communicable diseases. And they said no.

So if we are to put money on the table, then we have to ask ourselves, what's the balance? Should we keep this model of like, yeah, infectious diseases are very, very important and they're all important thing, and you're going to deal with HIV, TB, malaria and forget everything else. We have to ask ourselves those hard questions and figure out how do we balance the system? Because the system that we have currently is driven by narratives about how important infectious diseases and maternal newborn and child health issues are.

They are important, yes, but they're not the only important things. There are other important things. And maybe in some countries, there are more important things. So we cannot, if we are to rethink systems with our own money, we can't keep the same Rolls-Royce that we've had. We have to find a car that is fit for us. And it may mean that, some of these programs may suffer, which is unfortunate. But then after five years, after 10 years,

We also need to balance because I think it's, I don't think it's right to have this narrow focus on a set of issues for years and years and years and years and a set of issues coming up and then we pretend that those things don't exist. We need to look at the system that works for everybody. Data systems, HIV, perfect data. Data for everything else, yeah, yeah, there, there. In some countries, very bad, unusable. But for HIV, perfect data systems. Why?

Why don't you use the HIV platform to have a data system where HIV is one of the things that is in there? And it's understandable if this was at the beginning, 20 years ago. But 20 years ago, had HIV data system. 20 years later, we have an HIV data system. Five years, understandable, but 20 years, 25. Come on. So for me, think, number one, we don't need to replace all the money. Number two, when we replace it,

There are things we can do differently. We can create efficiencies. There's been, I think I've seen several opinions which say we should focus number one on primary care and we should focus more on prevention. We cannot afford a system that replicates what we have, first of all, in the narrow focus on specific health conditions, but also a very dominant.

Tashari care kind of thing, especially when you think about non-communicable diseases. Currently, when our governments invest in non-communicable diseases, they invest in Tashari care. Tashari care that is, does not even scratch the surface in terms of accessibility, does not even scratch the surface in terms of outcomes. So why don't we focus on primary care for non-communicable diseases?

make sure that every woman gets screened for cervical cancer. And then if they have primary lesions, they can be treated at the district hospital.

instead of waiting for stage three cancer to go to the National Reflector Hospital and you treat them in when you know that you're fighting a losing battle, you put a lot of resources with very poor outcomes rather than directing those resources to the lower levels where most people can access and where you actually have a higher chance of success. So the whole system needs to rethought from primary care, primary prevention.

rather than replicating this very expensive system that we've had.

Emmanuella Amoako (46:19)
That's very hard, that's very loaded. And I hear that we need to take aid on a case by case basis or on a country by country basis. And we should stop trying to always firefights, but rather prevent the fire from happening in our country. If the aid does come back, we have to rethink how it's redistributed how it's distributed and what we use it for. And if Africa decides to pick up

Catherine Kyobutungi (46:20)
That's very hard, that's very loaded. And I hear that we need to take aid on a case by case basis or on a country by country basis and we should stop fighting to always firefight but rather prevent the fire from happening in our country. If the aid does come back, have to really think how it's distributed and what we use it for and if Africa decides to

pick up

Emmanuella Amoako (46:50)
take up the mantle of solving the health problems. It's on a country by country basis because every country has a unique problem. So I've always felt like the problem of A dependency is the lack of accountability. So how does A dependency really challenging for Africans to hold their leaders accountable for how external

Catherine Kyobutungi (46:51)
take up the mantle of solving the health problems, and it's on a country by country basis, because every country has a unique human problem. So I've always felt like the core problem of A dependency is the lack of accountability, right? So how does A dependency lead to challenging for Africans to hold their leaders accountable for how

external.

Emmanuella Amoako (47:18)
and the impact that it has on our lives.

Catherine Kyobutungi (47:18)
and the impact that he has on

us.

I'm not sure about the accountability for external funds because the accountability mechanisms are opaque. So let's look at it this way. When the US government gives money for HIV programming, most of that money does not go directly to government. So government cannot account for money it does not receive. The money is largely channeled through international NGOs that have branches or implementing partners or affiliates or whatever it is within the recipient countries.

So you have a grant that is coming from USID, half a billion dollars, I don't know, for Nigeria. And then there are some institutions within the US which bid for that half a billion dollars. They win the bid, the money is given to them. And then they now they look either they have affiliates or branches in Nigeria. And so the money is coming from maybe New York to this affiliate. the Nigerian government cannot account for money that he did not receive directly from the US government.

But then of course, you look, when you in other sectors like, infrastructure and I don't know what those, the money sometimes comes directly to government. So that is part of the thing. And I don't think we should be necessarily focused on how governments account for funding directly that is coming from outside. I think what should be looking at is how do we support our governments to make the right choices on where to invest. And that's the thing, if you have your own priorities,

in which the development partners or the aid givers are not willing to invest, then let's see how we invest in those priorities now that other people are not willing to invest in. But then there's a point which was made in this, BMJ editorial, and it was something which was quite striking, that aid should not be the mainstay of a health system.

And I don't think it's something that I had actually thought about critically, that aid should not be the mainstay of a health system. So our governments will argue and say, no, no, maybe 60 % of our health budget is funded by domestic resources. But then you take the aid and you put it in critical health issues like HIV, like malaria, like TB, like data systems. put things which are really critical for the function of the health system. That's why you apply your aid.

So again, as I said, it's understandable when there's a crisis, yes, get this aid, apply it. And then when you come out of this crisis, then find other ways of sustaining what was put by aid and then address other crisis.

You know, so from that, I think it's more about what's our role in supporting our governments in making good choices. But it seems to me that that is the biggest issue that we can't hold our governments accountable for the health that we're receiving because it's coming.

Global Health Unfiltered (50:10)
But it seems to me that that is the biggest issue that we can't hold our governments accountable for the health that we're receiving because it's coming

through external organizations and nonprofits, right? If I'm in Cameroon and I'm paying taxes,

Catherine Kyobutungi (50:29)
through external organizations and nonprofits, right? If I'm in Cameroon and I'm paying taxes,

the government ought to be providing services and I should be able to hold the Cameroonian government accountable if they are not providing these basic health services that I'm paying.

Global Health Unfiltered (50:40)
The government ought to be providing services. And I should be able to hold the Cameron government accountable if they are not providing these basic health services that I'm

for, paying taxes for. So it's almost as though the aid helps to circumvent the accountability that should.

Catherine Kyobutungi (50:58)
paying taxes for. So it's almost as though the aid helps to circumvent the accountability that

should go towards our leaders. So the pressure is off of them in a sense. No, no, think the pressure is not off. The pressure is not off. I think it was that we should hold them accountable for the foreign aid. That's what I'm saying. I don't think we should hold them accountable for that.

Global Health Unfiltered (51:08)
go towards our leaders. the pressure is off of them, in a sense.

Mm-hmm.

Catherine Kyobutungi (51:27)
I think we should hold them accountable for a functional health system that serves everybody. And I really think like, again, as I've said, when you look at the reactions on the continent, most people are like, my God, finally, free at last. think somebody wrote free at last. And you look at that social media, finally, our governments, they've been stealing the money, they've been corrupt. So finally, now this thing has been taken.

Global Health Unfiltered (51:32)
Mm-hmm.

Mm-hmm, mm-hmm.

Catherine Kyobutungi (51:56)
Now they're going to shape up. And I think it's too much to expect that our governments are going to shape up without like interventions. And those interventions I think need to come from different quarters. The public needs to like have a way of saying, okay, tell us what's going to happen in a way that is consistent and like persistent, not, you know, one of

Global Health Unfiltered (51:57)
Hmm.

Okay.

Catherine Kyobutungi (52:24)
social media thing for two days and then everybody moves on to another trend. So there has to be a structured systematic way of demanding for accountability. There are a of civil society organizations on the ground. I think they need to be beefed up. If I was somebody now who wants to see change and I'm a donor, say, how do we support civil society organizations to put pressure on their own governments so that the governments can step up? And governments do listen to certain pressures if they are applied right.

Global Health Unfiltered (52:44)
Mm-hmm. Mm-hmm.

Catherine Kyobutungi (52:53)
And if the message is clear and the public and resonates with the public, governments do listen sometimes, not all the time, but they sometimes listen. So I think there's need for some really large scale, structured, systematic, sustained campaigns about this. And I'm looking at a three, five year timeframe. I'm not looking at what's going to happen today and tomorrow and maybe next month. A lot of countries are already in the budgeting cycle. The budgets are being read in maybe like three months time.

And if things are not in that budget, I don't think things are going to get into that budget if they're not already there. But now it's to say, we may not get what we wanted 2025, 2026, but perhaps we can get something better in 2026, 2027, 2027, 2028, 2028, 2029. So in the next medium term and long term that we start seeing change and the time to start thinking about that is now. So if you start any kind of campaign,

is to see how it can shape the budget for maybe next financial year, not necessarily this financial year, because the time to organize and what may not be there to get us that. So I think we need to see institutions investing in public campaigns around this, but also being constructive and helpful, because it's one thing to say, put money in health, put money in health, but it's also possible to say, this is actually what is possible.

as a public health institution, we've done some economic modeling and I don't know, we've done all this and we think that this is something which could work. Or as a public health institution, we've done some kind of scenario building and we've done some research and we've tested out these things and we think this is the best thing for Uganda or for Nairobi, I mean, for Kenya or Malawi. So I think we need to be constructive also that we do some kind of work that shows government what the options are.

what the possibilities are instead of demanding and saying you must put money into health. Because the reality is governments have a lot of pressing needs and health is one of them. And the way we see health when you're in health is not the way government sees health. Sometimes there's an election and the election must happen whether people are dying or not, the election must happen. And the way our elections happen, you know, you have to buy tear gas and buy, you know, armored cars and all this. So that's a reality. it's good to show government that,

Number one, with the resources that you have, if you invest in XYZ, at the population level, you can get the same amount of health as you are getting if you invest in a different way. So I think there's a role for scientists and researchers and academics to provide solutions of what our governments can do. Now, the third piece of that is the development partners slash donors who are still left in the field.

that they can be also constructive and say, yes, we see the danger of the way we've been doing business. That if there are political changes, that they can have such a devastating impact on the people we support or we intend to help. And therefore, why don't we do things that over time make it less likely?

that any changes in the politics of a country can have such a devastating impact on other countries. So I think funders have a role, development partners or aid givers have a role, the public has a role, and then of course the scientific community has a role. And I think if you all come together, there's a chance that you might actually come up with something strong and better for the African continent.

Emmanuella Amoako (56:36)
Thank you. I like when you said that sometimes an election has to happen and irrespective of what is going on, must happen. I remember when COVID was raging and we had to have elections because it was election time and nobody understood that even though an infectious disease was ongoing in the country, people still needed to vote somehow.

Catherine Kyobutungi (56:37)
Thank you. I like when you said that sometimes an election has to happen and be respective of what is going on. must happen. I remember when COVID was raging and we had to have elections because it was election time and nobody understood that. Even though an infection was ongoing, in the country people still needed to vote somehow.

Emmanuella Amoako (57:06)
I

mean, have touched on salient points. You think that change in this landscape is a threat or should it be an opportunity? either way, you like, how can, if it's an opportunity, how can we capitalize on this? And if it's a threat, what are the things that we can do to avert this threat?

Catherine Kyobutungi (57:07)
I mean, have touched on salient points. You think the change in this landscape is a threat or should it be an opportunity? either way, you, how can, if it's an opportunity, how can we capitalize on this? And if it's a threat, what are the things that we can do to avert

this threat?

I think it's both a threat and an opportunity. We cannot really minimize the devastating impact this has had on livelihoods, thousands and thousands of jobs lost on the African continent. Some people have been in sector for their whole career. So if you've been working like an international NGO, an NGO for like 20 years, and all of a sudden, like within a week, your job is gone.

Like how do you even start? So we cannot minimize really the devastating impact this is going to have. And then of course, there's the, these NGOs where they are providing a service. There's so, there's there's a real threat when it comes to livelihoods, but also when it comes to lives and health for people. And then there are other things that are less visible. I don't know that you're familiar with the demographic and health survey. This was the, I would say, flagship data.

you know, national survey that a lot of countries depended on. These surveys were done every five years. They are very comprehensive. are country-wide. They bring a lot of data. It was almost like everybody's waiting for the next DHS, DHS, DHS, DHS. So countries can tell how we're doing in maternal mortality, how we're doing in child mortality. And DHS was funded through a program called Measure DHS, which was providing like the technical assistance and coordination for DHS surveys across the world. This has been scrapped.

So I can't even imagine like a world without DHS. Like just imagine DHS, I don't know. But having said that, DHS had issues. So yes, DHS was very, very useful, but it had issues. So while it's a threat, that we might have a phase where we don't know what is happening in terms of even tracking SDGs for women and children. And this is less than five years towards the end of the SDGs. So we might have a phase where that's uncertain.

but then it's an opportunity to question the DHS model and say in 2025 with everything that exists, have digital tools, have mobile phones, we have data science tools, have AI, do we need a DHS? So if we are going to build back, should we build back a DHS or should we build back a different system that is like fit for purpose in 2025? So yes, threat, data loss, but opportunity.

we can imagine a world without DHS because DHS is not there. If DHS was there, it would be difficult to imagine a world without it. So that's the thing. And again, from the health side, yes, I've said there will be loss of life, most of it undocumented, most of it unmeasured. But then also you have an opportunity to say, yes, this is a reality, it has happened. So rather than sit down and say, okay, people are going to die, people are going to die, people are going to die.

Can we think of something better? That the people who die, maybe they don't die in vain. So that at least we are not caught up in a similar situation. What election is every four years? So maybe eight years from now, another Trump takes power, then we are back to where we were. Or somebody takes power that I don't know in which country, and we're back to where we are. So it's almost like somebody said it's a never was the crisis kind of mode. There's a crisis that is not of our making.

Global Health Unfiltered (1:00:33)
Hmm.

Hmm.

Catherine Kyobutungi (1:01:01)
that it's hard to do something to reverse this crisis. So these are lemons, why don't we make lemonade?

Global Health Unfiltered (1:01:10)
Right. At the risk of beating that analogy to death, it seems as though we are in the withdrawal phase, right? Kind of a forced withdrawal. It wasn't prepared. It just happened in like a day, really. And it's going to be painful.

Catherine Kyobutungi (1:01:10)
Yeah. Right.

At the risk of beating that analogy to death, it seems as though we are in the withdrawal phase, right? A kind of a forced withdrawal, it wasn't prepared, it just happened in like a day, really. And it's going to be painful.

Global Health Unfiltered (1:01:42)
We shouldn't undersell the impact that this is going to have on lives and livelihoods on the continent, the US, everywhere. So we're obviously going through a very challenging, but we've also talked throughout the episode about the opportunity that this presents.

Catherine Kyobutungi (1:01:43)
We shouldn't undersell the impact that it is going to have on lives and livelihoods on the continent, the US, everywhere. So we're obviously going through a very challenging, but we've also talked throughout the episode about the opportunity that this presents

and...

Global Health Unfiltered (1:02:09)
We don't know what the US will look like in four years. If there's a Democratic Party that comes on, perhaps they reverse everything and we find ourselves in the same position. So as we conclude the episode, Catherine, what is it that gives you hope in this current moment as we're talking about global health financing and this withdrawal?

Catherine Kyobutungi (1:02:10)
We don't know what the US will look like in four years, right? If there's a Democratic Party that comes on, you know, perhaps they reverse everything and we find ourselves in the same position. So as we conclude the episode, what is it that gives you hope in this current moment as we're talking about global health financing and this withdrawal?

Global Health Unfiltered (1:02:39)
period that

we're in. What is it that gives you hope for the future of health care on the continent?

Catherine Kyobutungi (1:02:39)
area that we're in. What is it that gives you hope for the future of healthcare and the

continent?

I mean, I think what gives me hope is something I talked about earlier. The fact that there's almost unanimity about what this moment means for the African continent from Africa's global health, public health, research leaders. I think for me that is something which gives me hope. And because it would be one thing where we are also like falling in line and perpetuating the same narrative and that we are on the same page exactly, especially when

we've known that the aid architecture is problematic. So I think that's something that gives me hope. And then I think I can extend that hope and say that I hope it won't stop at stalking and writing opinions, that we are going to fold our sleeves and say, let's get to work and let's be constructive and let's be helpful. And again, COVID showed us that the African continent has a lot of experts, it has a lot of scientists, really highly committed people.

that just need a nudge in the right direction and maybe a hand up and some maybe some element of coordination and put things together. But I think every single country has the experts that can sit with them and help them work through what is what is possible. Of course, the hope is that politicians are listening to their scientists and they're not listening. They're not they're not watching Fox News and CNN and taking direction.

from the narrative on the other side of the Atlantic. That's my hope that they actually listening to African scientists and they can see a future for the continent that is better than the future than the present. and then of course, there are other opportunities. I've talked about data. I think I have a lot of hope in what the current data technology can do for the continent. And this is a good time as any.

maybe something which may have been very difficult to contemplate is now possible to contemplate that we can set up new systems that serve the continent better than the ones we had before. So yeah, I'm still hopeful. And then of course, yeah, I don't know how long this madness is going to last. I hope the Americans rise up and say enough is enough because it just goes beyond what we see. There are lots of other things like science is under attack. There are things you can't do. There are things you can't do. These, they are slashing research funding.

they are counseling fellowships there. So there's a whole other set of madness happening. And I hope the Americans say enough is enough and soon so that we can get our lives back. That's right. The Americans have a law to remove from their eyes. But Catherine, that's a very helpful note.

Global Health Unfiltered (1:05:28)
That's right. The Americans have a log to remove from their eyes. But Catherine, that's a very helpful note

to end on. Thank you very much for joining us for the third time on Global Health on Filter. We've had you back that many times because we enjoy having the insights and the expertise that you share with us and with our audience.

Catherine Kyobutungi (1:05:42)
Thank you very much for joining us for the play time on Global Health on filter week.

Global Health Unfiltered (1:05:58)
Thank you very much for an enlightening discussion and I have no doubt that we'll be having you back soon.

Catherine Kyobutungi (1:06:06)
Okay, thanks, anytime. I love that this is totally unfiltered. That's what we're going for. Yeah. Yes, thanks for having me. Thank you. And thank you to our listeners. Thank you, Ella, for hosting the episode with me. And to our listeners, thank you for tuning in Global Heart Unfiltered. We'll you soon.

Global Health Unfiltered (1:06:10)
That's what we're going for. Thank you. Thank you to our listeners. Thank you, Ella, for co-hosting the episode with me. And to our listeners, thank you for tuning to Global Heart Unfiltered. Be sure to like,

subscribe to get more of these unfiltered conversations. Until next time.

Catherine Kyobutungi (1:06:32)
like, subscribe to get more of these unfiltered conversations. Until

next time, take care. Bye bye.

Global Health Unfiltered (1:06:40)
Take care.

Emmanuella Amoako (1:06:43)
Until next time,