What if every baby born in Africa started life with an all-access key to the 21st century? Not a smartphone or an AI assistant, but something much more – fundamental recognition that says you are here, you are known, and you belong.
At the just-concluded UNGA81, I listened to African leaders reflect on what it will take for the continent to realize the promise of artificial intelligence. At the Unstoppable Africa session, Rwanda’s Prime Minister Justin Nsengiyumva spoke about decades of government investment in digital public infrastructure, including nationwide 4G coverage and the digitization of more than 250 government services. His point was clear: “AI cannot thrive on algorithms alone.” Sierra Leone’s Chief Minister, David Moinina Sengeh, brought another dimension to the conversation when he reflected on Africa’s history of extraction and asked whether, in the 21st century, we will allow our data to be extracted too.
These are different perspectives, but they speak to something I hear increasingly in conversations with governments across Africa – how do we make sure this next technological era strengthens our institutions, reflects our realities and creates value for our people? For those of us working in public health, answering that requires us to look much further back than the algorithm, to the foundations that determine whether people are visible to public systems in the first place.
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Almost half of children under five in sub-Saharan Africa do not have their births registered. And by 2050, Africa is expected to account for one in every three births globally. This is not just a bureaucratic or administrative gap. This is a global equity gap. Whether you work in health, financial inclusion, education or agriculture; whether you are in the public or private sector, an entrepreneur, an investor or a funder, I am willing to bet that you are counting and reporting on how many people you have reached. But do you know how many people you have missed, who they are and how you can reach them? Without knowing the denominator, how can we properly evaluate our impact and hold ourselves accountable?
A government cannot fully know whether children are being vaccinated, communities are receiving health services or resources are reaching those most in need if significant parts of its population are missing from the equation. How can we close the gap if we don’t know how large it is?
That is why every birth registered and every death counted matters. It gives governments a clearer picture of the population they are responsible for serving and, increasingly, creates the foundation from which people can participate in a digital society. More than 800 million people globally still lack official proof of identity, and more than half are children whose births were never registered. As governments digitize more public services, being recognized by the system will increasingly shape how easily people can access health care, education, social protection and economic opportunities.
We are already seeing African countries approach this in different ways. In Kenya, Maisha Namba is intended to provide a lifelong personal number beginning at birth. Rwanda has invested over many years in connecting civil registration, identity, and public services, while Ethiopia is expanding Fayda, its digital identification system. These examples point to a larger opportunity – to count people from birth, recognize them throughout their lives, and connect them to the services and opportunities they need. As more of those services become digital, we must also ensure that the systems intended to expand access do not inadvertently exclude people who lack the required documentation, connectivity, or digital literacy.
This becomes even more consequential as AI plays a greater role in how governments understand populations, identify risks, and allocate resources. As the Vital Strategies Foundation’s and Futures analysis of AI readiness across 83 countries has shown, countries are starting from very different places, and readiness depends on much more than access to AI itself. There is enormous potential for AI to strengthen disease surveillance, help health workers make better decisions, and enable governments to respond earlier to emerging health needs. But AI learns from data, and that should force us to ask who is represented in that data and who is missing. If populations are absent or poorly represented in the systems feeding AI, technology does not suddenly make them visible. Their realities can remain absent from the insights being used to make decisions about them.
Inclusion in the AI age therefore cannot begin once an algorithm has been built. It begins with whether a child is counted at birth, whether she is recognized by the state, whether she can access health care and education, whether her experiences become part of the data used to understand her community, and whether people like her have a voice in how technologies intended to serve them are designed and governed. This is why some of the smartest investments we can make in the AI era may not look like AI investments at all. They will look like reliable birth and death registration, trusted identity systems, interoperable public infrastructure, strong data governance, skilled public-sector workforces and institutions capable of protecting people’s data while using it to make better decisions.
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At Unstoppable Africa, one phrase particularly resonated with me – “radical inclusion.” I think that is an ambition worth carrying into Africa’s approach to AI. Success should not simply mean that more AI solutions are developed or deployed across the continent. It should mean that African institutions have the capacity to shape them, African realities are reflected in the data that powers them, and the benefits reach people who have historically been easiest for public systems to miss.
That also changes the investment conversation. We should not have to build another disconnected system every time new technology or health intervention arrives. Governments, philanthropy and development partners have an opportunity to invest once, and invest well, in strong public foundations that many solutions can build upon, and that countries can own and sustain. We talk frequently about Africa’s opportunity to leapfrog in the AI era, and I believe that opportunity is real. But leapfrogging still requires strong ground from which to leap.
For a continent that will soon be home to one in every three children born in the world, building that ground starts with something remarkably fundamental, making sure every child is counted, recognized and connected.
Mary-Ann Etiebet, MD, MBA, President and CEO, Vital Strategies
