Africa Health and WaSH Futures: Thematic Futures

This research paper outlines the 'Demographics and Health Scenario' for Africa, a model designed to accelerate the continent's demographic transition and enhance its demographic dividend through targeted interventions in fertility, mortality, and Water, Sanitation, and Hygiene (WaSH) infrastructure.

• The scenario proposes a large-scale rollout of modern contraceptives to reduce fertility rates. By 2050, average usage is projected to reach 75% in sub-Saharan Africa (a 24 percentage point increase over the Current Path) and 85% in North Africa. This is based on progress observed in countries such as Ethiopia and Malawi.
• To address the 'double burden of disease', the scenario targets a 20 percentage point reduction below the Current Path for mortality rates of the top five disease types in each African country. Respiratory infections and cardiovascular diseases are identified as top five causes of death across all African countries. Additionally, HIV infection rates are targeted for a 20% reduction below the Current Path in nine countries where the rate exceeds 1% of the population.
• The scenario aims to increase access to safely managed water and sanitation to reduce communicable diseases and improve workforce productivity. In sub-Saharan Africa, average urban access is projected to rise from 45% in 2025 to 74% in 2050, while rural rates are projected to increase from 17% in 2050 to 45%. Total access rates in North Africa are projected to increase from 78% in 2025 to 92% by 2050. These targets reflect progress seen in Ghana and Kenya.
• The model targets a 20% reduction in under-five stunting rates below the 2050 Current Path in 39 African countries where the rate exceeded 20% in 2021. This would reduce the number of stunted children from 30 million in 2025 to 12.8 million in 2050. While Burundi, Eritrea, Niger, and the DR Congo had the highest rates in 2025, Burundi is projected to still have the highest rate in 2050, followed by Lesotho, Malawi, and the CAR.
• Implementing these health improvements requires increased funding: a 5% increase in health spending, totaling an additional US$18.9 billion continentwide, with infrastructure spending peaking at US$4.7 billion per annum in 2037. The largest improvements in the ratio of working-age persons to dependants are expected in Central and West Africa.

APA

Cilliers, J. (2026). Africa Health and WaSH Futures: Thematic Futures. Institute for Security Studies. https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario

Chicago

Cilliers, Jakkie. Africa Health and WaSH Futures: Thematic Futures. Institute for Security Studies, 2026. https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario.

Wikipedia

{{cite report |last1=Cilliers |first1=Jakkie |title=Africa Health and WaSH Futures: Thematic Futures |publisher=Institute for Security Studies |date=29 March 2026 |url=https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario |access-date=17 August 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{cilliers2026africa, author = {Cilliers, Jakkie}, title = {{Africa Health and WaSH Futures: Thematic Futures}}, institution = {Institute for Security Studies}, year = {2026}, month = mar, url = {https://futures.issafrica.org/thematic/guide.pdf?thematic=05-health-and-wash&topic=03-demographics-health-scenario}, urldate = {2026-08-17}, note = {Indexed by Climate Insights Directory} }