As we approach the end of a disastrous year that brought death, misery and economic hardship for so many around the world, those of us lucky enough to still be here have a lot to reflect upon. Indeed, the ongoing coronavirus pandemic exposed the economic, social and political fault lines in our societies and bared our vulnerabilities like never before. BY Kastern Noko For many on the African continent, COVID-19 was not the only public health emergency of the past year. In the Democratic Republic of Congo, for example, people were also faced with the re-emergence of Ebola and a measles outbreak. In Nigeria, a yellow fever outbreak detected in early November has already claimed dozens of lives. In Cameroon, an outbreak of cholera in September killed at least 90 people. As our governments struggled to efficiently respond to multiple, interconnected public health crises, we became acutely aware of the shortcomings and failures of our health systems and social safety nets And perhaps for the first time in recent history, our political leaders also personally experienced the weaknesses of local health systems. With international travel having come to a halt, they found themselves unable to travel to Europe, Asia and the Gulf for treatment, and had to make do with treatment and facilities available in their own countries. Burundian President Pierre Nkurunziza unexpectedly died in June, a week after travelling to Kenya for medical treatment, at the age of just 55. So these last few days of 2020 should be an opportunity for every single one of us in Africa, but especially for our political leaders, to ask: Where did our health systems go so wrong, and what can we do to make sure we never again find ourselves in such a disastrous situation in the face of a global health emergency? A time when healthcare was a political priority In 1952, when Kwame Nkrumah became Ghana’s prime minister, the country’s health system was crumbling. According to medical historian Stephen Addae, the health service consisting of a few mostly European doctors and a small cadre of auxiliary medical staff was only able to meet the needs of around 20% of the population and its efforts were mostly concentrated in the relatively prosperous southern regions of the country. Yet, Nkrumah, who was Ghana’s first post-colonial leader after the country’s declaration of independence from Britain in 1957, managed to turn the situation around in less than a decade. He built new health centres and medical field units across the country, adopted modern healthcare concepts, introduced holistic medical care to communities, invested in educating medical staff and created doctor-led health teams to oversee local medical operations. With no direct out-of-pocket payment at the point of service delivery, healthcare in the country was financed entirely through government tax revenue. As a result of his efforts, the infant mortality rate declined from a high of 350/1 000 in 1915 to 110/1 000 in 1960. The successful national health system Nkrumah managed to build in a matter of