Rwanda has been selected as the first country to pilot Horizon1000, a $50 million artificial intelligence (AI) initiative announced by the Gates Foundation in partnership with OpenAI, aimed at strengthening primary healthcare systems in low- and middle-income countries.
The initiative will support the deployment of AI tools across primary healthcare clinics, communities, and households, to reach 1,000 clinics and surrounding populations by 2028.
Rwanda’s inclusion reflects both the scale of its health system challenges and its growing reputation as a testing ground for digital and policy innovation in Africa.
Announcing the initiative, Bill Gates said it builds on the foundation’s long-standing mission to close the innovation gap between wealthy countries and the rest of the world.
“People in poorer parts of the world shouldn’t have to wait decades for new technologies to reach them,” he wrote on his page, Gates Note.
He noted that the foundation has spent the past 25 years accelerating access to life-saving medicines and vaccines in low- and middle-income countries.
Rwanda’s health workforce shortage remains one of the most significant barriers to expanding access to quality care.
The country has roughly one health care worker per 1,000 people, far below the World Health Organization’s recommended ratio of four.
At the current pace, closing that gap through conventional training and recruitment would take generations.
“These huge shortages put health care workers in these countries in an impossible situation,” Gates wrote, describing systems where clinicians are forced to manage overwhelming patient loads with limited administrative support, outdated tools, and insufficient clinical guidance.
He pointed to World Health Organization estimates showing that low-quality care contributes to between six and eight million deaths each year in low- and middle-income countries.
Against this backdrop, Rwanda has positioned AI as a tool to strengthen, rather than replace, its health workforce.
Under the country’s 4×4 health reform agenda, the Ministry of Health recently announced the launch of an AI-powered Health Intelligence Center in Kigali.
The centre is designed to enhance the allocation of limited health resources and support more data-driven decision-making throughout the health system.
Gates described Rwanda’s approach as an example of how AI could help address structural constraints in under-resourced health systems.
“Today’s AI can help save those lives by reaching many more people with much higher-quality care,” he wrote, arguing that technology can extend the reach of overstretched health workers and improve consistency in service delivery.
Through Horizon1000, AI tools are expected to support frontline workers with clinical decision-making, data analysis, and administrative tasks, thereby reducing paperwork and freeing up time for patient care.
The Gates Foundation has emphasized that the initiative is designed to support health workers, not replace them, particularly in settings where shortages are already severe.
Globally, Gates has described AI as a technological shift on par with microprocessors, personal computers, mobile phones, and the internet.
He has noted that advances in large language models and machine learning are moving faster than anticipated, with applications reshaping sectors from education to science and health care.
In wealthier countries, AI is already being used to transcribe consultations, summarize patient visits, and automate documentation.
Gates believes similar tools could have an even greater impact in low-resource settings.
“In poorer countries with enormous health worker shortages and lack of health systems infrastructure, AI can be a game-changer in expanding access to quality care,” he said.
Rwanda’s Minister of Health, Dr. Sabin Nsanzimana, has described AI as the third major discovery to transform medicine, after vaccines and antibiotics a view Gates has publicly endorsed.
While Rwanda is the first country named under Horizon1000, the Gates Foundation and OpenAI say the initiative is designed to expand to other African countries over time.
For philanthropic actors, Rwanda’s pilot will be an early test of whether AI investments can strengthen public health systems without deepening inequalities, offering lessons that could shape how emerging technologies are deployed across Africa in the years ahead.
Help us tell more untold stories of African Philanthropy!
