The Gates Foundation and OpenAI are launching a new partnership aimed at bringing artificial intelligence into frontline health care systems across Africa, starting with Rwanda.

The initiative, called Horizon1000, will deploy AI-powered tools to support primary health care workers in patient intake, triage, follow-up, referrals, and access to trusted medical information in local languages. The organizations said the effort is designed to augment — not replace — health workers, particularly in regions facing severe workforce shortages.

The Gates Foundation and OpenAI are committing up to $50 million in combined funding, technology, and technical support, with a goal of reaching 1,000 primary health clinics and surrounding communities by 2028. The tools will be aligned with national clinical guidelines and optimized for accuracy, privacy, and security, according to the organizations.

“I spend a lot of time thinking about how AI can help us address fundamental challenges like poverty, hunger, and disease,” Bill Gates wrote in a blog post. “One issue that I keep coming back to is making great health care accessible to all — and that’s why we’re partnering with OpenAI and African leaders and innovators on Horizon1000.”

In sub-Saharan Africa alone, health systems face a shortage of nearly six million workers — a gap Gates said cannot be closed through training alone.

“AI offers a powerful way to extend clinical capacity,” wrote the Microsoft co-founder.

The announcement comes during the World Economic Forum’s 2026 annual meeting, where Gates appeared alongside Rwanda’s Minister of ICT and Innovation and the head of the Global Fund to discuss how AI and other technologies could help reverse recent setbacks in global health outcomes.

OpenAI, backed by Microsoft, earlier this month rolled out ChatGPT Health as part of its foray into healthcare.

Other nonprofits are exploring ways to apply AI in healthcare. PATH, a Seattle-based global health nonprofit, has received funding from the Gates Foundation to support this work. That includes grants to develop diagnostics and other healthcare services targeting underserved populations in India, and funding to study the accuracy and safety of AI-enabled support for healthcare providers.

Previously: Gates Foundation will cut up to 500 positions by 2030 to help reach ‘ambitious goals’

The Gates Foundation on Wednesday unveiled a record $9 billion operating budget for 2026 — which includes a plan to reduce its workforce by up to 500 positions over the next five years, or about a fifth of its current headcount.

The foundation’s board approved a cap on operating expenses of no more than $1.25 billion annually — roughly 14% of its total budget — prompting the cuts and other cost controls to align internal spending with that new limit.

The Seattle-based foundation said headcount targets and timelines will be adjusted year by year, and that it will continue to hire selectively for roles deemed critical to advancing its mission.

The decision comes after the foundation announced last year that it would shut down by 2045.

Bill Gates, the Microsoft co-founder who helped launch the Gates Foundation in 2000, announced plans in May to give away $200 billion — including nearly all of his wealth — over the next two decades through the foundation.

The philanthropy is the world’s largest and has already disbursed $100 billion since its founding, helping save millions of lives with its focus on global health and other social initiatives.

“The foundation’s 2045 closure deadline gives us a once-in-a-generation opportunity to make transformative progress, but doing so requires us to focus relentlessly on the people we serve and the outcomes we want to deliver,” Mark Suzman, CEO of the Gates Foundation, said in a statement. “Ensuring as much of every dollar as possible flows toward impact is critical to achieving our ambitious goals to save and improve millions more lives over the next 20 years.”

The foundation had already begun ramping up its grant making, issuing $8.75 billion in 2025, and previously committed to distribute $9 billion this year. It has a $77 billion endowment.

This year the foundation will increase spending in priority areas, including maternal health, polio eradication, U.S. education, and vaccine development.

The increase in funding commitments comes amid Trump administration cuts to global foreign assistance, its shutdown of the U.S. Agency for International Development (USAID), and broader reductions in funding for health and scientific research.

In his annual letter released last week, Gates wrote that “the thing I am most upset about” is that the number of deaths of children under 5 years old increased in 2025 for the first time this century, which he traced to cuts in aid from rich countries.

“The next five years will be difficult as we try to get back on track and work to scale up new lifesaving tools,” he wrote. “Yet I remain optimistic about the long-term future. As hard as last year was, I don’t believe we will slide back into the Dark Ages. I believe that, within the next decade, we will not only get the world back on track but enter a new era of unprecedented progress.”

Bill Gates had a front-row seat for the rise of AI, from his longtime work at Microsoft to early demonstrations of key breakthroughs from OpenAI that illustrated the technology’s potential. Now he’s urging the rest of us to get ready.

Likening the situation to his pre-COVID warnings about pandemic preparedness, Gates writes in his annual “Year Ahead” letter Friday morning that the world needs to act before AI’s disruptions become unmanageable. But he says that AI’s potential to transform healthcare, climate adaptation, and education remains enormous, if we can navigate the risks.

“There is no upper limit on how intelligent AIs will get or on how good robots will get, and I believe the advances will not plateau before exceeding human levels,” Gates writes.

He acknowledges that missed deadlines for artificial general intelligence, or human-level AI, can “create the impression that these things will never happen.” But he warns against reaching that conclusion, arguing that bigger breakthroughs are coming, even if the timing remains uncertain.

He says he’s still optimistic overall. “As hard as last year was, I don’t believe we will slide back into the Dark Ages,” he writes. “I believe that, within the next decade, we will not only get the world back on track but enter a new era of unprecedented progress.”

But he adds that we’ll need to be “deliberate about how this technology is developed, governed, and deployed” — and that governments, not just markets, will have to lead AI implementation.

More takeaways from the letter:

Job disruption is already here. He says AI makes software developers “at least twice as efficient,” and that disruption is spreading. Warehouse work and phone support are next. He suggests the world use 2026 to prepare, citing the potential for changes like a shorter work week.

Bioterrorism is his top AI concern. Gates warns that “an even greater risk than a naturally caused pandemic is that a non-government group will use open source AI tools to design a bioterrorism weapon.”

Climate will cause “enormous suffering” without action. Gates cautions that if we don’t limit climate change, it will join poverty and infectious disease in hitting the world’s poorest people hardest, and even in the best case, temperatures will keep rising.

Child mortality went backward in 2025. Stepping outside AI, Gates calls this the thing he’s “most upset about.” Deaths for children under 5 years old rose from 4.6 million in 2024 to 4.8 million in 2025, the first increase this century, which he traced to cuts in aid from rich countries.

AI could leapfrog rich-world farming. Gates predicts AI will soon give poor farmers “better advice about weather, prices, crop diseases, and soil than even the richest farmers get today.” The Gates Foundation has committed $1.4 billion to help farmers facing extreme weather.

Gates is using AI for his own health. He says he uses AI “to better understand my own health,” and sees a future where high-quality medical advice is available to every patient and provider around the clock.

AI is now the Gates Foundation’s biggest bet in education. Personalized learning powered by AI is “now the biggest focus of the Gates Foundation’s spending on education.” Gates says he’s seen it working firsthand in New Jersey and believes it will be “game changing” at scale.

Read the full letter here.