Conversations around health progress in Africa usually focus on lives saved. And rightly so. Across the continent, people are living longer than they did a generation ago. Advances in prevention, treatment and public health have reduced deaths from many major diseases and improved survival for millions. But there is another side to this success story that receives far less attention: quality of life. As a physiotherapist and rehabilitation researcher, I am interested not only in whether people survive illness, but also in how they live afterwards. The latest findings from the Global Burden of Disease 2023 study, to which I contributed, suggest that while mortality is falling, the number of people living with disability and chronic health conditions that affect everyday functioning is rising. The study shows that globally, healthy life expectancy at birth increased from 61.1 years in 2010 to 63.1 years in 2023. But the gap between living longer and living healthier is widening. Globally, years lived with disability rose from 786 million to 990 million between 2010 and 2023. These numbers suggest that many people are spending more years living with the consequences of disease and injury. In many African countries, this is occurring alongside a growing burden of noncommunicable diseases such as heart disease, stroke and diabetes.Health systems have become increasingly effective at reducing mortality, but they have not expanded rehabilitation services at the same pace. Many health systems are still poorly equipped to help people live well after illness or injury. This matters because health is about more than survival. It is also about whether people can move, work, learn, care for their families and participate fully in their communities. And that is where rehabilitation has a crucial role to play.Rehabilitation can help people recover after illness or injury, maintain independence and participate fully in society. Yet it remains overlooked in many health systems. To address this growing challenge, governments, health systems and development partners need to make rehabilitation a core part of healthcare rather than an afterthought. This means integrating rehabilitation into primary care, expanding the rehabilitation workforce and ensuring that services are available in communities, where people live and work.Looking beyond deathsTo understand what is happening to population health in Africa, I worked with colleagues from around the world as part of the Global Burden of Disease 2023 study, one of the largest and most comprehensive health research collaborations ever undertaken. The latest studies examined trends in life expectancy, causes of death and disability across the world. This provides one of the clearest pictures yet of how health is changing in Africa. I was particularly interested in the findings related to disability. Public health discussions often focus on reducing mortality. But surviving a health condition does not necessarily mean returning to full health. The studies show that although life expectancy is improving across much of sub-Saharan Africa, the amount of time people spend living with disability is also increasing. These trends are increasingly visible in sub-Saharan Africa, where long-term conditions such as heart disease and diabetes are becoming more common.Several forces are driving this trend. More people are surviving conditions such as HIV, tuberculosis and neonatal complications. At the same time, population growth, ageing and the rising prevalence of noncommunicable diseases such as stroke, heart disease, diabetes and musculoskeletal disorders mean that more people are living with conditions that affect their functioning.From a rehabilitation perspective, this is a critical finding. It suggests that Africa’s health systems are increasingly caring for people who need support not only to survive, but also to maintain independence, mobility, communication and participation in everyday life. This growing need for rehabilitation is one of the most important, yet least recognised public health challenges emerging from the latest global health evidence.What the findings tell usWhat stood out most to me was not simply that disability is increasing, but why it is increasing. For many years, policymakers, researchers and development organisations often viewed disability in Africa primarily as a consequence of weak health systems. The underlying assumption in many policy and public health discussions was that if healthcare improved, disability would naturally decline. The Global Burden of Disease 2023 findings tell a more complex story. In many cases, rising disability is linked to health system success. More people now survive conditions that were once fatal.But survival often comes with consequences that can last for years or even a lifetime. The studies show that noncommunicable diseases are becoming a larger contributor to health loss across sub-Saharan Africa. Someone who survives a stroke, for example, may live for many years afterwards but continue to experience weakness, mobility difficulties or communication problems that require ongoing rehabilitation and support. At the same time, injuries remain a major cause of long-term disability, particularly among younger adults.Improvements in survival from infectious diseases also mean more people are living with chronic health needs.The way forwardGovernments and development partners can change the lack of rehabilitation capabilities by integrating rehabilitation into primary healthcare, investing in workforce development and expanding access to community-based services. Africa’s health gains over recent decades are worth celebrating. But success should not be measured only by lives saved. It should also be measured by whether people can live well after survival.Ukachukwu Abaraogu receives research funding from the National Institute for Health and Care Research(NIHR), the Royal Society of Edinburgh (RSE), and the Chief Scientist Office (CSO) Scotland. These awards supported research in evidence synthesis method, rehabilitation, behaviour change, physical activity, dementia, chronic pain, and vascular health. He is co-Lead of Cochrane Heart, Stroke and Circulation, Honorary Senior Lecturer Population Health, Health Services Research & Primary Care University of Manchester at the University of Manchester, and Senior Collaborator within the Global Burden of Disease Programme at University of Washington.