Recent advancements in large language model (LLM) performance on medical multiplechoice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-andmiddle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA , the first largescale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

Large language models (LLMs) are increasingly deployed in global healthcare, yet their outputs often reflect Western-centric training data and omit indigenous medical systems and region-specific treatments. This study investigates cultural bias in instruction-tuned medical LLMs using a curated dataset of African traditional herbal medicine. We evaluate model behavior across two complementary tasks, namely, multiple-choice questions and fill-in-the-blank completions, designed to capture both treatment preferences and responsiveness to cultural context. To quantify outcome preferences and prompt influences, we apply two complementary metrics: Cultural Bias Score (CBS) and Cultural Bias Attribution (CBA). Our results show that while prompt adaptation can reduce inherent bias and enhance cultural alignment, models vary in how responsive they are to contextual guidance. Persistent default to allopathic (Western) treatments in zero-shot scenarios suggests that many biases remain embedded in model training. These findings underscore the need for culturally informed evaluation strategies to guide the development of AI systems that equitably serve diverse global health contexts. By releasing our dataset and providing a dual-metric evaluation approach, we offer practical tools for developing more culturally aware and clinically grounded AI systems for healthcare settings in the Global South.