Drought and food insecurity continue to be among the most severe and complex threats to human life worldwide. Between 2020 and 2023, the Horn of Africa experienced their most severe drought in 40 years and in some areas famine still presented a viable risk, prompting us to ask ourselves, ‘What if we were able to avert the next famine in the Horn of Africa?’. This Outcome Report presents key insights gleaned from a series of expert roundtables. Over 40 practitioners participated, applying a systems lens to collectively explore and unravel the complexities of drought and food insecurity in the Horn of Africa. The goal of these roundtables was to gain a deeper understanding of the big picture and underlying issues, and then leverage the transformative power of foresight to imagine and co-create pathways for action to achieve a common vision of a drought-free and food-secure Horn of Africa.