Mandilakhe Tshwete
Experts argue that rather than abandoning aid, the US should reform its approach to maintain influence and counter-balance China’s growing dominance in Africa.
President Donald Trump’s administration has suspended almost all USAID aid programs and cut its workforce.
Funding for aid projects has been frozen for 90 days while they are reviewed to ensure they align with Trump’s priorities.
Pepfar-funded HIV organisations in South Africa were asked to resubmit work plans and adjusted budgets that adhered to USAID rules.
Head of African Futures and Innovation at the Institute for Security Studies, Jakkie Cilliers, said the cuts will likely harm US-Africa relations, creating an opportunity for China to expand its influence.
“Following the 20 January executive order on Reevaluating and Realigning United States Foreign Aid, USAID started distributing notices of suspension, instructing recipients to stop working on awards and not incur any new costs.
“Subsequently, emergency food assistance and administrative expenses necessary to administer it were exempted by a 90-day waiver, as was life-saving humanitarian support to several countries, including the Central African Republic (CAR), Chad, South Sudan, Democratic Republic of the Congo (DRC), Uganda and Rwanda.
“In line with the Republican Party’s war on diversity, equity and inclusion (DEI), all activities related to abortions, family planning, gender or ‘DEI ideology programs,’ transgender surgeries and other non-life saving assistance are specifically excluded from the waiver.”
Cilliers added that reforming aid should not mean abandoning it.
“Compared to these more gradual reductions – which are themselves hugely problematic – the deep and hurried cuts in US aid to Africa will seriously damage attitudes toward the US, increase poverty and reduce economic growth. China may cheer at the damage the US is doing to its standing in Africa, but African people won’t.
“If US policymakers truly seek to pursue their national interests and counter China in Africa, they must rethink their approach – before the damage becomes irreversible.
Cilliers added that Donald Trump’s cuts could push 5.7 million more Africans into extreme poverty next year.
Public Health Specialist & Project Management Professional (PMP) Rudi De Koker said the cancellation of USAID funding will have a devastating impact on healthcare programmes, particularly HIV/AIDS treatment and prevention efforts.
“South Africa has the largest HIV treatment programme in the world, with over 1.1 million people at risk of losing access to antiretroviral therapy (ART) due to funding cuts. The withdrawal of financial support will place immense strain on healthcare facilities, leading to increased treatment interruptions, higher transmission rates and a reversal of the progress made in controlling the epidemic.
“The focus of USAID funding in South Africa has been to allocate to NGOs to support the efforts of the Department of Health.”
He explained that the key programmes affected include HIV testing, ART provision, community-based support services, tuberculosis (TB) screening and treatment and maternal and child healthcare services.
“Health systems will struggle to maintain ART distribution and that HIV prevention efforts, such as pre-exposure prophylaxis (PrEP) and harm reduction programmes, will be severely disrupted.
“The most vulnerable populations include people living with HIV, pregnant women, children, key populations such as sex workers and men who have sex with men (MSM) and those in rural and underserved communities will be disproportionately affected.
“The funding loss will deepen health inequalities, leaving marginalised communities with even fewer healthcare options. Families where treatment interruptions occur will experience increased financial strain, affecting their overall well-being, as untreated HIV leads to the increase of opportunistic infections thus increasing absenteeism. The loss of USAID support will slow progress in reducing HIV transmission rates and controlling TB and malaria. Without sustained investment, TB cases will likely rise due to reduced screening and treatment access,” said De Koker.
Dr Munya Saruchera, director at the Africa Centre for Inclusive Health Management at Stellenbosch University, added South Africa spends R44.4 billion on HIV counselling, testing and treatment per year, and PEPFAR contributes 17% of this budget, and the balance comes from domestic budget and other donors like the Global Fund To Fight AIDS, TB and Malaria.
“Clearly the implications are huge for SA’s HIV/AIDS counselling, testing and treatment services given the high prevalence rate of about 12.7% and 19% infection rate.
“The implementation of the NHI has never been more urgent, and this development plus other stringent measures and drastic changes to come remind us about the strategic need for facilities like NHI – however a lot still needs to be done to address the various implementation challenges and concerns raised by different stakeholders.
“SA and other African countries (as a block under the AU most importantly, much as there will be individual country competition) have an opportunity to engage entities like the European Union, Canada, Australia, Japan and China to step into the breach and increase their contributions to the Global Fund, or even to directly plug holes left by PEPFAR using bilateral aid – though such funding may come too late for some.”
Saruchera further stated that this was a huge opportunity for African countries, many of which remain too dependent on foreign aid to run their health systems.
“A country like South Africa should be able to pay for every last cent of its health systems. Corruption and mismanagement have had an inordinate role in making this difficult.
“For countries like Malawi, Mozambique and others, there is a long way to go before they can pay their own way for HIV treatment. But pressure, from within and out these countries, must be put on their governments to build robust economies capable of delivering tax revenue to spend more on health.
“In a divided world where nationalist populism is on the rise, on the backdrop of a polycrisis, and African governments remain weak and corrupt, these opportunities should be seized,” said Saruchera.
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