The Trump administration’s freeze on foreign assistance and dismantling of the US Agency for International Development, or USAID, in 2025 have sharply reduced health support for countries across Africa and the Global South. The administration also terminated 80 percent of global health funding awards in 2025, disrupting programmes for HIV, tuberculosis, malaria, maternal health and other essential services.
External financing for health in Africa contracted by close to 70% between 2021 and 2025. The reduction has left governments facing widening gaps at a time when national debt and other fiscal pressures are limiting the money available for public health.
New bilateral memorandums of understanding under the “America First Global Health Strategy” set out a 59% reduction in funding across 18 countries by 2030, or about $2 billion less than pre-2025 spending. By the final year of the agreements, US government funding across those countries is set to fall by between 43% and 97% from baseline levels.
Rwanda faces a 97% reduction in US funding compared with pre-2025 levels by 2030. Liberia faces an 84% reduction, Burundi 78%, Madagascar 77% and Sierra Leone 71%.
The agreements also impose steep co-financing requirements on governments. Countries that fail to meet them may face penalties that could deepen the cuts. Countries are barred from adding contributions from other donors or multilateral organisations to US funding. The brief says 11 countries are unable to raise domestic funds within 5 years, although it remains unclear how many have sought other sources of financing.
The January 2025 freeze on funding from the President’s Emergency Plan for AIDS Relief, known as PEPFAR, caused substantial disruption to HIV prevention and treatment. The freeze led to the closure of 1,714 service delivery sites. These included more than 1,000 public health facilities, 206 private HIV-specific facilities, 47 mobile clinics and 126 drop-in centres.
Some 87% of PEPFAR partners reported staffing reductions, accounting for 16,452 lost full-time equivalent posts. More than 8,000 healthcare workers were retrenched in South Africa after PEPFAR cuts. The withdrawal of PEPFAR funding there led to HIV clinic closures across the country, leaving 1.4 million people living with HIV uncertain about their treatment.
The effects have also been recorded in the range of services still being delivered. Among PEPFAR partners, 73% stopped at least one service. Male circumcision fell by 88%, viral-load testing by 68%, pre-exposure prophylaxis, or PrEP, by 64%, condom distribution by 55% and antiretroviral therapy initiation by 30%.
Clinical research has also been interrupted, with more than 27 HIV trials and 20 tuberculosis trials suspended. Modelling studies predicted 552,500 additional infections and 330,400 HIV-related deaths in a single country if PEPFAR disruptions continued. The brief does not identify the country or establish the patient outcomes already experienced since the January 2025 freeze.
Several governments are trying to absorb costs previously met by US programmes. Nigeria is absorbing 28,000 health workers at a cost of $200m. South Africa is losing over $400m annually from PEPFAR. At the World Health Assembly in May, Ghana said it had lost $78m after USAID programmes closed, affecting maternal healthcare, malaria treatment, nutrition and HIV/Aids interventions.
The loss of support comes as countries continue to manage infectious disease threats, including Ebola in the Democratic Republic of Congo’s fastest-spreading outbreak on record. Health systems that relied on outside financing for vaccination, disease surveillance, maternal care and infrastructure now face pressure to maintain services with smaller budgets.
Congressional appropriations for global health remain available, although they have not been disbursed. More than $3.6 billion allocated by Congress remains undisbursed, while $1.35 billion is set to expire on 30 September. Congress rejected a proposed $6.2 billion cut in health spending and approved a $615 million decrease instead. The brief does not say how the undisbursed funds will be allocated or whether they will lapse.
Comments (0)