News and Insights
Funding Cuts and Emerging Risks for Africa’s Health Sector
April 8, 2025
The impact of recent shifts in US health policy on Africa is becoming increasingly evident, raising urgent questions about the sustainability of healthcare programs that have long relied on foreign aid. Across the continent, discussions are intensifying as funding reductions threaten essential services such as HIV/AIDS treatment, malaria control, and maternal healthcare. In countries such as Cameroon, where US support has covered nearly all tuberculosis and HIV programs, the situation has reached a breaking point. The government has had to ask health workers to continue volunteering while seeking alternative funding sources. Similarly, in Uganda, experts fear a surge in malaria cases as funding gaps limit access to vital preventive measures. These cuts are not just about lost funding; they are about lives and livelihoods, with fragile healthcare systems struggling to adapt.
Governments across Africa are now forced to shift focus toward domestic solutions, regional collaboration, and alternative funding avenues, but the transition is not easy. Countries are working to reallocate resources and explore new funding strategies, but there are doubts about whether internal funding alone can bridge the gap. Beyond securing new money, significant improvements in efficiency, resource management, and innovation will be critical to determining whether healthcare systems can adapt to this new reality.
Fragile Gains at Risk
For decades, Africa’s health sector has heavily relied on international donors for basic care, life-saving medication, and disease control. With the withdrawal of US funding and reductions in European funding, health workers face an uncertain future.
It’s important to keep donor funding in context. Almost two-thirds of health expenditure in Africa is by individuals – making that spending more affordable, efficient, and effective is the most important route to improving health. In March 2025, the Center for Global Development broke out the impact of the loss of $12 billion in USAID funding. In a few heavily AID-dependent states such as Malawi and South Sudan, external funds support over half of health expenditure – although the money comes from multiple donors – but Cameroon and Kenya are more typical with 14 and 18 percent of overall health spending coming from sources outside each country.
Some health workers are already losing salaries tied to donor-funded programs, and clinics are feeling the strain. Countries that once depended on external support for essential medications and disease prevention are now grappling with how to deliver care without this backing.
The situation demands more than just plugging funding gaps. It is about transforming health systems, boosting efficiency, addressing corruption, and encouraging innovation. Without these reforms, new domestic or foreign funding may not be enough to sustain healthcare systems.
On the Ground: Realities in Different Regions
In North Africa, the consequences of funding cuts are limited, as the majority of healthcare funding in the countries in the region is sourced domestically, with minimal reliance on external assistance. In Morocco, external health expenditure represented 3.62 percent of total health spending in 2021, and 0.63 percent in Egypt. External assistance primarily supports specific health programs, such as the fight against HIV/AIDS and tuberculosis in Morocco and Algeria. Due to the recent funding cuts, local NGOs and institutions that relied on these funds are struggling to maintain services and sustain these critical health initiatives.
In East Africa, the impact is immediate and felt on the ground. Countries such as Uganda, Tanzania, and Kenya are now facing significant challenges as donor funding shrinks. “Uganda has long depended on external support for essential medications and disease prevention,” says Ignatius Bahizi, a senior Ugandan health journalist. “Now, health workers are facing salary cuts, and morale is low. Corruption and inefficiencies only worsen the challenge.”
In Tanzania, HIV/AIDS programs have long relied on donor aid. Syriacus Buguzi, a prominent health journalist in Tanzania, explains, “We are already seeing services cut off for millions, job losses, and a dangerous void in the national health system.” While Tanzania had previously established the AIDS Trust Fund (ATF) to reduce reliance on foreign aid, progress has stalled, and Buguzi believes that this moment should serve as a wake-up call. “We need to revitalize the ATF and expand it into a national health fund covering malaria, tuberculosis, and vaccines. This crisis is an opportunity to build a sustainable healthcare system before the progress we’ve made is lost.”
Kenya’s Health System Faces Growing Strain
In Kenya, the situation is further complicated by the ongoing shift in the national health insurance system. The country is replacing its National Health Insurance Fund with a new Social Health Authority (SHA), but with donor support frozen, there are concerns that the new scheme may not reach vulnerable populations.
For decades, agencies including USAID, PEPFAR, and the CDC, have played a pivotal role in keeping Kenya’s health system afloat. A 2020 report suggested that about $1 billion a year in foreign aid came from the US to Kenya, out of a total of $3 billion a year in transfers from the US to Kenya (trade, corporate investments, NGOs, and philanthropies are responsible for the other $2 billion). However, US aid funded over 80 percent of Kenya’s HIV response in that year.
Now, clinics are understaffed, HIV services have been disrupted, and data management systems are faltering. If the government cannot fill the gaps, years of progress in parts of the healthcare system may be undone. US bilateral assistance in total, though, is worth less than one percent of Kenya’s total GDP, so the shortfall can be made up with sufficient focus and political will.
Seizing the Moment: Turning Challenges Into Solutions
Despite these challenges, there are emerging opportunities. Governments across Africa are reassessing their reliance on traditional donors. Some are looking toward other global players such as China, Russia, and Gulf states, while many are strengthening regional cooperation through the African Union. Public-private partnerships are gaining momentum, with pharmaceutical companies playing an increasingly important role in bridging funding gaps. Innovations in digital health, such as telemedicine and mobile diagnostics, are beginning to play a crucial part in maintaining healthcare access despite shrinking funding.
In Morocco, for example, the recently launched African Academy of Health Sciences aims to help drive regional research collaborations, focusing on long-term sustainability and local leadership. The private sector is no longer just a passive observer; it is becoming an essential partner in building more resilient and responsive healthcare systems.
What Lies Ahead for Africa’s Healthcare Systems
The months ahead will be critical in determining how African governments navigate these funding challenges. Countries must not only fill funding gaps but also strengthen their healthcare systems to withstand future shocks. This will require difficult decisions and long-term reforms, but the alternative of faltering services, rising disease burdens, and deepening health inequities comes at too high a cost.
The question remains: Will this crisis serve as a catalyst for Africa to build a stronger, self-reliant health sector, or will it lead to the erosion of the gains made over the years? What is clear is that the stakes could not be higher. Countries across Africa are scrambling for answers, and the world is watching closely.