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By Henry Owino
Nairobi, Kenya: African countries have heavily relied on foreign aid to support their healthcare system. Unfortunately, the financial assistance came to an astounding close with the new United States of America (USA) administration headed by Donald Trump.
The USA’s 47th President Trump froze the international financial support to African countries in late January 2025, claiming it needed to review the country’s budget on foreign aid funding. The regime had said that the USA spends about $40 billion every year in aid, hence it’s time to review and prioritize America’s core national interests one dollar at a time.
Yes, the US government did implement a 90-day freeze on most foreign aid funding, including significant portions of health aid, in 2025. This freeze, initiated by the Trump administration, affected various programs managed by USAID, with exceptions for emergency food aid and military assistance to Israel and Egypt.
Most other programs have since been affected by the freeze, causing widespread concern and disruption to global health programs, particularly those related to HIV/AIDS, and leading to job losses for health workers in several countries.
A significant portion of the frozen aid was allocated to health programs, including those focused on HIV/AIDS prevention and treatment, impacting global health initiatives like PEPFAR (President’s Emergency Plan for AIDS Relief).
The USA international aid budget was a significant portion of the federal budget, although it’s a common misconception that it constitutes a large percentage. In FY2023, the USA disbursed $71.9 billion in foreign assistance, which represented 1.2 percent of the total federal outlays.
The aid encompassed various programs, including development, humanitarian, and economic assistance, with USAID being a key agency involved.
Consequences of Foreign Aid Shut
Dr Githinji Gitahi, the global CEO at Amref Health Africa, said Africans must never have relied on the West for their healthcare systems in the first place. He claimed the United States Agency for International Development (USAID) was mainly for official development assistance (ODA).
Dr Gitahi emphasized that ODA is a government aid that promotes and specifically targets the economic development and welfare of developing countries. It is more focused on health production, thus essentially how changes in inputs affect health outcomes.
“The USAID had a primary purpose of promoting the economic development and welfare of low- and middle-income countries. It therefore looked more into health infrastructure such as project plan, design target, and build enabling faster, more efficient, and reliable services,” Dr Gitahi explained.
For instance, offering humanitarian assistance and disaster response programs during crises and conflicts globally. The assistance includes food, shelter, medical care, and other essential supplies. So, beyond immediate relief, USAID also focused on long-term recovery, helping communities rebuild and become more resilient to future challenges.
He therefore affirmed that treatment and management of diseases have not been interfered with because it is locally funded. It is only regrettable that the foreign aid withdrawal in Africa led to the loss of jobs and vital health programs.
Dr Gitahi disclosed about US$400 million in healthcare funding was pulled out, leaving several health programs stranded and thousands dismissed.
“Approximately 350 thousand health workers, including community health workers in Africa, faced layoffs in various facilities due to a funding freeze. Many vital health programs, such as those providing HIV testing, treatment, and prevention services, were suspended or severely disrupted,” Dr Gitahi regretted.
Subsequently, US$250 million is spent in health matters yearly in Africa. The sudden freeze caused a loss of trust in the USAID program and raised concerns about the sustainability of international health initiatives to Africa.
“As medical experts, we are now warning that the freeze could lead to a surge in HIV/AIDS cases, increased mortality rates, and a breakdown in healthcare systems in affected countries, and the situation might be worse if there are no immediate interventions,” he emphasized.
Director Amref Health Africa stated the freeze, even with a partial waiver issued after the initial 90 days, left many aid organizations and communities uncertain about the future of their health programs and the provision of essential health services. He encouraged that with the continued concern for most African countries, it is a wake-up call for the initiation of sustainable domestic funding.
Sealing Corruption Loop Holes in Healthcare
This dependence on USAID funding is actually a symptom of a more critical problem within the healthcare system and the government as a whole: widespread, high-level mismanagement and corruption. Each year, due to gross maladministration and unchecked corruption, South Africa loses billions of rand, funds that are essential for addressing vital service delivery needs, including those related to HIV/AIDS healthcare.
In Kenya, according to the findings of the Ethics and Anti-Corruption Commission (EACC), corruption is costing an estimated KES 608 billion annually ($4.7bn) to the country, equivalent to 7.8 percent of its gross domestic product (GDP).
Dr Rose Oronje, Director of Public Policy & Knowledge Translation at African Institute for Development Policy (AFIDEP) in Kenya, realized a lot of wastages in terms of health priorities financing.
For instance, considerations of factors like disease burden, cost-effectiveness, and equity are made when making decisions about which health interventions to fund. Most of times drugs are purchased that are not based on urgency, ending up in store beyond expiry dates.
“Vehicles would be fueled; drivers paid their per diems and allowances and travel long distances especially to Mombasa to collect drugs and healthcare commodities only to come back to Nairobi without any due to poor planning and communication Dr Oronje observed.
In Kenya, the Finance Act, 2025 increased the tax-free threshold for per diems to KES 10,000 per day, offering employers a simplified approach to expense management and reducing concerns about taxable benefits.
Dr Oronje also challenged the government to prioritize the healthcare sector by allocating it adequate resources in the national budget. She explained that the 47 counties in Kenya depend on the national treasury to properly run health facilities closer to communities, instead of travelling long distances back and forth for simple treatment.
“I noted that over 40 percent of Kenya’s health budget is currently donor-funded. This structure is not only sustainable but also limits national government autonomy in healthcare priorities,” she noted.
She regretted most Africa countries mismanage finances and steal money meant for healthcare services. For instance, allocating dubious funds for non-existing healthcare programs, allocating exorbitant money to existing healthcare services that do not provide value for money, paying ghost health-workers among other wastages and misuses.
Opportunities For Africa Own Funding
Without requisite funding in place, thousands of vulnerable children could fall seriously ill or die. Many more youths might be deprived of vital HIV/AIDS counselling services.
Kenya, like South Africa, has the opportunity to extricate itself from the grip of the USA aid industry and to support orphanages such as Nyumbani Children’s Home in Nairobi through its own funding. This, however, can occur only if the Kenyan government adopts a strong position against corruption, re-evaluates government expenditure, and focuses on enhancing effective governance
Suspension of aid from Washington has, in one instance, endangered the health of HIV-positive orphans residing at Nyumbani Children’s Home in Nairobi. Between 1999 and 2023, USAID and PEPFAR contributed more than $16m to the orphanage, allowing it to support approximately 50,000 children through its rescue centre and two outreach initiatives, Lea Toto and Nyumbani Village.
The children of Nyumbani Children’s Home should not have to rely on Washington for HIV/AIDS services. The primary reason these orphans are in such a challenging situation is the indifference of Kenya’s self-serving politicians towards their wellbeing and the overall welfare of the nation.
Dr Mercy Korir, CEO and Editor-in Chief Willow Health Media said Africa countries need to think of sustainable solutions by investing in creating its own funding strategies to help reduce disease burden.
She pointed out these could include focus on preventive strategies other than curative strategies, such as walking, maintaining a healthy diet to avoid lifestyle diseases like obesity or overweight.
“We do not need donor funding to prevent lifestyle diseases caused by personal eating habits and lack of physical activity. Thus, it is important to focus on health production, not just health consumption,” Dr Korir advised.
Dr Korir urged Africa countries to maneuver on new partnerships such as private sectors, local philanthropists and public-private partnerships. Yet again, focusing on sustainable opportunities in health systems appropriate to Africans, being accountable to every available fund spent and its outcome to patrons.
Past Situation Comparison
According to Dr Willis Akhwale, Special Advisor at Kenya’s End Malaria Council and former Chairman of Kenya’s COVID-19 Task Force, the pandemic between 2019-2022 taught them lessons as health workers in the sector.
Dr Akhwale recalled the challenges in health commodities supply in terms of planning, purchasing, transporting, and storing. The other was financial constraints limiting the sector to provide for medication and equipment, which kept increasing on a daily basis.
Unfortunately, medical attention required a few skilled medics to avoid crowding and risk of contamination.
Again, the need for urgent training of more medics to handle a swelling number of patients with slim budgets, job losses among staff, information update on prevention, control, and treatment, including statistics of infected persons and hotspot areas, is a replica of the current situation.
“We had to cancel all outreach programs to focus on Covid-19 with little money, under pressure, high financial demands for quarantine purposes, but we managed. So even this USAID shutdown, we will come through with time,” Dr Akhwale anticipated.
The team of health experts advises the need for urgent reforms in how Kenya finances its healthcare system. A recurring theme: public funding must be the bedrock of service delivery, but not donor aid, and not private investment.
Public health services are foundational, hence private sector complementary but not a replacement for a well-funded public system. This includes immunization, sanitation, reproductive health, and other life-saving services that often depend on consistent government support.
