NGOs count the cost of lost United States funding
No service: The US government's funding cuts have put further strain on already overloaded clinics and forced some to close their doors. (Delwyn Verasamy)
South Africa's non-profit organisations are still counting the costs of the cessation of US funding earlier this year, with financial shortfalls leading to healthcare job losses while critical HIV vaccine services and research have been heavily scaled back.
US President Donald Trump announced in January that he was cutting US Agency for International Development (
According to official data, USAid disbursed $24.5 billion to organisations in the 2024 financial year.
Accountability Lab, a global network for transparency and open government, ran a survey of 266 organisations affected by the freeze from 1 to 18 May, and a third reported being 'at imminent risk of closure', with African countries — Kenya, Nigeria, the Democratic Republic of the Congo, Uganda and Ghana — the most affected.
'Nine of the top 10 most affected are African countries, with El Salvador rounding out the top 10. Others include South Africa, Cameroon, Senegal and the US,' said Accountability Lab's global communications director Sheena Adams.
'Worryingly, 21% have only one month of financial resources remaining, while 24% report a three-month financial runway.
'In terms of job losses, almost 55% of respondents reported having furloughed or laid off staff, with a further 14% confirming that layoffs were under consideration.
According to the state department, the US government committed $330 million in aid to South Africa last year, with $318.2 million coming from USAid.
The lion's share, $219.7 million, was for HIV/Aids, followed by $43.11 million for basic health, $31.8 million for operating expenses, $7.512 million to environmental protection, $7.006 million for trade policy and regulation, $3.677 million for agriculture, $3.512 million for government and civil society and $1.608 million to basic education.
The aid suspension will roll back progress in the fight against HIV/Aids, says activist group Treatment Action Campaign (TAC).
'The USAid and Pepfar [the US President's Emergency Plan for AIDS Relief] funding freeze has had a chilling effect on the global fight against HIV/Aids, particularly in countries like South Africa that bear a high burden of disease,' TAC spokesperson Xabisa Qwabe said.
'Many community-led organisations — including treatment literacy programmes, support groups and outreach initiatives — have had to scale down or suspend operations.
'Pepfar funding [disbursed by
TAC received substantial support from USAid/Pepfar through the Ritshidze Project, which enabled it to monitor service delivery, engage communities and hold the health system accountable.
'At its peak, up to 60% or more of TAC's operational budget was supported through this funding stream,' Qwabe said, adding that dozens of jobs had been lost.
'Staff retrenchments have occurred, particularly among community health educators and coordinators working in high-burden districts. The exact number may vary by province, but it has affected dozens of livelihoods.
'TAC's presence in many communities has been scaled back, meaning fewer workshops on treatment literacy, weaker monitoring of medicine stockouts and reduced mobilisation for treatment access and rights-based advocacy.'
Pepfar funding didn't directly pay for medication in South Africa but funded crucial support systems.
'The funding freeze has disrupted these support structures, leading to reduced testing, longer turnaround times and greater strain on overburdened clinics. Patients are increasingly falling through the cracks, especially in under-resourced communities,' she said.
TAC is actively seeking alternative funding, including local philanthropic partners, international donors, and development agencies, and has urged the government to step up support for civil society organisations.
'While some government departments have expressed willingness to explore support avenues, this is yet to materialise in substantial funding,' Qwabe added.
The solution, she said, is the urgent resumption of Pepfar funding with clear transition plans.
'We also need a stronger financial commitment from the South African government to support community-led health programmes. There should be greater investment in building sustainable, locally owned health infrastructure that doesn't rely solely on foreign aid. Civil society must be recognised as a vital partner in achieving these goals.
'This funding crisis is not just a bureaucratic issue — it's a humanitarian emergency.
'Patients are losing access to services and dedicated community health workers are losing jobs they've held for years. These are the very people who ensured South Africa's HIV treatment scale-up succeeded.'
'We're beginning to hear reports that HIV testing is not being done as much as it was before, viral load testing and CD4 count testing is coming down, which obviously will have an impact on our ability to keep people virally suppressed.
'People will get sicker, and once they are no longer virally suppressed, they are also at risk of transmitting the virus,' Gray warned.
'We will probably see both an increase in morbidity and, if we're not careful, mortality in both children and adults who are not properly in care.'
She noted that USAid and National Institute of Health (NIH) funding had supported scientific trials, adding: 'This has huge effects on HIV science and TB science, because we were involved in everything from vaccine research and development in both HIV and TB, as well as HIV cure, TB treatment trials and HIV treatment trials.'
'It also affects the NIH funding that supported clinical trial research infrastructure, laboratory research infrastructure and the whole ecosystem required to do innovation in HIV and TB — from discovery to pre-clinical testing to clinical trials to biomarker discovery.
'That whole ecosystem of innovation is severely hampered. The NIH funding was substantial — up to $250 million per annum.'
There have been job losses affecting a range of people involved in the work, from scientists and master's students to nurses and drivers.
'It has a huge impact on the human resources for research. That has an effect both at a macro and micro level on the economy. Drivers, counsellors, recruiters — all of them get retrenched, which means their families are thrown into poverty.
'If you have a quarter of a million US dollars of revenue coming in, all of that gets taxed, so there's also an impact on revenue collection.'
For example, the Perinatal HIV Research Unit at Baragwanath Hospital in Johannesburg has retrenched 70 staff members after losing NIH funding, which comprised 66% of its income.
'A lot more people will be retrenched over the next couple of months as the money dries up.
'Unless the research unit is able to diversify its funding stream it faces even further closure,' Gray said.
The loss of its USAid funding also forced the Brilliant Consortium to hal
'The vaccine manufacturing has been put on hold but we managed to find funding [from the Gates Foundation] to conduct a smaller study at a single site in South Africa,' Gray said.
The
'Many of our partners have completely shut down programmes and had to retrench staff and we are already feeling that we have to fill some of those gaps.
'Even testing kids the other day, we were down to one … how can you turn someone away from knowing their status? In the community there are concerns about whether people will be able to get their medication for their children,' she said.
'As a community-based organisation that has been serving our local community for 35 years, it's just heartbreaking to see the ripple effects of what has progressed.
'It's those who don't have options who are going to suffer the most.
'It is tragic. HIV has always been a global initiative with global targets and countries working together as a global community — and that has been destroyed.'
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