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Daily Maverick
3 days ago
- Business
- Daily Maverick
Restructuring global health – WHO faces major challenges as foreign aid reductions take toll
While the immediate effects of the US cuts in health aid are being felt primarily by the Global South, the associated risks extend worldwide. Last week, global leaders gathered for the World Health Assembly in Geneva to address the reality that the global health landscape is being reshaped by dramatic shifts in funding, priorities, and leadership. Chief among these is the United States' decision to slash foreign aid and withdraw from the World Health Organization (WHO). Despite spending only 0.24% of its gross national income on foreign aid, the United States has been the largest donor to global health programmes, providing one-third of the international assistance in global health. This is not just a US issue – other countries have also signalled reductions in foreign health aid, and Argentina also recently announced it will withdraw from the WHO. These dramatic shifts have forced the WHO to plan a reduction in staff by nearly 50%, triggering massive restructuring. Non-government organisations (NGOs) are laying off large numbers of staff worldwide. While other donors and philanthropies are stepping in, they cannot fill the void alone. Meanwhile, the shock to the system is already resulting in lives lost. According to the WHO, countries such as Haiti, Kenya, Lesotho, South Sudan, Burkina Faso and Nigeria may run out of HIV antiretroviral medications within months. The Africa CDC's director-general, Dr Jean Kaseya, warned in March that 'two to four million additional Africans are likely to die annually' as a result of the aid cuts. T The continent now faces a $12-billion shortfall in healthcare financing. Substantial impacts will be felt across the globe, from Afghanistan to Lao PDR, in many low- and middle-income countries. While the immediate effects of these cuts are being felt primarily by the Global South, the associated risks extend globally. When countries become overwhelmed by preventable infections, they will lose the ability to detect and contain pathogens with epidemic potential that could cross borders in days. The current situation carries serious implications for global security as well as health. A new era needs to begin with a roadmap for sustainable domestic funding by individual nations, a strategic view of the role of WHO, and a coordinated plan among major donors. Governments must take the lead in reshaping their health budgets to reflect urgent needs while navigating competing priorities. Donors, NGOs, and multilaterals can support this shift if they embrace flexible, trust-based funding models tailored to local strategies. African health financing The desire to create long-term sustainability is apparent in the Africa CDC's strategic plan to transform health financing, which focuses on domestic resource mobilisation, diversifying funding sources, optimising health fund management and using evidence-based data for efficient resource allocation. The plan calls for member countries to meet the Abuja Declaration target of spending at least 15% of national budgets on health and explores innovative ideas such as solidarity levies and mobilising Africa's $95-billion in annual diaspora remittances. Nigeria's Basic Health Care Provision Fund, which dedicates 1% of revenue (about $150-million annually) to primary care, is a promising example. Any effort to reform global health infrastructure must prioritise resilient, widely accessible primary healthcare. Since the Alma-Ata declaration of 1978, we've known that primary care is the foundation of 'Health for All'. Doing so will not only reduce the impact of chronic and endemic infectious diseases, but also serve to enable systems that quickly identify when infectious disease outbreaks of concern appear. As the WHO recalibrates, it must assess realistically the current situation and focus on its most important core functions for the future: setting global standards, responding to emergencies and coordinating transnational responses. Routine programme implementation should be handled by individual countries, NGOs, and the private sector. The WHO can no longer afford to take on the management of basic health functions within countries. Instead, it needs to focus on maintaining surge capacity to meet needs during health emergencies and facilitate cooperation in transboundary issues. The WHO needs to prioritise doing fewer things better. Now is also the time for new global coalitions, agreements and leadership among non-government actors. The Gates Foundation has reaffirmed its commitment to address emerging challenges. Philanthropies must align their efforts to successfully cooperate, identify priorities and gaps, reduce duplication and maximise impact. Meanwhile, the private sector has a vital role to play in connecting national health priorities to new markets, innovations and partnerships. Global health needs a multisector coalition of the willing right now that is felicitous, innovative, able to learn from past mistakes and adapt to meet the world's current needs and prevent future crises. The time for action is now – the consequences of inaction are too great, and the lives lost are both predictable and preventable. DM Mitchell Wolfe is Senior Associate at the Center for Strategic Studies, Washington, DC; Nahid Bhadelia is Associate Professor at the Boston University School of Medicine; and Wilmot James is Professor and Strategic Advisor to the Pandemic Center at Brown University's School of Public Health and a former Member of Parliament (South Africa).
Observer
25-05-2025
- Health
- Observer
A plan to end malaria in Africa
Despite being preventable and curable, malaria has continued to claim African lives. In 2023, the continent accounted for around 95 per cent of the 597,000 deaths from malaria worldwide, 76 per cent of which were children under the age of five. But eliminating this scourge, which impedes development goals and realisation of the African Union's Agenda 2063, is within reach. Nine AU member countries – Algeria, Cabo Verde, Egypt, Lesotho, Libya, Mauritius, Morocco, the Seychelles and Tunisia – have become malaria-free, owing to sustained political commitment and well-targeted public investment in primary healthcare and disease surveillance and case management. African countries with a higher malaria burden should heed their example. Algeria, for example, invested in effective vector control through indoor residual spraying, universal healthcare access for malaria diagnosis and treatment, and rapid outbreak-response mechanisms. Cabo Verde's strategic malaria-elimination plan involved a multisectoral approach, whereby the government worked closely with local communities and international organisations. Egypt's multipronged strategy included, among other things, robust training programmes for primary health workers. Implementing these coordinated interventions required the political will and, crucially, increased domestic financing. Overall, Africa's efforts to control malaria – particularly through the use of insecticide-treated nets, indoor spraying and seasonal chemoprevention (which involves giving children a monthly course of antimalarial medicines) – have driven a notable decline in malaria deaths on the continent, from 805,000 in 2000 to 569,000 in 2023. (The Covid-19 pandemic, coupled with the emergence of partial resistance to the well-established malaria medicine artemisinin, caused a brief uptick, to 598,000, in 2020.) But these gains are fragile, particularly as new mosquito variants emerge, insecticide resistance grows, climate change worsens, humanitarian crises become more frequent, and, perhaps most importantly, the global malaria-funding gap widens. In 2023, only $4 billion was mobilised for malaria elimination, far below the $8.3 billion annual target, and a slight drop from the $4.1 billion raised in 2022. The problem is even more acute in Africa, where external health aid has declined by a whopping 70 per cent between 2021 and 2025. Moreover, most African countries devote less than 10 per cent of their national budgets to the health sector – well below the 15 per cent target set by the 2001 Abuja Declaration. Given the uncertain future of foreign aid, African governments must recognise malaria as a development priority and invest more in efforts to control and eliminate it. That means leveraging untapped resources, including the more than $95 billion in annual remittances from the African diaspora. Innovative financing instruments such as diaspora bonds could support the continent's public-health agenda. Solidarity levies on tobacco, mobile transactions, and airline tickets could also generate billions of dollars for health services. And scaling up national health-insurance schemes will be required to expand access to malaria prevention, diagnosis and treatment. Blended finance can unlock private capital for malaria-related research and development, as well as local manufacturing of therapeutics. With Africa's healthcare market projected to be worth $259 billion by 2030, policymakers should capitalise on this opportunity to create effective public-private partnerships, advance last-mile delivery solutions, and improve surveillance and vector control. This would be an investment in Africa's present and future, because every dollar spent on malaria control and elimination generates a remarkable return of $36 in economic growth. A malaria-free population is more likely to access education and contribute to the continent's socioeconomic development. And let me be clear: investing in the fight to end malaria is not only a health and economic imperative; it is an act of justice. The disease disproportionately affects the poorest and most vulnerable Africans, perpetuating cycles of poverty and inequality. Last year, I joined health ministers from 11 AU member countries with high malaria burdens in committing to accelerate efforts to reduce deaths from the disease. As part of the declaration, we agreed that 'no one should die from malaria given the tools and systems available.' The task now is to take concrete action. The Africa Centers for Disease Control and Prevention (of which I am Director-General) is ready to help develop a continental strategy for ending malaria in Africa by 2040. By making smart investments, implementing well-targeted policies and deepening collaboration, we can ensure that all African countries become malaria-free within the coming generation. @Project Syndicate, 2025 Jean Kaseya The writer is Director-General of the Africa Centers for Disease Control and Prevention
Zawya
11-04-2025
- Health
- Zawya
Africa Centres for Disease Control and Prevention (Africa CDC) Unveils Strategic Plan to Transform Health Financing and Advance Self-Reliance
With external health aid to Africa expected to plunge by 70% between 2021 and 2025, the Africa Centres for Disease Control and Prevention (Africa CDC) has launched a continent-wide strategy to radically transform how health systems are financed, putting African resources at the centre of African health. The sharp decline in official development assistance, paired with a 41% surge in disease outbreaks from 2022 to 2024, is overwhelming already stretched health systems. Without urgent reform, the continent risks losing decades of hard-won progress in disease control, maternal care, and epidemic preparedness. Africa CDC's response is deliberate and strategic. In collaboration with African Union Member States, the agency will guide efforts to revise national health financing plans, strengthen domestic investment in health, and pilot innovative, context-specific revenue mechanisms designed to mobilise sustainable and predictable funding. 'Africa cannot continue outsourcing its health security,' said Dr. Jean Kaseya, Director General of Africa CDC. 'This strategy is not about aid—it's about ownership. We are building a future where Africa invests in its people, drives its own health agenda, and responds to crises with speed, strength, and self-reliance.' The strategy urges governments to fulfil the Abuja Declaration by allocating at least 15% of national budgets to health. It also introduces innovative financing ideas such as solidarity levies on airline tickets, alcohol, and mobile services, while exploring how Africa's US$95 billion in annual diaspora remittances can support national health priorities. Blended finance tools will be used to unlock public and private capital for critical investments in infrastructure, digital health, and local production of vaccines and medical supplies. Implementation will be phased. The first phase (2025–2026) will focus on updating national health financing plans in 30 countries, piloting innovative revenue mechanisms, and launching transparency dashboards. The second phase (2026–2030) will scale successful approaches, with the goal of enabling at least 20 countries to finance 50 percent or more of their health budgets through sustainable domestic sources. To track results and ensure accountability, Africa CDC will deploy a new African Health Financing Scorecard to monitor progress, improve donor alignment, and boost efficiency in domestic spending. The strategy marks a critical turning point for Africa's health independence. With political momentum from the African Union and proven regional coordination mechanisms, Africa CDC is positioning itself and the continent to lead a new era of sustainable, sovereign health financing. Distributed by APO Group on behalf of Africa Centres for Disease Control and Prevention (Africa CDC).
Khaleej Times
24-03-2025
- Health
- Khaleej Times
End of US aid poses death threat to women and girls in Africa
Zimbabwean mother Getrude Mucheri had walked miles in the rain to get her expired contraceptive implant removed and a Depo-Provera birth control injection instead. But the 35-year-old mother, who relies on free family-planning services, was out of luck when she arrived at the Chitakatira health clinic in eastern Zimbabwe. Nurses at the public health facility, which is outside the city of Mutare and supported by charities including Population Services Zimbabwe, said they had run out of stock for that day. "I am stressed. I do not have money to buy birth control pills," Mucheri told the Thomson Reuters Foundation. "I cannot have more children. I am even struggling to feed the ones I have," said the unemployed mother of four. Mucheri is among millions of women worldwide who rely on free contraceptives from aid programmes that have been plunged into turmoil since President Donald Trump gutted the US Agency for International Development, a key global donor. Lydia Zigomo, regional director for the United Nations sexual and reproductive health agency UNFPA, said the cuts would have "severe consequences" with hundreds of thousands in east and southern Africa losing access to contraception. "Many countries in the region are expected to run out of contraceptives and life-saving maternal medicines within the next three to six months," Zigomo said by email. "Given that countries like South Sudan, the DRC (Democratic Republic of Congo) and Madagascar already have high maternal mortality rates, the withdrawal of funding will have catastrophic consequences," Zigomo said. The immediate loss of US funding for UNFPA in DRC, South Sudan and Ethiopia came to about $4 million, she said, noting that many local health providers had also lost US funding. "With the US freeze, the entire ecosystem for improving sexual, reproductive, maternal, neo-natal, child and adolescent health has been compromised." Violence against women, maternal mortality and unplanned pregnancies would all increase, while menstrual hygiene and pregnancy-related care would suffer, she added. Longer term, there will be more sexually transmitted infections and unsafe abortions. Child marriage and teen pregnancies could also rise as families fall into poverty. And there would be major disruptions in the supply chain for contraceptives and reproductive health medicines, Zigomo said. Unsafe pregnancies Pester Siraha, a country director at Population Services Zimbabwe, an affiliate of Marie Stopes International, said the USAID cuts violate women's rights. "This is a cruel decision," she said. "The sudden suspension created a lot of chaos and uncertainty. Sudden stoppage of services without notice is not ethically right." In 2024, USAID provided up to $360 million for health and agriculture programmes in Zimbabwe, whose own government has underfunded healthcare for decades. Each year, the health budget falls far short of the target set in the 2001 Abuja Declaration, in which African Union governments committed to spend at least 15 per cent of national budgets on health services. Zimbabwe's deputy health minister Sleiman Kwidini said the government had been buying its own family planning supplies through the National Pharmaceutical Company, a government agency, with funding from donors. "We have enough supplies and stock to provide family planning services around the country," he told the Thomson Reuters Foundation, without giving further details. Siraha said more than half of all funding for sexual and reproductive health services in Zimbabwe came from USAID, so the cuts would inevitably boost unplanned pregnancies. "(This leads) to unsafe abortions and maternal mortality. Teenage pregnancies lead to school dropouts and worsen the higher percentage of teenagers dying during delivery," she said. In January, Trump also recommitted to two international anti-abortion pacts, cutting all US family planning funds for foreign organisations that provide or promote abortions. Jobs lost The fallout from the aid cuts is already rippling through Zimbabwe: thousands of health workers were told via WhatsApp to vacate work premises in late January after Trump's executive orders kicked in, according to some of those affected. A 29-year-old single mother of two, who did not want to give her name for fear of reprisals, said on the eve of January 28, she was told not to report for work the following day at a USAID-funded not-for-profit organisation providing sexual health services to young girls in Gokwe, in Midlands Province. "I signed for unpaid leave. The last salary and savings is the one that I am using for all expenses and upkeep of my family," she said. "I am trying to find ways to get income. I am buying and selling clothes and food, but it is not yielding much." Ekenia Chifamba, director of Shamwari Yemwanasikana, a community-based organisation that promotes girls' rights, said the cuts were "unbearable" as they affected whole families. "It is quite devastating and disturbing," she said. Zigomo said UNFPA was seeking alternate funding, be it engaging with national governments, asking more of other donors or tapping the private sector and philanthropic organisations. It is also trying to mobilise civil society and grassroots organisations to push for local solutions and funding. "Despite these efforts, it appears highly unlikely that most (east and southern African) countries will mobilise resources to fill in the gaps ... in the short term," she said. "There remains an urgent need for sustainable and predictable funding to prevent a devastating rollback in progress on women's health and rights."
Zawya
07-03-2025
- Health
- Zawya
Government addressing funding gaps following United States (US) aid cuts - Prime Minister (PM)
The Prime Minister, Robinah Nabbanja has revealed that the Ministry of Health is preparing a Cabinet memorandum seeking guidance from the Executive on sourcing funds to bridge the gap occasioned by withdraw of United States Agency for International Development (USAID) funding. While addressing the House during the Prime Minister's Time on Thursday, 06 March 2025, Nabbanja said government is also engaging international and local stakeholders, to mobilise resources to ensure continuity of HIV/AIDS interventions. 'To address this crisis, an additional Shs480 billion is required to bridge the funding gap and sustain essential services,' Nabbanja said. She said this in response to concerns by Hon. Abdulhu Byakatonda (Indep., Workers Representative) who asked about government's plans to mitigate the impact of the US funding freeze and ensuring uninterrupted HIV treatment for. Byakatonda observed that the aid freeze has put the jobs of 12,551 community health workers in Uganda at risk. 'Uganda currently allocates only 6.5 per cent of the national budget to health. When will government fulfil its Abuja Declaration commitment to increase health funding to 15 per cent?' he asked. On 20 January 2025, the US issued a memo pausing potentially, trillions of dollars in federal aid that was being offered by the US Agency for International Development (USAID). In another development, the Prime Minister revealed that over Shs163 billion has been released to cater for capitation grants to government grant-aided schools for the first term of calendar year 2025. This followed concerns by Kalungu West MP, Hon. Joseph Ssewungu on delays by the Ministry of Finance, Planning and Economic in releasing the funds needed to procure instructional materials. The Prime Minister clarified that funds are only released during quarter one, quarter three and quarter four every financial year. 'The total approved budget for the capitation grant for financial year 2024/2025 is Shs490.2 billion. During quarter one, the Ministry of Finance released Shs163.4 to local governments to cater for term three in 2024,' said Nabbanja. She noted that the Ministry of Education and Sports initially requested local governments to halt the transfer of the funds to institutions until they validated their enrollments, which she said had been done and authority to transfer the funds to schools granted. Distributed by APO Group on behalf of Parliament of the Republic of Uganda.
