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News24
a day ago
- Health
- News24
After US funding cuts, Mozambican children died: Who bears responsibility?
After the US Agency for International Development (USAID) abruptly terminated billions of dollars' worth of overseas aid grants, the health system in central Mozambique was left in tatters. Earlier this year, I travelled to two badly hit provinces of the country to describe the toll. In one article, I reported how thousands of orphaned and vulnerable children in Sofala province had been abandoned by their USAID-funded case workers. Many of these children are HIV-positive and had relied on case workers to bring them their medicines or accompany them to hospitals. Without them, some children stopped taking their treatment and died. In a second piece, I reported how USAID had cut funding for contractors transporting medicines and diagnostic tests to health facilities in Manica province. This led to shortages of HIV drugs at hospitals in the area, which also led to the deaths of children. In the midst of all this chaos, I was often curious to know from people on the ground who they held accountable for this situation and who they believed needed to solve the problem. My assumption was that they would call for the Mozambican government to help them out. I was surprised to find that in the affected villages which I visited, this was far from anyone's expectation. In fact, for most it was simply unthinkable that their government could do anything to save them. 'You mentioned the government,' one community leader said after I asked whether the state should intervene. 'But even these chairs we're sitting on are stamped with USAID logos. So what help can we expect from the government?' Indeed, the more I learned about governance in Mozambique, the more understandable this attitude became. Throughout the country, core government functions have been outsourced to a combination of foreign governments, aid agencies, interstate bodies, and private companies. For instance, many of the country's essential medicines are procured by a large international financing body called the Global Fund to Fight Aids, Tuberculosis and Malaria. Up until January, the transportation of these medicines to hospitals was overwhelmingly financed by US aid agencies, as were the pay cheques of many health workers. Outside of the healthcare sector, the story is similar. The main highway that I travelled along to reach different villages was built and paid for by Chinese corporations and banks. To keep hydrated I relied on bottled water supplied by private companies since the taps either didn't run or produced contaminated water. In many of the impoverished rural settlements that I visited, there was virtually no state infrastructure, and people received no financial support from the government. Instead, they primarily depended on aid organisations. The country's national budget has historically been heavily supplemented by foreign bodies, including the International Monetary Fund (IMF) and European Union. (Though much of this support was suspended in 2016/2017.) Even national defence has been partially outsourced. When Islamist militants began rampaging through the northern province of Cabo Delgado, the government struggled to contain it and contracted Russian and South African mercenary groups. When that failed, they authorised a military intervention by the Southern African Development Community (SADC) and invited a parallel mission by the Rwanda Defence Forces. It is thus no surprise that Mozambicans have virtually no expectation that their own government will come to the rescue when facing an emergency. Instead, they look outward. As one community leader in a rural village told me, 'Here, we depend on Trump.' Cash-strapped and corrupt Mozambique has 35 million people. About 2.5 million live with HIV, the second highest HIV-positive population in the world after South Africa. Life expectancy is well under 60. The country is extremely poor: eight in ten people live on less than three dollars per day. The government is also deeply cash-strapped. The South African government spends 10 times more per citizen than the Mozambican government does. A large chunk of its spending goes towards paying off debt. At present, Mozambique simply doesn't have the money to build an effective health system, though had it spent its limited budget reserves more effectively over the years it could have developed a health system that was at least a bit more independent of donor support. Instead, the country's budgetary resources have often been wasted on corruption. Mozambique currently ranks 146th out of 180 in the world on Transparency International's Corruption Perceptions Index. This has directly played a role in its public health woes. One clear example of this is the Tuna Bonds scandal, in which state-owned companies took out two billion dollars' worth of loans, backed by secret state guarantees. This was supposedly to finance large fishing and maritime security projects. In reality, much of the money was siphoned off to enrich political elites, including the then-finance minister (who is now in prison). As a result of those decisions, the country was swallowed by debt. And when the extent of the corruption was publicised in 2016, the IMF pulled its financial support for Mozambique. A detailed 2021 report found this directly led to a fall in economic growth and government spending. It states: 'Comparing the three-year average of 2016-18 to the three previous years, spending on health and education fell by USD 1.7 billion – entirely due to the debt.' The country's governance crisis is further demonstrated by the political unrest that engulfed the country after the October elections last year, triggered by accusations of election fraud. The accusations were likely overblown, but international observers said the election was not free and fair. Even during the brief one-week period that I spent in central Mozambique, signs of corruption and mismanagement filtered into my interactions with officials. For instance, before I embarked on a multi-day tour of one province, government officials told me that someone from the provincial health department would need to accompany me on my trip. This was apparently in order to make formal introductions to district-level officials that I hadn't asked to meet. For this apparently vital service, the man would need to be paid a per diem of roughly 500 rand a day for two days, they said. The civil servant in question was a very senior person in the provincial health department. Despite facing a collapsing health system in the wake of the US cuts, he was apparently ready to drop everything he had going for the rest of that week to follow me around. READ | US cancels 83% of USAID programmes, impacting global aid efforts When I explained that I wouldn't pay a government official to stalk me, I was told that saying no wasn't an option. This is unfortunately the way things are done around these parts, said a local who helped arrange the tour. (Neither GroundUp, Spotlight nor I paid the bribe, incidentally.) US responsibility Against this backdrop, it is perhaps no surprise that defenders of the current US government have often resorted to arguments about moral responsibility when justifying the decision to abruptly slash aid. It is reasonable to ask why the American taxpayer should bear any of the brunt of Mozambique's public health system when so many of its problems have been caused by the Mozambican government itself. But it's not so simple. The Mozambican civil war from 1977 to 1992 destroyed the country. The anti-communist RENAMO insurgency likely received millions of dollars of support from US evangelists, despite committing numerous atrocities. It is strongly suspected that the US government also materially supported RENAMO. So the US's involvement in Mozambique has not been innocent. It could be argued that its aid spending was the least the US could do to make amends for its role in the war. Moreover, Mozambique didn't develop its high level of dependency in isolation. For over two decades, the US actively took responsibility for core functions of the country's health system. Up until January, the US government continued to sign numerous contracts with local organisations, pledging millions of dollars to help run life-saving health programmes for years into the future. The health system was consequently built around these commitments. If the US was going to take that much responsibility for the wellbeing of some of the world's most vulnerable people, then it had a duty to at least provide notice before pulling the plug. Instead, it chose to slash the funds instantly, and in a manner that needlessly maximised damage and confusion. Stop-work orders were issued overnight which required that people who were doing life-saving work down their tools immediately. Organisations decided to adhere to these instructions rigidly in the hope that their funding would be reinstated. At that point the Trump administration said it was only pausing aid funding pending a review, and no one wanted to give the reviewers a reason to terminate their programmes. The consequence was complete chaos. Orphaned children in extremely rural parts of Mozambique waited for their case workers to bring them their medicines, but often they simply never came. Many of these children had no idea why they had been abandoned. When certain case workers decided to defy the stop-work order and continue their work voluntarily, they were forced to do so in secret. To add fuel to the fire, the Trump administration routinely provided contradictory information to its former recipients and to the public. The initial executive order signed in January said all foreign development assistance would be suspended for 90 days, pending a review, and might be restored after this time. Then, Secretary of State Marco Rubio issued a waiver which stated that the suspension wouldn't apply to life-saving humanitarian services. Rubio told the public that organisations providing these life-saving services could instantly resume their work under this order. Yet the organisations themselves received different instructions from their USAID officers. Rather than immediately continuing their work, they were told to submit revised budgets that only covered life-saving services and to wait for approval. Organisations rushed to submit these budgets by the deadline. But in the end, the green light never came and their funds remained frozen. This was not only the case in Mozambique; researchers estimated that virtually no funds were released under Rubio's waiver globally. In the meantime, Rubio stated that organisations that hadn't resumed life-saving activities were clearly unable to understand instructions or were simply trying to make a political point. Later on, the organisations received explicit termination notices, ending their programmes. Despite this, US embassies and several large media outlets continued to reference Rubio's order as if it was actually implemented en masse. Even as I write this, the on-again, off-again US aid story is unfinished. This mixed messaging created an enormous amount of confusion for staff of these organisations and the recipients of their work, ultimately for no clear benefit to the American people. There was simply never any reason to act this callously toward health organisations to whom USAID had pledged its support. In contrast to the rampant corruption which has plagued the Mozambican government, these organisations were heavily audited in order to continue receiving funding. The work they were doing was clearly making a material difference to some of the poorest people on earth. In the far-flung settlements that I visited, villagers told me about how their lives had been transformed by these organisations. Many were only put on life-saving HIV treatment because of them. Whatever arguments one may want to advance about the importance of self-sufficiency and national responsibility, none of this justifies the US government administering the aid cuts in such a callous and confusing manner.
Daily Maverick
a day ago
- Health
- Daily Maverick
After US funding cuts, Mozambican children died — who bears responsibility?
Last month, Spotlight and GroundUp published a two-part exposé showing how US aid cuts led to the deaths of children in Mozambique. Here, Jesse Copelyn considers what led to this tragedy and who should bear responsibility for it. After the US Agency for International Development (USAID) abruptly terminated billions of dollars in overseas aid grants, the health system in central Mozambique was left in tatters. Earlier this year, I travelled to two badly hit provinces of the country to describe the toll. In one article, I reported how thousands of orphaned and vulnerable children in Sofala province had been abandoned by their USAID-funded case workers. Many of these children are HIV-positive and had relied on case workers to bring them their medicines or accompany them to hospital. Without them, some children stopped taking their treatment and died. In a second piece, I reported how USAID had cut funding for contractors transporting medicines and diagnostic tests to health facilities in Manica province. This led to shortages of HIV drugs at hospitals in the area, which also led to the deaths of children. Amid all this chaos, I was often curious to know from people on the ground who they held accountable for this situation and who they believed needed to solve the problem. My assumption was that they would call for the Mozambican government to help them out. I was surprised to find that in the affected villages which I visited, this was far from anyone's expectation. In fact, for most it was simply unthinkable that their government could do anything to save them. 'You mentioned the government,' one community leader said after I asked whether the state should intervene. 'But even these chairs we're sitting on are stamped with USAID logos. So what help can we expect from the government?' Indeed, the more I learnt about governance in Mozambique, the more understandable this attitude became. Throughout the country, core government functions have been outsourced to a combination of foreign governments, aid agencies, interstate bodies and private companies. For instance, many of the country's essential medicines are procured by a large international financing body called the Global Fund to Fight Aids, Tuberculosis and Malaria. Up until January, the transportation of these medicines to hospitals was overwhelmingly financed by US aid agencies, as were the paycheques of many health workers. Outside of the healthcare sector, the story is similar. The main highway that I travelled along to reach different villages was built and paid for by Chinese corporations and banks. To keep hydrated I relied on bottled water supplied by private companies since the taps either didn't run or produced contaminated water. In many of the impoverished rural settlements that I visited, there was virtually no state infrastructure, and people received no financial support from the government. Instead, they primarily depended on aid organisations. The country's national budget has historically been heavily supplemented by foreign bodies, including the International Monetary Fund (IMF) and European Union. (Though much of this support was suspended in 2016/17.) Even national defence has been partially outsourced. When Islamist militants began rampaging through the northern province of Cabo Delgado, the government struggled to contain it and contracted Russian and South African mercenary groups. When that failed, they authorised a military intervention by the Southern African Development Community (SADC) and invited a parallel mission by the Rwanda Defence Forces. It is thus no surprise that Mozambicans have virtually no expectation that their own government will come to the rescue when facing an emergency. Instead, they look outward. As one community leader in a rural village told me, 'Here, we depend on Trump.' Cash-strapped and corrupt Mozambique has 35 million people. About 2.5-million live with HIV, the second-highest HIV-positive population in the world after South Africa. Life expectancy is well under 60. The country is extremely poor: eight in 10 people live on less than $3 per day. The government is also deeply cash-strapped. The South African government spends 10 times more per citizen than the Mozambican government does. A large chunk of its spending goes towards paying off debt. At present, Mozambique simply doesn't have the money to build an effective health system, though had it spent its limited budget reserves more effectively over the years it could have developed a health system that was at least a bit more independent of donor support. Instead, the country's budgetary resources have often been wasted on corruption. Mozambique currently ranks 146th out of 180 in the world on Transparency International's Corruption Perceptions Index. This has directly played a role in its public health woes. One clear example of this is the Tuna Bonds scandal, in which state-owned companies took out $2-billion worth of loans, backed by secret state guarantees. This was supposedly to finance large fishing and maritime security projects. In reality, much of the money was siphoned off to enrich political elites, including the then-finance minister (who is now in prison). As a result of those decisions the country was swallowed by debt. And when the extent of the corruption was publicised in 2016, the IMF pulled its financial support for Mozambique. A detailed 2021 report found this directly led to a fall in economic growth and government spending. It states: 'Comparing the three-year average of 2016-18 to the three previous years, spending on health and education fell by USD 1.7 billion – entirely due to the debt.' The country's governance crisis is further demonstrated by the political unrest that engulfed the country after the October 2024 elections, triggered by accusations of election fraud. The accusations are likely to have been overblown, but international observers said the election was not free and fair. Even during the brief week I spent in central Mozambique, signs of corruption and mismanagement filtered into my interactions with officials. For instance, before I embarked on a multiday tour of one province, government officials told me that someone from the provincial health department would need to accompany me on my trip. This was apparently to make formal introductions to district-level officials that I hadn't asked to meet. For this apparently vital service, the man would need to be paid a per diem of roughly R500 a day for two days, they said. The civil servant in question was a very senior person in the provincial health department. Despite facing a collapsing health system in the wake of the US cuts, he was apparently ready to drop everything he had going for the rest of that week to follow me around. When I explained that I wouldn't pay a government official to stalk me, I was told that saying no wasn't an option. This is unfortunately the way things are done around these parts, said a local who helped arrange the tour. (Neither GroundUp, Spotlight nor I paid the bribe, incidentally.) US responsibility Against this backdrop, it is perhaps no surprise that defenders of the current US government have often resorted to arguments about moral responsibility when justifying the decision to abruptly slash aid. It is reasonable to ask why the American taxpayer should bear any of the brunt of Mozambique's public health system when so many of its problems have been caused by the Mozambican government itself. But it's not so simple. The Mozambican civil war from 1977 to 1992 destroyed the country. The anti-communist Renamo insurgency likely received millions of dollars of support from US evangelists, despite committing numerous atrocities. It is strongly suspected that the US government also materially supported Renamo. So the US's involvement in Mozambique has not been innocent. It could be argued that its aid spending was the least the US could do to make amends for its role in the war. Moreover, Mozambique didn't develop its high level of dependency in isolation. For more than two decades the US actively took responsibility for core functions of the country's health system. Up until January, the US government continued to sign numerous contracts with local organisations, pledging millions of dollars to help run life-saving health programmes for years into the future. The health system was consequently built around these commitments. If the US was going to take that much responsibility for the wellbeing of some of the world's most vulnerable people, then it had a duty to at least provide notice before pulling the plug. Instead, it chose to slash the funds instantly, and in a manner that needlessly maximised damage and confusion. Stop-work orders were issued overnight which required that people who were doing life-saving work down their tools immediately. Organisations decided to adhere to these instructions rigidly in the hope that their funding would be reinstated. At that point the Trump administration said it was only pausing aid funding pending a review, and no one wanted to give the reviewers a reason to terminate their programmes. The consequence was complete chaos. Orphaned children in extremely rural parts of Mozambique waited for their case workers to bring them their medicines, but often they simply never came. Many of these children had no idea why they had been abandoned. When certain case workers decided to defy the stop-work order and continue their work voluntarily, they were forced to do so in secret. To add fuel to the fire, the Trump administration routinely provided contradictory information to its former recipients and to the public. The initial executive order signed in January said all foreign development assistance would be suspended for 90 days, pending a review, and might be restored after this time. Then, Secretary of State Marco Rubio issued a waiver which stated that the suspension wouldn't apply to life-saving humanitarian services. Rubio told the public that organisations providing these life-saving services could instantly resume their work under this order. Yet the organisations themselves received different instructions from their USAID officers. Rather than immediately continuing their work, they were told to submit revised budgets that only covered life-saving services and to wait for approval. Organisations rushed to submit these budgets by the deadline. But in the end, the green light never came and their funds remained frozen. This was not only the case in Mozambique; researchers estimated that virtually no funds were released under Rubio's waiver globally. In the meantime, Rubio stated that organisations that hadn't resumed life-saving activities were clearly unable to understand instructions or were simply trying to make a political point. Later on, the organisations received explicit termination notices, ending their programmes. Despite this, US embassies and several large media outlets continued to reference Rubio's order as if it was actually implemented en masse. Even as I write this, the on-again, off-again US aid story is unfinished. This mixed messaging created an enormous amount of confusion for staff of these organisations and the recipients of their work, ultimately for no clear benefit to the American people. There was simply never any reason to act this callously towards health organisations to whom USAID had pledged its support. In contrast to the rampant corruption which has plagued the Mozambican government, these organisations were heavily audited in order to continue receiving funding. The work they were doing was clearly making a material difference to some of the poorest people on Earth. In the far-flung settlements that I visited, villagers told me about how their lives had been transformed by these organisations. Many were only put on life-saving HIV treatment because of them. Whatever arguments one may want to advance about the importance of self-sufficiency and national responsibility, none of this justifies the US government administering the aid cuts in such a callous and confusing manner. DM
Los Angeles Times
2 days ago
- Politics
- Los Angeles Times
What to know about the African kingdom of Eswatini, where U.S. has sent deportees
CAPE TOWN, South Africa — The United States has deported five immigrants from Vietnam, Jamaica, Cuba, Yemen and Laos to Eswatini, a small country in southern Africa where the king still holds absolute power. Eswatini says it is holding the men in correctional facilities until they can be sent to their home countries, after it became the latest nation to accept third-country deportees from the U.S. Here's what to know about Eswatini: Eswatini is one of a few countries that are still absolute monarchies, and the only one in Africa. That means the king has absolute power over government and is not just a figurehead or a ceremonial ruler. King Mswati III has ruled Eswatini since 1986, when he turned 18 and was allowed to take his place as the monarch. He can make decisions by decree. He succeeded his father, Sobhuza II, who died in 1982. The 57-year-old Mswati III has long been criticized for ruling over a government that suppresses political dissent while he lives a lavish lifestyle in one of the poorest countries in the world. The king is reported to have 11 wives and has been the subject of scrutiny for buying luxury cars. His wealth has been estimated at between $200 million and $500 million, while the World Bank says more than half of Eswatini's 1.2 million people live on less than $4 a day. Political parties were banned by Sobhuza II in 1973. Some exist now, but they are not allowed to play any role in elections or the political process and have been reduced to civic society groups. Candidates seeking public office in Eswatini's Parliament or Senate have to stand as individuals without any party affiliation and are generally approved by traditional leaders loyal to Mswati III. Pro-democracy protests have grown in recent years and Eswatini authorities under Mswati III have been accused of crushing them using the security forces. Many dissidents live in exile. The country was previously known as Swaziland but changed to Eswatini in 2018 after the king announced it should revert to its traditional name in the Swazi language. It was Swaziland when it was under British colonial rule, which ended in 1968. Eswatini has been severely affected by HIV and has the highest prevalence in the world, with an estimated 26% of the adult population HIV-positive, according to the United Nations AIDS agency. It has made significant progress in confronting that scourge but has been highly reliant on foreign aid to do that, including assistance from the U.S., which has now been cut by the Trump administration. Imray writes for the Associated Press.
Time of India
5 days ago
- Health
- Time of India
NAT should be mandatory at all blood banks: Experts
New Delhi: Diagnosed with thalassemia at the age of two, a 23-year-old woman depended on blood transfusions every three weeks to stay alive. But when she was hospitalised with dengue in Class VIII, doctors discovered something more alarming - she was diagnosed as HIV-positive. "I wasn't recovering. After several tests, they told me I was HIV-positive. I suspect it came from a transfusion. If the blood was properly tested, maybe this wouldn't have happened," she said. Now living with both thalassemia and HIV, she depends not only on regular transfusions, but also on antiretroviral treatment. The woman's testimony at the roundtable on "Ensuring Safe Blood for All: Strengthening Blood Safety Practices", organised by the Thalassemia Patients Advocacy Group (TPAG) at India International Centre on Thursday, brought into sharp focus the urgent need to fix India's entire blood safety ecosystem. Experts at the event called for comprehensive reforms - from mandatory nucleic acid testing ( NAT ) at all blood banks to boosting voluntary blood donation and patient participation in policymaking. NAT, which detects HIV, Hepatitis B and Hepatitis C during the early infection "window period", is far more effective than standard tests, but is not yet mandatory across India. "Safe blood is not just about testing - it begins at the source," said Dr Sangeeta Pathak, secretary general of Indian Society of Blood Transfusion & Immunohematology (ISBTI) and head of Transfusion Medicine at Max Saket. "Voluntary, non-remunerated blood donation is key. Sri Lanka has achieved 100% voluntary donation. Why not India?" She called on both professionals and the public to take ownership. "We must talk about it, promote it, and strengthen the culture of safe, voluntary blood donation." Anubha Taneja Mukherjee, member secretary, TPAG, reminded participants that blood safety is a matter of human rights. "This isn't just a technical issue. It's about dignity, equity, and the right to safe, life-saving interventions." Public health advocate Prof Bejon Kumar Misra emphasised the need for transparency and accountability. "Safety is non-negotiable. People have a right to know what is being done - and what's not. Communication is critical. We need strategies that ensure no patient falls through the cracks." P C Sen, senior Supreme Court advocate, reiterated the state's legal obligation to ensure access to pathogen-free blood .
India.com
5 days ago
- Health
- India.com
A New HIV Shield: One Shot Every Six Months – Could This Be The Turning Point The World's Been Waiting For?
New Delhi: A new drug that could change the way the world prevents HIV has just received the green signal from the World Health Organization (WHO). Its name is Lenacapavir. And what makes it different? You only need it twice a year. The announcement came from Kigali, Rwanda, where global health experts gathered for the 13th International AIDS Society Conference on July 14. WHO shared new global guidelines to strengthen HIV prevention, and with it, officially recommended Lenacapavir as a key tool – especially for those who face high risk every day. They include sex workers, healthcare workers and people in close contact with HIV-positive individuals. This long-acting drug is not entirely new. The United States approved it earlier. Back in 2022, it was already being used to treat HIV-affected patients. Now, WHO's decision brings it into focus as a prevention method, specifically for pre-exposure prophylaxis (PrEP). WHO Director-General Dr. Tedros Adhanom Ghebreyesus said, 'We still do not have a vaccine for HIV. But this drug, taken only twice a year, is the best new option we have got.' Globally, the HIV burden remains heavy. In 2024 alone, 1.3 million people were infected. Lenacapavir is being hailed as a potential game-changer for global HIV prevention, particularly among communities like sex workers, transgender individuals, people in correctional facilities, men who have sex with men and those who inject drugs, all of whom have been disproportionately affected. Funding for HIV prevention is drying up in many regions. That is why this drug, which works longer and requires fewer doses, feels like a breakthrough. Lenacapavir is a product of U.S. biopharma giant Gilead Sciences. It belongs to a class of medicines called capsid inhibitors, which disrupt multiple steps in the HIV life cycle and help block the virus from replicating. What sets it apart is its long-acting nature. Just two injections a year are enough to offer sustained protection, a significant improvement over daily pills or monthly regimens that are harder to maintain. Compared to daily pills or monthly shots, Lenacapavir offers a simple solution – two injections a year. For those facing daily exposure to risk, this could be the protection they have been waiting for. The need for such interventions has never been more urgent. Over 1.3 million people contracted HIV in 2024 alone, according to WHO data. A large share of these infections occurred in low- and middle-income countries, where preventive care is either unavailable or underfunded. As funding for HIV prevention declines globally, a low-maintenance, highly effective drug like Lenacapavir could help reverse troubling trends. Public health experts say its biannual dosage makes adherence easier, especially for people with limited access to clinics or stigmatised by their communities. While the drug is yet to be rolled out widely, WHO has urged governments and NGOs to accelerate access through partnerships with local health systems. With global focus now shifting toward long-term, low-cost solutions, Lenacapavir offers a ray of hope in a decades-long battle against HIV.
