Healthcare systems across Africa are facing increasing pressure following major reductions in US foreign assistance, with the disruption of programmes supported by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) raising concerns about the sustainability of essential health services, according to a report by the Accra Reset.
The report, released by the global health initiative led by Ghanaian President John Dramani Mahama, argues that African countries and other nations in the Global South need to take greater control of their healthcare development rather than relying heavily on overseas assistance. It comes amid a broader restructuring of US foreign aid that has affected programmes dealing with HIV, maternal and child health, disease prevention and other areas of public health.
Africa carries about a quarter of the global disease burden but produces less than 1% of the world’s vaccines, highlighting the continent’s continuing dependence on external support for several critical areas of healthcare. The report says the withdrawal of US-backed programmes has exposed vulnerabilities in health systems that were already under pressure from the Covid-19 pandemic, economic difficulties and shortages of healthcare resources.
The impact has varied from country to country. In Nigeria, governments have had to absorb thousands of health workers whose positions were previously supported through US-funded programmes, creating additional financial pressure on national health budgets. In South Africa, the end of PEPFAR funding has contributed to the closure of HIV clinics, with the changes affecting an estimated 1.4 million people who relied on the services, according to the report. Ghana has also faced a substantial financial gap, with the closure of USAID-supported programmes resulting in the loss of about $78 million in healthcare funding.
The disruption comes after the Trump administration moved to dismantle USAID and substantially restructure the way the United States provides assistance overseas. The agency, established in the early 1960s, had become one of the world’s largest sources of humanitarian and development assistance. Its programmes supported public health initiatives in numerous countries, including efforts to combat infectious diseases and strengthen healthcare systems. The dissolution has significantly altered the global foreign-aid landscape.
The Accra Reset report does not argue that African countries should simply replace US assistance with another external donor. Instead, it calls for a shift towards greater national and regional ownership of health policy, financing and development. The initiative says African governments need to build systems capable of responding to health emergencies while reducing vulnerability to abrupt changes in donor priorities.
The issue has also raised wider concerns about the consequences of reductions in international health assistance. The New Humanitarian reported in July that the US foreign-aid cuts were expected to have significant effects on health and humanitarian programmes globally, while funding shortages have already complicated responses to major disease outbreaks.
The changes are particularly significant for countries where donor-funded programmes have become deeply integrated into national healthcare systems. Abrupt withdrawal can leave governments with the immediate challenge of retaining health workers, maintaining clinics, purchasing medicines and continuing disease-control programmes, even as domestic budgets remain constrained.
The report therefore presents the current disruption as an opportunity for African governments to reconsider how healthcare is financed and organised. It calls for greater investment in domestic health systems, stronger local production capacity and policies that give countries greater control over their health priorities.
The developments also come as global support for international health cooperation remains a subject of debate. A recent survey cited in reporting on the US aid changes found that many Americans continue to support international cooperation on health and disease prevention, despite the substantial changes to the US foreign-aid system.
The Accra Reset report ultimately warns that the consequences of the aid withdrawal extend beyond individual programmes. For African countries, the challenge is now to prevent disruptions in essential healthcare while developing systems that are less dependent on external donors and better equipped to withstand future changes in international funding.
