Taking stock of foreign aid reductions

4th edition – April 17, 2025

The U.S. foreign aid outlook has continued to deteriorate.

Since our last update, PEPFAR’s congressional authorization expired, reports surfaced of a planned discontinuation of U.S. funding for Gavi, and the Trump administration announced plans to fold what’s left of USAID into the State Department.

What follows is our latest roundup of on-the-ground impacts on health and nutrition programs worldwide. Due to the length of this update, you may find the online version easier to read.

As always, your feedback is welcome. We’re proud to stand in solidarity with you, our partners.

— the Linksbridge team

PRIOR ISSUES: 1st edition, 2nd edition, 3rd edition

 

UNAIDS situation updates have been especially helpful to this issue. 

 

TOPICS: health delivery, HIV, malaria, TB, other infectious diseases, women’s health, health products, hunger and nutrition, waivers and other lifelines, contingency measures, foreign aid cuts from other countries.

Global health

Health delivery

• Afghanistan: "More than 200 health facilities run by the World Health Organization in Afghanistan, providing medical care for 1.84 million people, have closed or ceased operating after the US aid cuts announced by the Trump administration shut off life-saving medical care, including vaccinations, maternal and child health services." [The Guardian, Apr 3]

• Kenya: A hospital in the country’s largest and poorest county will “run out of USAID drugs next month.” [Japan Times, Apr 9]

• South Sudan: Seven Save the Children-supported health facilities in eastern South Sudan have been forced to shut completely, and 20 have had to close partially, following U.S. aid cuts. [Independent, Apr 9]

PEPFAR/HIV

• Eight countries—Burkina Faso, Haiti, Kenya, Lesotho, Mali, Nigeria, South Sudan and Ukraine—have “substantial disruptions to antiretroviral (ARV) therapy and will run out of medicines in the coming months.” [Health Policy Watch, Mar 17] 

• The DREAMS program, spanning 10 African countries, has been halted. "The programme was a PEPFAR initiative that served 2 million adolescent girls and young women in sub-Saharan Africa and focused on HIV prevention, sexual and reproductive health and rights, physical and sexual violence, education and empowerment." [UNAIDS, Mar 31]  

• Expert teams managing overseas programs “meant to prevent newborns from acquiring H.I.V. from their mothers and to provide treatment for infected children” were eliminated in a “chaotic reorganization” of the U.S. Health and Human Services Department. [NYT, Apr 8] 

• Maternal health programs still funded by PEPFAR are “without personnel to manage the initiatives or to disburse the money,” making it unclear how the work will continue. [NYT, Apr 8] 

• "Some of PEPFAR’s funding remains intact, but staff members, including whole divisions within U.S.A.I.D. and the Centers for Disease Control and Prevention, which together carried out the H.I.V. prevention and treatment, have been laid off. Employees in PEPFAR-funded programs in Africa say they still do not know which services they will be able to continue."[NYT, Apr 9]

Botswana

• "In Botswana, the abrupt closure of drop-in centres for key populations operated by CSOs has disrupted HIV testing treatment, care and support services for these populations facing higher risk of HIV/AIDS. The government has asked CSOs to refer their clients to government facilities, but the suddenness of the change means that no drop-in centre staff are present to make these referrals or transfer patient files." [UNAIDS, Mar 10] 

• "In Botswana, waivers were not accompanied by guidance. Some implementing partners who received waivers were in the process of seeking guidance when they were informed by the US Government that their project award had been terminated. This has contributed to uncertainty among US-funded projects that have not been terminated." [UNAIDS, Mar 10]

Ethiopia

• "In Ethiopia, the US government-supported Cab-La pilot has halted. This new HIV prevention technology would especially benefit adolescent girls and young women who face inequalities that create barriers to accessing sexual and reproductive health services." [UNAIDS, Mar 31] 

Kenya

• "In Kenya, nevirapine and condom stocks are running low. The USAID-funded procurement agency for viral load tests and ARVs is currently unable to distribute the stocks it has in country. If these US-supported commodities are not distributed, stockouts could occur in as little as three months. The transport system for samples for early infant diagnosis and viral load testing is operating at reduced capacity." [UNAIDS, Mar 10]

• "Panic about treatment availability, particularly among young people living with HIV, has led to some young people living with HIV spacing, sharing and/or stockpiling antiretrovirals." [UNAIDS, Mar 31]

• "The country has witnessed resumption of HIV prevention and treatment services, however not at full scale. For instance, community prevention and treatment services such as community outreach services, peer led awareness and education and differentiated service delivery have been impacted. Additionally, sample networking for viral load testing and early infant diagnosis remains impacted. Due to the unstructured and abrupt nature of the integration of HIV services into outpatient clinics, there have been reports of incidences of stigma and discrimination towards people living with HIV and key populations including fears of involuntary disclosure and lack of confidentiality." [UNAIDS, Apr 1] 

Malawi 

• "In Malawi 247 nurses, 3,513 community health workers, 206 technical and managerial staff and other 485 human resources reliant on US funding are facing contract terminations. Furthermore, HIV data management has been hugely affected; 20% of the 271 electronic medical record systems established at service sites were down during assessments in February." [UNAIDS, Mar 31] 

• "The sample transportation system has been suspended. Although the government redeployed ambulances to transport samples, hundreds of thousands of samples remain stuck and unusable, and a million HIV test kits risk expiring." [UNAIDS, Mar 27] 

• "Although the government of Malawi has rationalized the continuation of services and deployed staff to fill the gaps created by the stop order and waiver, HIV services are yet to recover fully. Facilities providing prevention of vertical transmission of HIV, early infant diagnosis (EID), pediatric and adult HIV treatment services are operating at reduced capacity.  Community-led monitoring and other activities led by civil society have reduced." [UNAIDS, Mar 27] 

Namibia

• "In Namibia, the US funding cuts have exacerbated some chronic supply chain challenges, especially for condom programming, and condom stock-outs are now more prominent. In addition, funding has not been confirmed for a subsequent shipment of ARVs needed to sustain treatment until the end of 2025." [UNAIDS, Mar 10]

• "In Namibia, some service providers received waivers but they have not received any additional funding since the initial stop-work order. As a result, some have notified staff of impending layoffs." [UNAIDS, Mar 10] 

Nigeria

• In Nigeria, one Elton John AIDS Foundation partner was forced to ration, and eventually suspend, "all antiretroviral therapy (ART), which has prevented over 400 patients from receiving their monthly refill at the time of writing." [Them, Apr 1] 

• “At the Heart-to-Heart Unit in Wuse General Hospital . . . a health worker confirmed that there is currently a shortage of ARVs, thereby forcing supply rationing to people living with HIV (PLHIV) . . . Checks around medical facilities in Enugu, including the Asata Primary Health Centre and Uwani Health Centre, indicated that HIV/AIDS drugs and test kits are no longer available. It was gathered that such tests had not been conducted in the past four weeks. A medical official at the Uwani PHC told The Guardian they had not run HIV/AIDS tests in the past three weeks due to lack of test kits. She stated that the last batch of drugs finished last month . . . In Ondo State, a top medical officer confirmed that they had stopped giving out antiretroviral drugs because there were no supplies in Akure.” [The Guardian Nigeria, Mar 24] 

South Africa

• "In South Africa, another partner was forced to halt ART provision for at least 2000 clients and PrEP for 4000 clients." [Them, Apr 1] 

• In South Africa, “programmes like GRIP were essential in providing support to survivors and helping curb the spread of HIV. It provided rape victims, who are at risk of contracting the virus, with preventive medication and education. GRIP’s care rooms now stand empty.” [Al Jazeera, Apr 11] 

• "People from the LGBTQ sector . . . were getting their meds at two LGBTQ-specializing clinics, the Ivan Toms Men’s Health Clinic and Wits RHI, which were both funded by PEPFAR . . . We don’t know if they’ll go to the other clinics where they’re supposed to go now. But we know there’s going to be hesitancy . . . People are going to die. The people who went to Ivan Toms and Wit RHI are not going to find it easy to go to a normal clinic." [Positively Aware, Mar 19]

• "If prevention, much of which PEPFAR covered, is too expensive for us, then we’d rather invest in treating the people who have HIV already. Right now, PrEP is still available for people . . . We’d rather mobilize treatment instead of PrEP. Because PrEP means you’re taking the pills that could’ve been by someone who’s already infected and needs those meds to survive." [Positively Aware, Mar 19] 

South Sudan

• "Two women, Martha Juan, 25, and Viola Kiden, 28, a mother of three, have already died because they lived in a remote area of South Sudan and could not get antiretroviral drugs when U.S.A.I.D. shut down supply lines." [NYT, Mar 15]

• "Until recently, Moses Okeny Labani was working with 145 orphans and vulnerable children with H.I.V. in Juba, South Sudan. Without American assistance, he says, they have begun to die." [NYT, Mar 15]

Uganda

• At the Family Hope Centre in Jinja, "healthcare workers say that all their funding – including even rent, water, and electricity bills – came from US government funding. In January, the centre was forced to shut down for over a month, turning away more than 5,000 patients. Due to overwhelming need, they have since reopened, now staffed by just nine of the original 37 workers, all volunteering without pay." [The Independent, Apr 17] 

• Some Ugandan HIV centers funded via U.S. CDC rather than USAID managed to remain open. But they cautioned that their funds were only available through April 19, when the U.S. was expected to complete its 90-day foreign aid review. "Their services have been badly disrupted by the contract confusion: Community outreach workers have been put on leave, prevention services have been halted, and there is lingering uncertainty about the supply of additional treatment drugs." [Foreign Policy, Mar 19] 

• "One health center no longer has the preferred primary treatment for children with HIV. Instead, pharmacists are portioning out adult versions of the drugs and hoping that the children will be able to tolerate them." [Devex, Apr 3]

 Elsewhere 

• "In Angola, all community outreach programmes supported by PEPFAR in four of the country’s 21 provinces have stopped." [UNAIDS, Mar 31] 

• Bangladesh: “Outreach programmes for adolescent girls and young women have been discontinued.” [UNAIDS, Apr 8]

• In Burundi, the "US funding cuts have disrupted services provided by ICAP, a major implementing partner financed by the US, and its two main civil society organization sub-recipients, affecting approximately 10,290 people living with HIV (PLHIV), including 528 pregnant/breastfeeding women, and 5,512 people most at risk of exposure to HIV." [UNAIDS, Apr 2] 
  
  
• “In Cambodia, US technical assistance to the rollout of long-acting PrEP has been terminated.” [UNAIDS, Apr 8] 

• In Eswatini, many community-led or peer-led facilities and services, as well as services provided by local and international NGOs, have stopped functioning. "Disruptions to HIV prevention programmes for adolescent girls and young women have affected an estimated 120,000-150,000 people." [UNAIDS, Mar 28]

• In Indonesia, "US funding cuts have affected access to HIV prevention services for roughly one third of the 80,000 gay men and other men who have sex with men living in Greater Jakarta." [UNAIDS, Mar 28]

• In Kazakhstan, "discontinuation of outreach services for key populations—previously led by four nongovernmental organization operating in two of the country’s 20 regions—affects about 20% of people who use drugs and 9% of gay men and other men who have sex with men. As these services focused on HIV testing, PrEP and linkage to care, their suspension is likely to hinder national progress on HIV prevention, new case detection and treatment enrolment." [UNAIDS, Mar 28]

• "In Liberia, funding to seven local partners that are providing services to key populations has been cancelled." [UNAIDS, Mar 10] 

• "In Rwanda, clinical programmes supported by PEPFAR through the US Centers for Disease Control and Prevention have received authorization to resume activities, but community support components implemented by civil society organizations (CSOs) that facilitate access, adherence and retention into HIV services by the populations most affected by HIV are still suspended." [UNAIDS, Mar 10] 

• In Tajikistan, "government institutions continue to function, but two community support centers run by civil society organization partners have closed." [UNAIDS, Mar 10] 

• In Togo, "11,000 people living with HIV will lose access to antiretroviral treatment; 24,769 people living with HIV will no longer have access to viral load testing; 10,000 individuals, including pregnant women and their children, will miss out on testing." [UNAIDS, Apr 3] 

• “Zambia has already reported a 20 percent increase in untreated HIV patients since aid funds were frozen.” [Die Welt, Mar 14] 

• "Zimbabwe has experienced disruptions in testing of pregnant women during prenatal care, early infant diagnosis, pediatric HIV treatment services and the sample transport system." [UNAIDS, Mar 31]

Malaria and TB

Malaria

• "By early April 2025, more than 40% of planned ITN distribution campaigns designed to reach 425 million people were either delayed or at risk of being derailed . . . Nearly 30% of seasonal malaria chemoprevention (SMC) campaigns to protect 58 million children were also off track. In many African countries, stocks of rapid diagnostic tests and medicines have reached critically low levels." [WHO, Apr 11]
  
  
• Cambodia: Amid uncertainty over procurement contracts, "more than 2 million locally produced mosquito nets are stacked in warehouses instead of being dispatched." [Bloomberg, Apr 3]

• "In Nigeria—home to 30 percent of the world's annual 600,000 malaria deaths—clinics that once served 300 people a day in the conflict-hit Borno state have abruptly shut down . . . 'The clinics have been closed and (there are) no more free drugs or mosquito nets.'" [AFP, Apr 15]

Tuberculosis

• Some 27 countries in Africa and Asia face crippling breakdowns in their tuberculosis response, and nine countries have reported “failing procurement and supply chains for TB drugs, jeopardising the lives of people with TB.” [Health Policy Watch, Mar 17]

• “In almost half of Mozambique . . . no one can currently be diagnosed with TB, since US funding supported its lab networks and system that transported samples.” [CNN, Mar 30]

• In Mathare, Nairobi, "Zilpha Adoyo, a widow, told me that she has been able to find new suppliers of her basic tuberculosis medicine, but not for a secondary medication that relieves its side effects. So Adoyo struggles with painful legs and is no longer able to wash clothes to earn $1.50 a day to support her children. One child dropped out of school last month to help support the family." [NYT, Mar 15]

• Pakistan: A case-finding program supported by USAID “in 27 of Pakistan's districts has ceased, along with the means of transporting sputum samples, and community monitoring that aims to identify any barriers to TB treatment, Kinz ul Eman, CEO of the Dopasi Foundation, told CNN.” [CNN, Mar 30] 

Other infectious diseases

• In Cox’s Bazar in Bangladesh, diagnosis and treatment of hepatitis C has been disrupted along with “disease surveillance, primary and secondary health care, laboratory services, procurement of supplies and salaries of health workers.” [Health Policy Watch, Mar 17]

• “WHO’s global measles and rubella network of more than 700 laboratories, funded solely by the US, faces ‘imminent shutdown.’” [Health Policy Watch, Mar 17]

• The Trump administration “fumbled” its role in Uganda’s Ebola outbreak earlier this year, which has “since resulted in 12 laboratory-confirmed cases and two deaths.” [Devex, Mar 26]

• In Kenya, 27,000 sets of U.S.-purchased personal protective equipment sat in a WHO warehouse “rather than being used to protect health workers from Ebola exposure in Uganda because the Trump administration had “forbidden U.S. staff from engaging with WHO, so USAID couldn’t work with WHO to retrieve this PPE.” [Devex, Mar 26]

Women's health

• “The United States is ending its financial support for family planning programs in developing countries, cutting nearly 50 million women off from access to contraception.” [NYT, Apr 1]

• “An estimated $27 million worth of family planning products already procured by U.S.A.I.D. are stuck at different points in the delivery system — on boats, in ports, in warehouses — with no programs or employees left to unload them or hand them over to governments.” [NYT, Apr 1]

• Afghanistan is seeing maternal and baby deaths that are “partly a consequence of a reeling blow” from USAID cuts: maternal care services “‘previously managed by foreign NGOs — are no longer operational.’” [NPR, Mar 31]

• “In Algeria, mental health services for vulnerable women remain suspended.” [UNAIDS, Apr 8]

• “In Namibia, an initiative to integrate cervical cancer services in HIV programming and services was severely disrupted when US-funded staff were let go. Since then, UNAIDS has received reports of delays in the screening and treatment of precancerous cervical lesions among women living with HIV.” [UNAIDS, Apr 8]

• In Nepal, programs affected by U.S. funding cuts include “neonatal care training for hundreds of doctors and nurses, and various programmes related to the Sustainable Development Goals, including maternal and child health, nutrition, reproductive health, and family planning.” [Kathmandu Post, Apr 8]

• Yemen: Amnesty International said slashed funding “has led to the shut-down of life-saving assistance and protection services,” including “treatment for malnutrition in children, services for pregnant women, breastfeeding mothers and other healthcare services for children. Dozens of safe spaces for battered women and girls have also been closed, Amnesty said, warning that multiple facilities providing reproductive health services or protection for women were also at risk.” [AFP, Apr 10]

• Zambia: Contraceptives have “already begun to run short” in some parts of the country, where the U.S. has supplied a quarter of the national family planning budget. [NYT, Apr 1]

Hunger and nutrition

• "The World Food Programme, for which the US is the largest single donor, has shut down its operations in South Africa, where 27 million people are at risk of hunger as the country faces its worst drought in decades." [Vox, Mar 16]

• "Because of cuts, WFP says it will only serve around 35,000 people in April—a fraction of the 15 million people unable to meet their daily food needs." [AFP, Mar 19]

• In Afghanistan, "Action Against Hunger initially stopped all U.S.-funded activities in March . . . But it kept the most critical services going in northeastern Badakhshan province and the capital Kabul through its own budget, a measure that stopped this month. Its therapeutic feeding unit in Kabul is empty and closing this week. There are no patients, and staff contracts are ending because of the U.S. funding cuts." [AP, Apr 15]

• "Nearly 700,000 people in Burkina Faso and Mali have lost access to water, food, or health services." [Vox, Mar 16]

• Kenya: The World Food Program, which supports just under 200,000 people in Kenya’s Kakuma refugee camp, has had to "cut rations—delivered as food and cash—to 40% of their previous level."[Japan Times, Apr 9]

• At Somalia's Al-Hidaya camp, "families report skipping meals, sending children to beg, and sharing what little they have with neighbors . . .'We used to get food and small cash payments,'" one woman explained. "'Pregnant women and malnourished children also got nutritional supplements. Now, there's nothing. This has affected us a lot.'" [Xinhua, Apr 13]

• South Sudan: In the remote Upper Nile town of Bobonis, "staff members of a nonprofit supported by U.S.A.I.D. used to visit weekly to provide an emergency high-nutrition paste to save the lives of young children with severe acute malnutrition—but that program was ended by the Trump administration last month. So now children in the village are starving." [NYT, Mar 15]

Waivers and other lifelines

In a handful of cases, U.S. funding freezes have been walked back.

• Bangladesh: “The Trump administration said . . . it will provide $73 million in new financial aid to Rohingya refugees through the U.N. World Food Programme, amid concerns that aid cuts could deepen the crisis for the world's largest stateless population.” [Reuters, Mar 27]

• "In Peru, services targeted at key populations, adolescent girls and young women and migrants living with HIV have been the most impacted by the US freeze. However, an NGO providing services to 2,300 migrants living with HIV has resumed antiretroviral therapy to its patients following receipt of a waiver." [UNAIDS, Mar 10]

• In Ukraine, "a pilot project for long-acting PrEP has sufficient stocks of cabotegravir to maintain the pilot at its current size until April 2026." [UNAIDS, Mar 10] 

Contingency measures

The suspension of U.S. aid has left countries and donors looking for ways to fill the funding gaps and keep vital services running. 

Country measures

• "In Botswana, a task team of government, civil society and UN partners has been established to monitor the impact of the U.S. funding freeze. Two rapid surveys of the situation were conducted, one led by the government and another by civil society." [UNAIDS, Mar 10] 

• "Botswana and South Africa are among those countries working with organizations that have lost US funding to refer their clients to government facilities for essential services." [UNAIDS, Mar 31] 

• "Ethiopia’s parliament has introduced a new payroll tax as part of measures to fill the financial gap left by the USAID funding pause. The new bill has been forwarded to a parliamentary committee for deliberation. The funds collected will go to a new Ethiopian Disaster Risk Response Fund to pay for projects previously funded by USAID including HIV medication." [UNAIDS, Mar 31] 

• Lesotho: "Led by the Ministry of Health and operational since January 27, the task team is mapping out affected US-funded projects and identifying mitigation measures, including government payment of salaries for essential staff, task shifting, recalling staff on leave, and integration of health workers' roles." [UNAIDS, Mar 17]

• In Liberia, "the Ministry of Health has allocated US$300,000 for commodity distribution following US funding interruptions." [UNAIDS, Mar 10]

• “In Malawi, the Government’s 2025-26 budget has allocated 23.3 billion Malawian Kwacha (US$13.3 million) to the Ministry of Health and plans to hire 6,000 workers to mitigate the impact of the US funding cuts.” [UNAIDS, Apr 8]

• In Panama, "PrEP services for key populations were recently reestablished after the Ministry of Health took over distribution of the medicines for these services." [UNAIDS, Mar 28]

• In Rwanda, the "Ministry of Health has committed to mobilizing domestic resources to ensure the continuity of HIV services. All facilities/service points providing antiretroviral therapy (ART) are operating at full capacity. Peadiatric HIV treatment services and data collection activities continue without disruption." [UNAIDS, Mar 18] 

• In Vietnam, “92 facilities that provide pre-exposure prophylaxis (PrEP) to 71% of the country’s 44,780 people using this HIV prevention service are funded by the US. The current stock of US-procured antiretroviral medicines for PrEP is expected to last until June 2025 . . . Despite the challenges, the Vietnamese Government has expressed its commitment to continued implementation of effective measures for HIV prevention and control.” [UNAIDS, Apr 8]

• "In Zambia, the Ministry of Health has developed a minimum package of HIV services for 12 months. Government facilities continue to deliver HIV services, including some HIV prevention services for key populations." [UNAIDS, Mar 10]

Nonprofits and donors

• Norway will provide “300 million kroner ($28.7 million) in emergency funding to help NGOs hit by the US aid freeze, the government announced on Wednesday.” [AFP, Apr 2]

• "The US canceled two aid projects in Cambodia in late February — one to encourage child literacy and another to improve nutrition and development for kids under five. A week later, China’s aid agency announced funding for programs to achieve almost identical goals." [Bloomberg, Mar 25]

• "The Nutrition for Growth, or N4G, summit in Paris, France, has garnered $27.55 billion in commitments from donors to end malnutrition globally—breaking the record set at the previous N4G summit in Tokyo in 2021." [Devex, Mar 29]

Foreign aid cuts from beyond the U.S.

• Even prior to the present crisis, "international aid from official donors fell in 2024 by 7.1% in real terms compared to 2023, the first drop after five years of consecutive growth, according to preliminary data collected by the OECD." [OECD, Apr 16]

• Shifting its foreign aid focus to neighbors in Asia and the Pacific islands, "Australia will suspend or delay AU$119 million ($75 million) in payments to the multinational U.N. Development Program, the Global Partnership for Education and the Global Fund to Fight HIV, Malaria and TB." [AP, Mar 26] 

• Germany’s new government unveiled a coalition contract calling for aid cuts. “The extent of the cuts remains unclear, but the draft budget includes an 8% cut to the country’s primary aid agency, the German Federal Ministry for Economic Cooperation and Development, or BMZ.” [Devex, Apr 10]  

• "'Savage' cuts to UK foreign aid will leave 55.5 million of the world’s poorest people without access to basic resources . . . Women and girls will suffer the most as the government is likely forced to scale back programmes across global education, family planning, water and food aid." [The Independent, Apr 13]