Linksbridge continues to track how the turmoil in U.S. aid policy is affecting health and nutrition programs worldwide. This second edition of our emergency coverage includes a roundup of contingency measures from countries and donors trying to mitigate harm.
Unfortunately, there’s much to report. The online version may be easier to read. You can also see the first edition here.
As always, we welcome your feedback, and we’re grateful to our counterparts and partners for your inspiring work.
— the Linksbridge team
TOPICS: health delivery, HIV, malaria, TB, mpox, polio, women's health, health products, hunger and nutrition, contingency measures.
Global health
Health delivery
Afghanistan: “The United Nations Population Fund has frozen all U.S.-backed programs in Afghanistan, potentially leaving more than 9 million people cut off from health services.” [VOA, Feb 11]
“A total of 41 healthcare centers in Afghanistan’s Ghazni and Bamyan provinces have ceased operations due to cuts in U.S. assistance.” [Kabul Now, Feb 12]
DRC: The sudden funding freeze is expected to leave over 1.2 million people in the DRC“without life-saving support.”[Global Citizen, Feb 7]
Eswatini: A key hospital contributing to plummeting snakebite deaths in the country temporarily “closed its doors to most patients following sudden cuts to its funding from USAID.” [BIJ, Feb 25]
In Kenya, some “500 workers at Kisii Referral Hospital were told that due to the halting of United States aid money, ‘we regret to inform you that you should not report to work henceforth.’” [The Telegraph, Feb 19]
“At the Moi Teaching and Referral Hospital, one of Kenya’s largest research hospitals, employees were ‘requested to proceed to unpaid leave with effect from February 1.’” [The Telegraph, Feb 19]
“Another 1,000 staff on a US-funded programme at the University of Nairobi’s Faculty of Health Services were told they were being put on three months unpaid leave.” [The Telegraph, Feb 19]
Malawi: “At least 30 nursing students at a teaching hospital in Malawi can no longer finish their studies” due to halted grants. [The Telegraph, Feb 19]
In Myanmar, almost 60,000 people—mostly women and children—are without access to life-saving services.[WHO, Feb 12]
A Burmese refugee has died after being discharged from a U.S.-funded hospital on the Myanmar-Thailand border that was ordered to close as a result of the stop work order. [Reuters, Feb 7]
On the Myanmar-Thai border, the Karenni Refugee Camp closed down. “Suddenly, its equipment and medicines were unavailable to those who needed it most, including pregnant women and people dependent on oxygen tanks to breathe.” [South China Morning Post, Feb 16]
Pakistan: The USAID-supported Integrated Health Systems Strengthening and Service Delivery Activity that aims to strengthen Pakistan’s disease surveillance and response efforts has been paused. [ANI, Jan 28]
Somalia: “In Kismayo, a hospital serving 3,000 people each month has had to close its doors.” [NYT, Feb 12]
Sudan: “600,000 displaced people in Sudan will lose access to food, water, and healthcare, leaving them vulnerable to disease outbreaks.” [Global Health Council, Feb 5]
Syria: “U.S.A.I.D.-funded health care serves 1.65 million people in the area, the official said. Those services have been drastically cut. How many will die? ‘We can’t see them. They’re not even making it to a health care center,’ the official said.” [NYT, Feb 21]
Syria: One branch of Doctors of the World “has cut its daily consultations across northern Syria from 5,000 to 500. The organization has applied for a waiver from the U.S. but has received no response.” [Independent, Feb 13]
In Uganda, “at least 3,000 doctors, nurses, lab technicians, and other health personnel have told the Ugandan Medical Association that they have lost their jobs.” [The Telegraph, Feb 19]
“A Ugandan organization providing ‘free quality health services’ relied on U.S. funding to make their office rent, pay six staff members, and provide critical health care services. Now, in addition to the inability to care for target populations, ‘our landlord is chasing us out of his building.’” [Outright International, Feb 13]
In Ukraine, “access to healthcare could become very limited for 18,000 people living in remote areas and in precarious conditions.” [Action Against Hunger, Feb 19]
West Africa: “An organization that provides medicine and other forms of support to intersex persons who underwent intersex genital mutilation in West Africa has ‘canceled plans to extend medical support we provide to our community.’” [Outright International, Feb 13]
Sub-Saharan Africa: Partners have paused a five-year USAID-funded project from The Task Force for Global Health to improve how sub-Saharan governments and organizations prevent and treat NTDs. [Rough Draft Atlanta, Feb 20]
PEPFAR/HIV
UNAIDS estimates that since the foreign aid freeze began, “more than 3,000 new HIV infections have already happened worldwide as a direct result of the policy." [Advocate, Feb 13]
In a survey of 65 PEPFAR partners, 36% had completely closed down their organizationsand less than 10% had resumed providing any services after a waiver was granted to allow the organization to resume some lifesaving humanitarian assistance. [amfAR, Feb 14]
One Africa-based NGO said: “More than 3250 orphans and others made vulnerable by HIV/AIDS no longer benefit from school community support or treatment for malnutrition.” [ICVA, Feb 18]
Uncertainty is growing for generic production of long-acting PrEP: “PEPFAR was expected to be a significant buyer, and without its financial clout the commercial viability of manufacturing generic lenacapavir at vast scales is in doubt.” [Wired, Feb 21]
Country-specific impacts
“In Botswana, the non-profit Tebelopele testing centres – which provide nationwide STI screenings, HIV prevention, and TB treatment – closed down as a result of the USAID withdrawal, according to a Ministry of Health spokesperson.” [Independent, Feb 18]
DRC: “Thousands of people were left without support and with a high risk of developing advanced HIV” after PEPFAR-supported points of care were closed and other activities frozen. [MSF, Feb 15]
In Colombia, “around 300 Venezuelan migrants with HIV cannot continue their treatment as it was run with PEPFAR support.” [CNN, Feb 16]
Ethiopia: “We have people traveling 300 kilometers from the mountains to try to find their medications at other hospitals, because there are none left where they live.” [NYT, Feb 20]
Ghana: Doctors have warned of potential disruptions to supplies for the estimated 150,000 people who depend on USAID-funded antiretroviral drugs. [AFP, Feb 19]
“In Guatemala, the Lambda LGBTQ+ organization has already had to suspend a sexual health education project, as well as support, treatment and testing for people living with HIV.” [AFP, Feb 12]
In Indonesia, “local groups have had to lay off staff members, including more than 100 outreach workers who assist patients seeking H.I.V. treatment.” [NYT, Feb 21]
Kenya: Over 35,000 workers have lost jobs and 150 clinics have closed down following the aid freeze, affecting 72,000 people living with HIV. [The Eastleigh Voice, Feb 13]
Kenya: Around 100 children living with HIV may no longer have access to antiretroviral medication their orphanage has been receiving from USAID. [AP, Feb 20]
Kenya: On a recent Monday at Mathare North Health Center, “17 pregnant or lactating women with H.I.V. went to the center for H.I.V. medication to prevent the transmission of the virus to their babies, but the workers who usually managed the program were not there to provide the medication.” [NYT, Feb21]
In Kenya, South Africa, Uganda and Zambia, some 1,200 people enrolled in an IAVI-led study informing new HIV prevention tool development have “lost access to health services they were receiving” after the USAID-funded study was paused. [Science, Feb 13]
Nigeria: In Bauchi, ongoing treatment shortages, reduced clinical support and a lack of essential services stemming from the funding freeze have “heightened the risk of diseases spread in the state.” [The Guardian, Feb 20]
Philippines: The aid freeze threatens to disrupt ongoing services for 550,179 people in PEPFAR-supported regions. [GMA News, Feb 6]
South Africa: 5,000 people will be left without access to antiretrovirals and HIV prevention services because the Engage Men’s Health project, which offered HIV and TB testing and supplied PrEP for HIV-negative patients, has been forced to shut its doors. [Mail & Guardian, Feb 15]
South Sudan: The U.S. aid freeze “directly affects” around 70,000 people living with HIV. [Eye Radio, Feb 17]
Uganda: Dozens of clinics are closing. “Many of those that are open are rationing the pills they have because the pipeline for new deliveries is stalled. Facilities are also running out of HIV testing kits and are unable to provide the viral load tests that confirm if a patient’s HIV medicines are actually working.” [Devex, Feb 20]
Uganda: “I interviewed a sex worker on Tuesday morning just after she took the last of her supply of pre-exposure prophylaxis, or PrEP, medicine that prevents her from acquiring HIV. She does not know where she will get more, but she also cannot stop working despite the heightened risk.” [Devex, Feb 20]
Uganda: All health workers supported by Reach Out Mbuya (ROM)—a U.S.-backed community organization “providing medical and psychosocial support to people living with HIV”—have been laid off. One ROM clinician reported serving 200 patients with HIV and tuberculosis daily. [BBC, Feb 14]
In Uganda, supplies of antiretrovirals “have stopped . . . We are seeing clinics shuttered. This is people living with HIV - mums and dads who take this lifesaving medication.” [AFR, Feb 14]
In Ukraine, Vykhid Charitable Foundation “has had to shut down a key project focused on detection of new HIV cases since the freeze was announced.” [CNN, Feb 17]
In Zimbabwe, clinics “such as the Population Solutions for Health (PSH) and New Start centres providing counselling, free testing, voluntary male circumcision, ART and pre-exposure prophylaxis, known as PrEP, across the country were closed down.” [The Guardian, Feb 14]
Zimbabwe: Trans Smart Trust, which offers HIV services to transgender and intersex people, has been “forced to stop implementing programmes.” [The Guardian, Feb 14]
“In a West African country, a PEPFAR-funded organization said it lost US$60,000 in funding for HIV care and treatment. Overnight, community health workers were left without jobs, and services were at risk.” [Outright International, Feb 13]
Southern Africa: “‘We were forced to close and stop operations to do with PEPFAR’ and to lay off 24 staff members; in addition, most of the nurses the organization had trained, who were working at HIV clinics funded by USAID, had also lost their jobs.” [Outright International, Feb 13]
More than 3,000 women may no longer get access to HIV PrEP after researchers were forced to “walk away without meeting our most basic ethical obligations” to participants in a study in Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. [Science, Feb 13]
Tens of thousands of providers supporting HIV services have received stop-work orders, including nearly 20,000 clinical workers in Mozambique, 15,374 PEPFAR-funded HIV response staff in South Africa, 2,332 critical staff—including 258 doctors and nurses—in Cameroon and 1,258 health workers in Lesotho. [UNAIDS, Feb 18]
Malaria and TB
Malaria
The schedule of an upcoming seasonal malaria chemoprevention program in Cameroon that relied on U.S. funding has been “completely thrown off.” [Devex, Feb 20]
Close to 6 million people in Ghana, Kenya and Uganda will be impacted by the shutdown of U.S.-funded malaria spraying operations in coming weeks. [Global Health Council, Feb 5]
Due to the spending freeze, 1.45 million people will be left unprotected in Kenya, 3.2 million people will be at risk in Uganda, and 2.6 million people in Ethiopia won’t receive bed nets. [Global Health Council, Feb 5]
In Liberia, the “withdrawal of these funds is expected to create a severe shortage of malaria drugs and commodities in health facilities nationwide, putting millions of Liberians, particularly pregnant women and children under five, at risk.” [China Daily, Feb 18]
Tuberculosis
Due to the stop-work order, the Stop TB Partnership had to suspend $11 million in funding to civil society and community-based organizations working to combat TB, affecting over 100 organizations in 38 countries. [Devex, Feb 14]
Active case finding (ACF) in half of Cambodia has halted, resulting in “100,000 people missing TB screening, 300 DR-TB cases, and 10,000 DS-TB cases potentially going undetected.” [Stop TB Partnership, Feb 14]
India: “a programme to eliminate tuberculosis in Karnataka, for which USAID provided $7 million in 2022-23, will come to a halt.” [Indian Express, Feb 24]
Kenya: At Mathare North Health Center, “The X-ray machine that had been operated by workers supported by U.S.A.I.D. grants to diagnose tuberculosis is no longer running because the personnel trained to operate it were forced out of work.” [NYT, Feb 21]
Pakistan’s Tuberculosis Local Organisation Network—a USAID-funded initiative to provide expert guidance and resources to help eradicate TB—has been paused. [ANI, Jan 28]
Other infectious diseases
Mpox
Mpox testing rates have “dropped dramatically”: only 29% of suspected cases in some of the hardest-hit areas are now being tested due to logistical constraints, as USAID was responsible for transporting mpox samples to the central laboratory. [Health Policy Watch, Feb 13]
What’s more, “hundreds of thousands of mpox vaccine doses are now stuck in a warehouse far from the DRC.” [NPR, Feb 12]
Some provinces dependent solely on USAID funds have been “stripped of any resources to contain the virus.” While USAID workers have been seeking a waiver to continue mpox programming in the country, as of February 20, “one had not been approved yet.” [The Guardian, Feb 20]
Polio
The work of a polio vaccination program in Ethiopia has reportedly halted, meaning vaccine doses “risk expiring before they can be put into children’s arms.” [The Guardian, Feb 21]
Women's health
As of February 12, “about 2.5 million women and girls have been denied contraceptive care” due to the U.S. funding freeze. [NYT, Feb 13]
Indonesia: “A major Indonesian government program to revamp access to primary care is supported in part by a U.S.A.I.D. project focused on maternal and newborn health, which has now been halted.” [NYT, Feb 21]
In Nepal, up to 36 staff nurses “hired to promote exclusive breastfeeding practices” at hospitals have been indefinitely suspended. [Kathmandu Post, Feb 18]
In Pakistan, “62 health facilities located amid refugee villages will lose access to lifesaving maternal healthcare.” [Global Health Council, Feb 5]
In Turkey, “11 service units providing maternal healthcare will be forced to close, leaving 28,900 people without access to care.” [Global Health Council, Feb 5]
Health products
Sustainable development firm Chemonics said about $150 million in health commodities are “stranded in warehouses around the world” while another $88.5 million worth remain in transit—potentially impacting as many as 560,000 people (including 215,000 children) with diseases like AIDS and malaria. [NYT, Feb 11]
Impacts on the supply chain for HIV, malaria, and other products will potentially prove long-lasting: “For medical supplies, the freeze could also hit prices, because companies have been able to operate more efficiently knowing that they would continue to get orders from USAID.” [Reuters, Feb 21]
“At least $20 million worth of medical oxygen and supplies needed to deliver it, enough to help hundreds of thousands of adults and children with often life-threatening breathing problems, is currently stalled at several points in the supply chain.” [Reuters, Feb 13]
Medical supply chain issues are expected throughout Ghana: “We are staring at potential stockouts, which could see a rise in preventable diseases, maternal deaths, and a resurgence of viruses like malaria and tuberculosis.” [AFP, Feb 19]
Portable, battery-charged ultrasound and X-ray machines—which can each serve an estimated 50,000 people—are left “sitting in boxes” in Myanmar because transportation funding has been impacted. [Amnesty International, Feb 13]
Hunger and nutrition
Transit or storage obstacles
A pediatric ward in rural Burundi is running out of therapeutic food. “Without USAID employees, nobody can open the warehouses where the life-saving packets from the American people are stored.” [Time, Feb 18]
Enough food to feed 2.1 million people for a month is trapped in Djibouti’s port, “at risk of spoiling before it reaches those in need because there is no money to pay contractors to bring it into Ethiopia.” Another report estimated that almost 50,000 women and girls in Ethiopia will be at risk of potentially fatal malnutrition due to the stop-work order. [The Guardian, Feb 21; Global Health Council, Feb 5]
Ghana: “If we don't get the fertilisers and seeds on time, our yields will drop drastically... it means less food in the markets, higher prices for everyone, and possible food shortages across the country.” [AFP, Feb 19]
“In a warehouse in Haiti, nearly four metric tons of seeds cannot be distributed.” [AP, Feb 12]
Impacted nutrition programs
In the DRC, “4.5 million children under the age of 5 face acute malnutrition without access to therapeutic feeding centers and support for their breastfeeding mothers.” [Global Health Council, Feb 5]
Haiti: “After the aid freeze, Action Against Hunger shut down a program that worked with about 13,000 Haitians to educate families about better nutrition and provided training for pregnant and breastfeeding women, among other services.” [NYT, Feb 21]
In Nigeria, the Danish Refugee Council “has been forced to stop providing treatment to 150 children under the age of 5 each month who suffer from severe acute malnutrition, along with other medical complications. It has also stopped providing supplemental nutritional assistance to 400 children monthly and halted cash aid that helps 30,000 displaced people meet their basic food needs on their own.” [Devex, Feb 19]
In Nigeria, ready-to-use therapeutic food for severely malnourished children spent weeks “in a warehouse that was waiting for permission from Washington to reopen its doors. Once that permission came through, staff members who would normally distribute the food were unavailable because their employer did not have the funding or permission to let them work.” [NYT, Feb 21]
In Nigeria and Cameroon, “thousands of children and their families will soon lose the daily treatment they rely on for acute malnutrition and overall food assistance” because of disruptions in the Danish Refugee Council’s U.S. government-funded work. [DRC, Feb 12]
South Sudan: “A therapeutic food program cannot treatacutely malnourished children.” [NYT, Feb 20]
In Sudan,soup kitchens are shutting down that used to feed “between 30,000 to 35,000 people every day.” The U.S. aid freeze has “forced the closure of almost 80% of the emergency food kitchens set up to help people left destitute by Sudan's civil war.” [AFP, Feb 13; BBC, Feb 24]
Syria: A USAID-funded project that once provided food for 135,000 displaced people is shutting down due to a lack of funds. [Devex, Feb 17]
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.
In Cameroon, plans were put in place to ensure “uninterrupted continuity” of essential prevention, care and treatment services for HIV, TB and malaria, including by recruiting additional personnel and adjusting ongoing HIV product-related orders from the Global Fund. [Cameroon MOH, Feb 4]
Malawi circulated a six-month antiretroviral therapy dispensation plan, among other contingency measures, to provide “uninterrupted HIV services” across all health facilities. [Malawi MOH, Feb 3]
Nigeria’s government has approved $1 billion for healthcare sector reform and will allocate over $3.2 million to purchase 150,000 HIV treatment packs. [VOA News, Feb 4]
Nigeria: “Coordinating Minister of Health and Social Welfare, Muhammad Pate, says the federal government is working round the clock to employ 28,000 health workers whose salaries were previously covered by the United States Agency for International Development (USAID).” [The Guardian, Feb 17]
Depicting itself as “a reliable donor,” Norway has announced $851 million in new funding to NGOs over a five-year period “to provide rapid, flexible and targeted humanitarian aid.” [Government of Norway, Feb 17]
In South Africa, a government contingency plan has stipulated that certain people living with HIV can receive a six-month supply of antiretroviral pills at a time, “so that they only have to return to clinics or community pick-up points twice a year to collect their medication.” [Bhekisisa, Feb 18]
Zambia’s Ministry of Health committed to maintaining “uninterrupted HIV/TB and Malaria service delivery” at all facilities. [Zambia MOH, Feb 14]
“A couple of small organizations, such as Founders Pledge, have started ‘bridge funds’ ranging from about $20 million to $200 million, to try to help plug immediate gaps.” [NYT, Feb 22]
Images
A lab in Kenya supported by U.S. CDC capacity-building activities (U.S. CDC)
In Vietnam, U.S. CDC staff help to develop a network of national Emergency Operations Centers (U.S. CDC)
Scientists from South Africa study the mRNA vaccine production process while visiting the U.S. Vaccine Research Center (NIAID)
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