Taking stock of foreign aid reductions

3rd edition – March 14, 2025

The outlook for U.S. aid policy has grown worse, with the initial chaos of stop-work orders, court intervention, halted payments, and staff purges giving way Monday to the complete elimination of 5,200 of USAID’s 6,200 programs. 

Linksbridge continues to track the on-the-ground impacts of these cuts on health and nutrition programs worldwide. Due to the length of this update, you may find the online version easier to read.

Your feedback is welcome. We recognize these are extraordinarily difficult times for vulnerable people everywhere and for many in the global health community. Linksbridge stands in solidarity with our counterparts and partners who are steadfast in their vision of a better world.

— the Linksbridge team

PRIOR ISSUES: 1st edition, 2nd edition

 

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

Global health

Health delivery

• In Afghanistan, funding cuts led to the closure of 32 health facilities that had supported 134,046 children in January alone. [Save the Children, Mar 12]

• Afghanistan: In the past month, more than 200 health facilities have closed, “depriving 1.8 million people from essential health services.” [UN News, Mar 6]

• Bangladesh: As a “direct result of the USAID freeze,” at least “five hospitals have halted services” and 14 facilities that provide physiotherapy and other treatments in Rohingya refugee camps have been shut down. [Amnesty International, Mar 13]

• Ethiopia: Canceled USAID-funded programs include “a project run by Plan International that provided drugs and other medical supplies, health care, treatment of malnutrition programming, and water and sanitation for 115,000 displaced or affected by the conflict in northern Ethiopia.” [NYT, Feb 27]

• “India's first three clinics for the transgender community closed last month following a stop-work order from the U.S. Agency for International Development (USAID) that funded them, disrupting services for nearly 5,000 people.” [Reuters, Feb 28]

• Somalia: 50 health centers that service over 19,000 people monthly have closed “because health workers are not being paid.” [MedPage Today, Mar 3]

• Sudan: “The availability of healthcare services has likely worsened, as at least 335 health facilities across the country had been affected” by stop-work orders [SWOs] since January 31. [ACAPS, Mar 13]

• Sudan: “In the Darfur region, by 31 January the SWOs had affected around 21% of the region’s health response capacity, including 57 health facilities. In North Darfur, two of the four USAID-funded clinics closed in Saraf Omra and Tawila, with crowdfunding keeping the remaining two open. Three health centres in eastern Sudan have also closed, leaving approximately 30,000 people without essential medical services. In Sennar, funding shortages resulting from the SWOs have reduced mobile clinic operations in an area where only one hospital clinic remains operational across seven localities, affecting access to healthcare for those in more inaccessible areas.” [ACAPS, Mar 13]

• A Sudan-based project that ran “the only operational health clinics in one of the biggest areas of the Kordofan region” has been shut down, “cutting off all health services.” [NYT, Feb 27]

• A dozen health clinics in Syria, including the main referral hospital for the area, have shut down. [MedPage Today, Mar 3]

• In Thailand, “hospitals helping some 100,000 refugees from Myanmar have shuttered, according to aid group Border Consortium.” [Inquirer, Mar 12]

• Uganda: Baylor College of Medicine Children’s Foundation programs that strengthen district health systems to better deliver HIV, TB and maternal and child services have been terminated. [Health Policy Watch, Feb 27]

• In Vietnam, “a program assisting disabled people through training caregivers and providing at home medical care stopped, according to Humanity & Inclusion.” [Inquirer, Mar 12]

• Among canceled USAID-financed programs: a West Africa-based project run by Helen Keller International that “last year provided more than 35 million people with the medicine to prevent and treat neglected tropical diseases, such as trachoma, lymphatic filariasis, schistosomiasis and onchocerciasis.” [NYT, Feb 27]

PEPFAR/HIV

Ethiopia

• In Ethiopia, “local hospitals and clinics have all run out of HIV medication since there was no forewarning or transition plan before aid was cut.” [NPR, Feb 28]

• Ethiopia’s USAID-supported Organization for Social Services, Health and Development program has been canceled. The effort helped 1,600 children and adolescents get the daily HIV medications they need to keep the virus in check. [NPR, Feb 28]

• Ethiopia “has been forced to lay off 5,000 local healthcare workers who were working on its HIV response.” [AP, Mar 12] 

Kenya

• Kenya: Some $34 million worth of medicine and equipment are stuck in a warehouse outside Nairobi, including "2.5 million bottles of ARVs, 750,000 HIV test kits and 500,000 malaria treatments." About $10 million is needed to distribute the products, but "officials in Washington have not authorised the release of money." [Reuters, Mar 11]

• Kenya will “run out of US-bought HIV medicines and laboratory supplies” starting in May. In addition to vanishing ARV stores, diagnostic commodities are at risk: “The supply of Abbott Alinity Viral Load Kits and Roche Viral Load Tests will be completely depleted” by May unless alternative funding is secured. [The Star, Mar 3]

• Also in Kenya, “for the time being, some patients can only get refills of their ARVs for one week at a time.” [Reuters, Mar 11]

South Africa

• South Africa: Health nonprofit NACOSA (Networking HIV and the Aids Community of Southern Africa) estimates that a 90-day service freeze will leave 26,000 HIV-affected orphans and children without services, including 7,000 living with HIV who “could be at risk of treatment default.” [Daily Maverick, Mar 4]

• Some 620 staff working at NACOSA’s implementing partner organizations have been laid off. [IOL, Mar 6]

• South Africa: “In central Johannesburg HIV testing has almost completely stopped.” [Daily Maverick, Mar 4]

• Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups, had to let go of 2,800 people “who are mainly peer educators and data capturers.” [Health Policy Watch, Feb 27]

• The Crystal Fountain—a lifeline for parents raising children living with HIV—has “already been forced to lay off staff, straining its ability to provide critical services.” [ENCA, Mar 7]

• A South African clinic with 7,200 active patients receiving antiretrovirals and more than 1,500 patients on HIV pre-exposure prophylaxis will be “stretched to its limits” after May. The clinic is already seeing a surge in patients as other clinics in Johannesburg close. [The Citizen, Mar 6]

Elsewhere

• “The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children.” [Health Policy Watch, Feb 27]

• An estimated 750,000 people in Haiti are affected by the U.S. aid freeze. Out of 181 total PEPFAR-funded sites, 128 have “completely halted services” and remaining sites flooded by patients are “unable to meet the increased demand.” [UNAIDS, Mar 5] 

• The Ivory Coast has suffered an “almost total collapse” of HIV services since the funding freeze began. [The Guardian, Feb 27] 

• Lesotho's USAID-funded Phelisanang Bophelong HIV/Aids Network—a community-based organization that dispensed vital antiretrovirals to nearly 1,000 people—has collapsed. [Daily Maverick, Mar 5] 

• In the Philippines, “suspension of USAID funding affected free deliveries of about 8,000 free HIV testing kits and pre-exposure prophylaxis (PREP) every month to clients all over the country. The kits now must be picked up at the clinics.” [Business World, Mar 4]

• Uganda: The U.S. Department of Defense-funded Makerere University Walter Reed Project—which provided critical healthcare services and “played a pivotal role in HIV care and treatment” under PEPFAR—has been forced to cut its workforce from 236 health workers to just 36. [The Observer, Mar 7]

Malaria and TB

Malaria

• With the cancellation in late February of 5,800 USAID contracts, former USAID head Atul Gawande posted: “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated.’” [Bluesky, Feb 27]

• The REACH Malaria program, which “protected more than 20 million people in 10 countries in Africa from the disease,” was canceled. [NYT, Feb 27]
• A President’s Malaria Initiative mosquito control program has shuttered. The program operated in 21 countries and protected 12.5 million people last year from the disease vector. [NYT, Feb 27] 

• Senegal’s biggest malaria project has closed: the effort “distributed bed nets and medication to tens of thousands of people.” [MedPage Today, Mar 3]

• In Myanmar, the suspension of USAID funding has “cut off” supply of antimalarial drugs in several districts. [BNI, Mar 13]

Tuberculosis

• The U.S. canceled all the operating costs and 10% of the drug budget of the Global Drug Facility—the “main supply channel for tuberculosis medications, which last year provided tuberculosis treatment to nearly three million people, including 300,000 children.” [NYT, Feb 27]

• USAID’s funding for Smart4TB—a research consortium “working on prevention, diagnostics and treatment for tuberculosis”—has been canceled. [NYT, Feb 27]

• Days after USAID stopped its funding, the Stop TB partnership was told that “the termination of its USAID funding is rescinded” and it could continue its work, but per the organization’s director, “they still don’t have access to funding.” [Devex, Mar 5]

• “The whole system of finding, diagnosing and treating tuberculosis — which kills more people worldwide than any other infectious disease—has collapsed in dozens of countries across Africa and Asia.” [NYT, Mar 11]

• Bangladesh: USAID-supported active case finding projects have been interrupted, “affecting pediatric TB detection, diabetic clinics, and field operations for 26 portable X-ray systems.” [Stop TB, Mar 3]

• Cambodia: Tuberculosis treatment support for half the country has been impacted. [Stop TB, Mar 3]

• DRC: Some 30% of the 3HP treatments procured under USAID catalytic funding have been distributed to four provinces, “while the remaining 70% remain in Kinshasa, set to expire in 2026.” [Stop TB, Mar 3]

• In Kenya, transportation of some TB samples has stopped after U.S-paid drivers scheduled to bring the samples to labs “were fired on the first day of the funding cut.” [NYT, Mar 11]

• Kenya: The U.S. has stopped paying for the tests patients need before beginning treatment for multi-drug-resistant TB. “Without the tests, clinicians don’t know what drugs to prescribe very sick patients. Prescriptions stopped.” [NYT, Mar 11]

• Nigeria has halted the procurement of 200,000 Xpert TB tests. [Stop TB, Mar 3]

• In Pakistan’s Shikarpur district, “over 100 workers have already been laid off due to the abrupt termination of a US-funded tuberculosis control program launched in November 2023 to combat tuberculosis across 15 underdeveloped districts by 2029.” [Pakistan Observer, Mar 4]

• In Tanzania, “direct TB service delivery, including case finding, in 18 regions has ceased,” and the country has delayed the rollout of BPaLM treatment “as the key DR-TB focal person and supporting partners are no longer available.” [Stop TB, Mar 3]

• Uganda: Patient data collection has been disrupted, “leading to up to 50% underreporting, which will hinder new regimen uptake monitoring and stock analysis.” [Stop TB, Mar 3]

• Zambia: The aid freeze has severely impacted GeneXpert cartridge procurement, “leaving 600,000 planned tests (9.6 months of stock) unfunded and unprocured, with the country already facing stockouts.” [Stop TB, Mar 3]

Other infectious diseases

• Uganda: Baylor College of Medicine Children’s Foundation had just begun contract tracing patients with Ebola when it received a termination notice. It will likely now “have to halt all U.S.-funded operations and hope that the Uganda health ministry can step in.” [ProPublica, Mar 1]

• Only six USAID staff dedicated to Uganda’s Ebola response are left after about 50 people—including the organization’s “leading expert in lab diagnostics, and the manager of the Ebola response”—were fired. [NYT, Feb 27]

• Mpox testing rates in the DRC have significantly declined over the last month: only 17% of suspected cases were tested in the past week, “a drop of almost 10%.” [Health Policy Watch, Mar 6]

• A loss of funding for Save the Children will mean the organization’s polio immunization project in Ethiopia “will grind to a halt, undoing years of work to eradicate the infection and risking the spread of deadly disease.” [Save the Children, Mar 12]

• “A $131 million grant to UNICEF’s polio immunization program, which paid for planning, logistics and delivery of vaccines to millions of children,” has been canceled. [NYT, Feb 27]

Women's health  

• Bangladesh: “600,000 women and children will lose access to critical maternal healthcare, protection from violence, reproductive health services, and other lifesaving care.” [MedPage Today, Mar 3]

• About 200,000 displaced people in Yemen will lose access to “critical maternal healthcare, protection from violence, rape treatment, and other lifesaving care.” [MedPage Today, Mar 3]

• Senegal has seen the closure of maternal and child health and nutrition services that provided “lifesaving care to tens of thousands of pregnant women and treatment that would have prevented and treated acute malnutrition.” [MedPage Today, Mar 3]

• A Nepal-based program providing pre- and postnatal health services for 3.9 million children and 5.7 million women has been shuttered. [NYT, Feb 27]

Hunger and nutrition

• “The UN’s World Food Programme (WFP) is closing its southern Africa office in the wake of the Trump administration’s aid cuts.” [The Guardian, Mar 3]

• Afghanistan: A Save the Children-supported clinic that provides essential care to 2,500 malnourished patients each month “is only being kept open with limited emergency funding.” In a matter of weeks, “the clinic could be gone—leaving hundreds of malnourished children without access to the care they desperately need.” [Save the Children, Mar 11] 

• In Afghanistan, “Action Against Hunger had to cancel its already planned expansion of treatment beds in Kabul and has stopped accepting new patients.” [Mother Jones, Mar 10]

• Bangladesh: “A project serving more than 144,000 people . . . that provided food for malnourished pregnant women and vitamin A to children” has been scrapped. [NYT, Feb 27]

• Bangladesh: Because of a funding shortfall, the World Food Programme will have to implement cuts to food rations, taking effect from April 1 in Cox’s Bazar. “The monthly ration for Rohingya refugees had been reduced from $US12.50 ($20) to $US6 ($9.50).” [ABC, Mar 10] 

• Colombia: “A program shuttered by the Norwegian Refugee Council in Colombia left 50,000 people without lifesaving support including in the northeast, where growing violence has precipitated a once-in-a-generation humanitarian crisis.” [Inquirer, Mar 12]

• DRC: “In Congo, the aid group Action Against Hunger will stop treating tens of thousands of malnourished children from May, which the charity said will put the children in mortal danger.” [MedPage Today, Mar 3]

• In Ethiopia, food assistance has stopped for more than 1 million people. [MedPage Today, Mar 3] 

• In Gaza, “aid cuts mean reducing treatment and services for malnourished children mid-recovery and closing 10 mother-baby areas where Save the Children is supporting pregnant women and newborns with critical nutrition assistance.” [Save the Children, Mar 11] 

• In Kenya, “more than 600,000 people living in areas plagued by drought and persistent acute malnutrition will lose access to lifesaving food and nutrition support.” [MedPage Today, Mar 3]

• Kenya: Over 154,600 children under five and 142,100 pregnant and lactating women in hard-to-reach areas will miss out on lifesaving nutrition interventions due to foreign aid cuts. [Save the Children, Mar 12] 

• “In Mali, critical aid, such as access to water, food, and health services was cut for more than 270,000 people.” [MedPage Today, Mar 3]

• Myanmar: "The United Nations World Food Programme (WFP) today warned that more than one million people in Myanmar will be cut off from WFP’s lifesaving food assistance starting in April due to critical funding shortfalls." [WFP, Mar 14]

• In Nigeria, a project that provided 5.6 million children and 1.7 million women with treatment for severe and acute malnutrition has shuttered, meaning “77 health facilities have completely stopped treating children with severe acute malnutrition, putting 60,000 children under the age of 5 at immediate risk of death.” Separately, about 25,000 “extremely malnourished children will stop receiving food assistance” in Nigeria by April. [NYT, Feb 27; MedPageToday, Mar 3] 

• Somalia: Save the Children has been “forced to close about 121 health and nutrition sites,” cutting off support for more than 250,000 people. [Save the Children, Mar 11]

• Somalia: Nonprofit Alight was forced to shutter 33 primary health centers and 13 clinics that provided check-ins for around 700 malnourished children each day. [ProPublica, Mar 1] 

• South Sudan: The International Rescue Committee closed a project providing access to quality healthcare and nutrition services to more than 115,000 people. [MedPage Today, Mar 3]

• Sudan: As “millions face starvation,” U.S. funding cuts have “severely impacted ‘emergency response centers,’ a volunteer-run network that provides food aid and was previously 80% funded by the United States. [LaCroix International, Mar 8] 

• Sudan: “90 communal kitchens closed in the capital, Khartoum, leaving more than half a million people without consistent access to food, according to the International Rescue Committee.” [Inquirer, Mar 12]

• Sudan: “At least 900 of the 1,400 community kitchens, which serve up to two million people country-wide, remain closed after halting activities, including in areas facing and at risk of IPC 5 levels of food insecurity.” [ACAPS, Mar 13] 

• Sudan: “Closures had also been reported in Dilling, South Kordofan (19 communal kitchens serving 11,000 households), where 2,025 malnutrition-related deaths had also been reported; River Nile (35 kitchens serving 100,000 IDPs and host communities); Tawila, North Darfur (12 kitchens), the locality to which IDPs from Zamzam camp fled following an RSF attack and at risk of starvation; and West Kordofan (all 49 kitchens serving 28,000 households). Community responders were also forced to stop food baskets in the Kordofan region (serving 80,000 IDPs across 14 localities).” [ACAPS, Mar 13]

• Yemen: FHI 360 has shut down a project that “supported community health workers’ efforts to go door-to-door seeking malnourished children.” [NYT, Feb 27] 

• In Latin America, over 2,000 children will be denied access to food, education and other fundamental rights each day due to foreign aid cuts. [Save the Children, Mar 11] 

• Worldwide: Save the Children has been “forced to close hundreds of health facilities and nutrition centres that provide lifesaving care for children.” [Save the Children, Mar 11] 

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

• Mali: The Malian government allocated nearly $200,000 to affected associations to help them “continue their activities and mitigate the negative effects of the suspension.” [UNAIDS, Mar 4]

• Kenya’s ministry of health is seeking an additional nearly $40 million within the next three months and an additional $100 million in the next financial year “to keep HIV mitigation programmes afloat following the USAID funding freeze.” [Eastleigh Voice, Mar 13]

• “Lesotho's Health Ministry has reached out to final-year medical students and recent graduates, encouraging them to volunteer at local health centers to fill staffing gaps.” [Africanews, Feb 20]

• South Africa’s government “cannot fill the funding gap” left by the termination of USAID-funded programs, but the country’s “immediate aim is that nobody must run out of ARVs when they need and deserve them,” per the country’s health minister. [Times Live, Mar 6]

Nonprofits and donors

• Philanthropic fundraising service Freedom Together Foundation has committed to spending “10% or more” of its endowment, moving to “provide rapid response grants to communities and organizations under attack.” [Freedom Together, Feb 25]

• The MacArthur foundation called on philanthropy to “step up” and pledged to “raise our baseline payout to 6 percent for the next two years, at a minimum, and where we can, use trust-based practices to reduce burdens on grantees.” [MacArthur Foundation, Feb 25]

• Unlock Aid and a number of partners have launched the Foreign Aid Bridge Fund, an emergency grant-based financing mechanism to help “on-the-ground organisations feeling the pinch." [Alliance, Feb 20]

Foreign aid cuts from other countries

The U.K. government on February 25 announced a planned 40% reduction in development assistance spending by 2027.

• The planned U.K. cuts will mean an estimated 606,000 fewer deaths averted over 5 years, due to cuts to Gavi. [One Data, Mar 3]

• The cuts would lead to an estimated 9 million fewer immunized children. [One Data, Mar 3]

• An estimated 293,000 fewer children will receive meals and essential food assistance through the World Food Programme. [One Data, Mar 3]

Elsewhere, France cut development spending 35% in its recently approved budget, Germany made smaller aid reductions in 2024, Belgium in February landed on a 25% foreign aid cut, the Netherlands plans €1 billion in cuts to its development budget over 5 years, Sweden plans further ODA cuts beginning in 2026, Switzerland’s aid reductions in 2025 include discontinued support for UNAIDS, and the EU has proposed aid cuts of about €2 billion through 2027.