‘We should have been hammered a long time ago’: African countries thank Trump for aid wake up call
Just as European countries have grouped together on defence, African leaders want to take back control too
African countries are realising they cannot rely on US generosity Credit: Ben Curtis/AP
Ben Farmer in Durban
https://www.telegraph.co.uk/global-heal ... ding-cuts/
28 March 2025
European defence hawks and African public health experts are not known for speaking the same language, but in recent weeks
Donald Trump has forced them to take the same line.
Just as Europe has realised it must stand on its own and pay up to defend itself without American muscle, African countries are realising they cannot rely on US generosity to provide health care to their people.
Steep aid cuts from some of the world’s biggest donors, particularly America,
https://www.telegraph.co.uk/global-heal ... own-usaid/ are blowing holes in African health budgets as Washington, London, Paris and others slash their assistance spending.
Foreign money which has for years gone to pay doctors and nurses, buy drugs and deliver services has been halted, often overnight, and it seems unlikely it will be turned back on again.
The response from many African leaders has been the same as the response from jilted European Nato leaders: This is a wake up call. We must step up to stand on our own and it might even be an opportunity.
‘Whoever gives you aid controls your life’
The subject of how to deal with the sudden aid gaps and how to fill them has this week dominated a G20 health meeting held outside Durban, South Africa.
In public at least, many are trying to put on a brave face.
[African nations] must stand on their own,
South Africa’s health minister, Dr
Aaron Motsoaledi, told the Telegraph on the sidelines of the G20 health summit in Durban.
This message is to say please stand on your own, because no country can depend forever on another country. It’s a wake up call.
I personally do not think it is humanly possible for a country to feed others for life. I think foreign aid was there to bridge the country over a particular period, I do not think it was meant to be permanent in any way.
Similar sentiments have been voiced in other African capitals.
I want to thank Mr Trump actually, I think he’s slapped us not on one cheek but on both cheeks, we should have been hammered a long time ago,
Zambian President
Hakainde Hichilema said.
His country was receiving £460m ($600m) in aid a year from the US.
Paul Kagame, Rwanda’s president, has used the crisis to repeat his criticism of how aid undermines sovereignty.
Whoever gives you aid controls your life,
he said earlier this month.
Meanwhile Nigeria has said it refuses to beg.
We are a capable country and we are determined to own up to that responsibility. If others step in and support us, we appreciate it but we are not begging,
said Nigeria’s health and social welfare minister,
Muhammad Ali Pate.
The subject of how to deal with the sudden aid gaps has dominated a G20 health meeting Credit: Farah Abdi Warsameh/AP
Such bravado might be expected from politicians. In private health officials are more candid about their worries.
Plenty are reluctant to discuss the matter at all, in case complaints attract unwanted reaction from Washington.
Yet even among these officials there has been a realisation that action is overdue, said Prof
Nicholas Crisp, a deputy director general in South Africa’s health department.
He said:
I was impressed with ministers of state, permanent secretaries, saying this was a wake-up call. It wasn’t like a rejection, it was like saying ‘Jeez, we really need to get our act together’.
There was no aggressive kickback.
We don’t want to be dependent. You lose your sovereignty and you make yourself vulnerable when you are dependent on donors. Everyone has been mature and supportive about it. The question has rather been how fast you get out of that donor dependence.
Just how much money African health stands to lose is still unclear. The Trump administration has paused almost all foreign aid for a 90-day review, but it has already said it will cut 90 per cent of contracts overseen by America’s USAID agency, amounting to £46bn ($60bn).
The UK, France, Germany and Netherlands have also said they will cut aid, as they try to rein in public spending and pivot to rearming in the face of Russian aggression.
‘A defining moment in health financing’
An internal Kenyan government assessment seen by the Telegraph underlines the scale of what these cuts might mean to countries.
Some 31 per cent of the money needed for Kenya’s national health programmes comes directly from the US government. Other donor funding comes from organisations like Gavi, the vaccine alliance, which are themselves reliant on the US.
https://www.telegraph.co.uk/global-heal ... ald-trump/
Large numbers of staff have already been laid off, supplies are running out and IT and management systems are faltering.
The assessment says:
The funding freeze poses an existential threat to Kenya’s health infrastructure. With donor support halted, many health facilities face a grim future: without necessary financial backing, they risk falling into disrepair or even closure, severely limiting access to essential care.
The pattern is likely to be repeated across the continent.
Modelling published in
the Lancet estimated that if gaps in HIV funding cannot be filled, rates of new global infections could soar
https://www.telegraph.co.uk/global-heal ... s-aid-cut/ and there could be millions more deaths.
It has quickly become clear that there are no other similar donors big enough to fill the hole. No other country, including China, comes close to American largesse.
China does not freely share data on aid, but a 2021 white paper from Beijing said it had spent around (£5.4bn) $7bn a year between 2013 and 2018, over half given as loans. America spent 10 times that on foreign assistance in 2023.
China may fill some of the gaps as it vies for geopolitical influence, but no one expects Beijing to come close to replacing America. Philanthropists and charitable organisations also lack Washington’s financial might.
We are facing a defining moment in health financing,
says
Diane Stewart of the Global Fund.
Protests outside USAID buildings shortly after Trump made the controversial announcement Credit: Kent Nishimura/REUTERS
Instead, in Durban, the focus was on how countries can raise money themselves.
Magda Robalo, of Guinea Bissau’s Institute for Global Health and Development, said:
Currently we are in a situation where external aid is going to dramatically reduce. Of course we need to increase domestic public finance. But the lesson is never let external financing replace domestic financing in health.
African countries had already decided that funding their own health was the only sustainable way forward.
The Lusaka Agenda, agreed in late 2023 vowed to find
a gradual transition toward sustainable, domestically-financed health services.
The problem for them now is that any transition can no longer be gradual. The money has gone overnight.
Rob Yates, a political health economist at the London School of Economics, said:
I think that what we are recognising is that the only alternative is domestic public financing.
That could involve tax spending, re-prioritising government spending away from other areas and towards health, or setting up social health insurance contributions.
Nigeria for example has added an additional £155m ($200m) in health-care spending in an attempt to make up for the £620m ($800m) in lost US funding.
South Africa’s African National Congress (ANC) government says its solution is a long-touted national health insurance scheme, though that faces stiff resistance from opposition parties.
Dr Motsoaledi said:
We believe if that is done, we do not have to go around, scuttle around, asking for money. That’s our belief. Not that we don’t appreciate being helped. We appreciate being helped, but I don’t think we could encourage ourselves to be dependent forever.
Others are thinking about how they can better involve the private sector in public-private partnerships.
Some countries are in a far better place than others to deal with the deficit.
South Africa is a middle income country and for them, they have options,
says
Matt Jowett, a health financing expert with the World Health Organization.
They are much more likely to be able to absorb this compared with a country like Malawi or Sierra Leone for example.
Huge debt means many African governments already have strained finances and many countries spend more on servicing debt than health.
The continent has more than £0.93 trillion ($1.2 trillion) in external debt. The debt-to-gross domestic product ratio has risen by about two-fifths since 2008, according to the African Export-Import Bank.
If countries do start to try to fill the gaps themselves, then they will have a bigger say on where the money goes.
Indeed optimists say this could be a chance to get rid of some of the worst inefficiencies and distortions of the aid system. Tangled aid architecture is often accused of inflating salaries and costs, being too centralised and unwieldy, and maybe not even delivering what recipient countries want.
There is a suspicion that some aid programmes are accepted, not because they are a domestic priority, but simply because they are being given away. When countries pay themselves, priorities could change.
Mr Jowett said:
Look, lets be clear there’s a health financing emergency in terms of this massive departure of aid.
The positive spin is that they can take back control of a lot of these programmes.
The problem for countries is that while they may have been heading in that direction, or planning to at least, the immediate cuts in aid have left an immediate crisis.
Prof Crisp said:
The biggest challenge was not whether funding would be reduced, it was the rapidity of the reduction, that was the problem.
The challenge for every country I have spoken to was: ‘We needed warning’.
