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Daily Maverick
5 days ago
- Health
- Daily Maverick
Closing the funding gap — how SA can respond to US aid cuts
South Africa still lacks an action plan after the withdrawal of US aid for HIV and related health services. But when funds do arrive, how will they be managed? The answer may lie in the District Health Programme Grant. The government's extended silence on how it plans to solve the funding crisis created by the withdrawal of US aid has thrown much of the health sector in South Africa into despair. It has been five months since the withdrawal of the aid amounting to about R7-billion per year. It covered the salaries for 15,000 health workers, of whom 8,000 are community health workers, 2,000 are nurses, and 300 are doctors working in 27 of South Africa's high HIV priority districts. As a result, volumes of high-risk populations have lost access to care, while overstretched healthcare workers are facing increased pressure amid ongoing staff shortages. Recently, the Global HIV Treatment Coalition and civil society organisations wrote a strongly worded letter to the government demanding action on a fully costed emergency plan. They accused the state of not taking concerted action. They are not wrong: The government has still not made a clear plan available to the public, although there is consensus on the urgent need to strengthen the emergency response. Plans have been developed internally in the National Department of Health, and a national technical support unit has been established in the office of the health department's director-general to support the integration of services. It is understood that several provinces are being supported to develop provincial transition plans that can be translated into concrete action. But ongoing discussions with the National Treasury have made little meaningful progress in closing the funding gap. The Treasury has indicated that any new funding will either be part of the adjustment budget or as an emergency allocation. At this stage, it is still unclear how much money, if any, will be allocated. There is another challenge that is yet to be considered. When the funding does arrive, there will need to be consensus on how the money is coordinated, incubated and managed. Here, the answer may already be in our back pockets in the form of the District Health Programme Grant. The grant is a mechanism for funding South Africa's public health efforts, particularly relating to HIV, TB and other communicable diseases. As an existing instrument, this grant programme could help address issues linked to the funding gap and lay the foundation for the sustainable integration of activities previously funded by the US President's Emergency Plan for Aids Relief (Pepfar). Why the District Health Programme Grant could work The District Health Programme Grant presents an ideal mechanism that can be used to strengthen governance and ensure that the funding, plans and activities, down to a district level, align with national campaigns and priorities. The grant would need to be amended to ensure that there is improved management of the conditionalities so that the funds invested meet their purpose. Conditional grants are funds allocated to provinces with the primary purpose of ensuring that national priorities are implemented consistently across the country. They facilitate targeted service delivery, equity, accountability and performance monitoring. The District Health Programme Grant, which has a budget of about R25-billion, already has a large HIV component, so additional funding for the HIV and TB services that are needed could easily be allocated to this grant. And if the health department amended the grant mechanism to allow for the contracting in of service providers, such as the Pepfar implementing agents, which are mostly South African NGOs previously funded by the US government, the country would be able to use the capacity built up over time in these organisations to strengthen the delivery of HIV and TB services. The concern, however, is accountability. In the current set-up of the grant, provinces can act more autonomously, and the grant's conditionalities are poorly managed. For the system to be more effective, there needs to be a greater emphasis on cooperative engagement, where two-way reporting between the national and provincial levels can take place. Amending the grant to include stronger accountability mechanisms would help the health department to better coordinate and manage it. The clock is ticking The funding gap comes at a time when the health department has launched two ambitious campaigns to tackle HIV and TB. The Close the Gap campaign aims to enrol a record number — an additional 1.1 million — of people living with HIV on life-saving antiretroviral medicine this year. Along with teenage girls and young women, the initiative prioritises an estimated 600,000 men who know their status but are not on treatment. This campaign aligns with the country's strategy to end TB by 2030. This year, the health department also hopes to accelerate TB case-finding by scaling up testing to five million TB tests to reduce the high rate of infections and deaths. The linkages between the campaigns make sense. TB is the leading comorbidity for people living with HIV. HIV is also the leading contributor to TB mortality, accounting for an estimated 55% of TB deaths, according to the World Health Organization's data on TB in South Africa. The campaigns are evidence-informed and well considered. However, the ambition is not matched by budgets that can support and ultimately enable its success. In addition to the R7-billion Pepfar funding gap, there is a funding gap of at least R600-million in TB to sufficiently fund the required five million tests needed for the campaign. Funding pressures at the provincial level are also constraining the scaling up of the capacity required to administer the tests. A recent analysis by the South African National Aids Council situation room, which every month evaluates the HIV response as part of the Close the Gap campaign, suggests that while there are increases in the number of people being initiated on HIV treatment, the pace is not fast enough to mitigate the losses SA experiences in retaining patients in care. This has resulted in negative growth in many high-prevalence districts. Similarly, in the first TB provincial managers' programme meeting coordinated by the national TB programme, reports of poor performance against the testing targets underpinned the underlying frustrations many are experiencing. South Africa has made incredible progress in expanding access to healthcare in the last 30 years. These include significant declines in maternal mortality, decreases in the under-5 mortality rates, and significant declines in the incidence of TB. Much of this success, particularly in the last decade, is the result of the mass rollout of lifesaving antiretroviral treatment to about six million of the estimated eight million people in SA living with HIV. The abrupt withdrawal of US aid has put at least some of this progress under threat. As we look to the mid-year adjustments budget, we don't just need new money to plug the gap; we also need a sensible framework for spending that money. Channelling the funds through a tweaked District Health Programme Grant is a financial solution that will both provide some quick relief and mitigate the impact that the funding gap will have on universal health coverage more broadly in the long run.
IOL News
6 days ago
- Health
- IOL News
Motsoaledi: SA's HIV/AIDS programme will not collapse despite US funding cuts
Health Minister Aaron Motsoaledi says South Africa's HIV/AIDS programme remains secure, with Treasury and global partners stepping in after the withdrawal of US funding. Health Minister Dr. Aaron Motsoaledi says South Africa's world-leading HIV/Aids programme 'will not collapse' following the withdrawal of US President's Emergency Plan for Aids Relief (Pepfar) funding earlier this year. This as the National Treasury injected R753 million into the programme with global partners pledging a further R600 million to support treatment and research. Earlier this year, US President Donald Trump's administration announced it would halt all Pepfar funding, following previous global health aid cuts under the same administration. The decision by USAID to withdraw support has left a significant funding gap, particularly for countries like South Africa, where approximately 17% of the HIV/AIDS response was funded by Pepfar. Presenting the Department of Health's 2025/26 budget in Parliament on Wednesday, Motsoaledi outlined the National Department of Health's three key priorities: strengthening the public health system in preparation for National Health Insurance (NHI), eliminating key diseases such as HIV/AIDS and TB, and implementing long-overdue reforms in the private health sector. 'There is no way we are going to allow the world's biggest HIV/AIDS Programme to collapse- never.' He described claims of a collapse as premature and inaccurate, insisting the department had developed clear plans to bridge the funding gap. 'In South Africa we seem to like the word 'collapse'. Every time something meets headwinds, it is said to have collapsed,' he said. Motsoaledi told Parliament, emphasising that despite funding cuts, government and partners are stepping in. 'We presented our plans to National Treasury and asked for help. At the same time we approached other funders, both domestic and globally.' Motsoaledi revealed that National Treasury had responded to the department's request for support by releasing R753,528,000.
The Independent
17-06-2025
- Politics
- The Independent
Congress should be ashamed over helping Trump cutting foreign aid, activists say
The US Congress should be ashamed by its role in helping Donald Trump claw back billions of dollars in foreign aid funding already allocated to projects around the world, activists have said. The House of Representatives recently narrowly voted through a request to claw back $9.4 billion (£7bn) of funds – known as rescissions – with $8bn of that coming from foreign aid. It is the first step to making these cuts permanent. Programmes operating in 14 African countries have told The Independent they have been denied ring-fenced funding since Trump re-entered the White House in January and issued executive orders to slash aid spending, something HIV advocacy group, the Aids Vaccine Advocacy Coalition (AVAC) has claimed was 'illegal' and 'immoral'. Each year, US legislators vote through a budget setting out what the government must spend on different activities. By not spending money already allocated by Congress on foreign aid projects, Trump had been acted beyond the powers of the presidency, said Prof Lawrence Gostin, a law professor at Georgetown University. A federal judge ruled in Marc h that Trump had overstepped in withholding funds and that his government owed aid recipients money for work done in the first few weeks of his presidency, before contracts were cancelled. That case is currently being appealed by the government. 'The president has no power to unilaterally withhold funding already allocated by Congress,' he said. However, using a 'rare vote of Congress to rescind the funds it has already allocated' allows Trump to withhold the promised money legally. 'And to its shame, the House of Representatives has done just that,' Prof Gostin said. The package of cuts must now go to the Senate for a vote before becoming law. It has been suggested that he Senate will pick up the bill next month, but may try to tweak the contents. Thursday's vote was a, 'pretty clear example that [lawmakers] are happy to roll over and give the president what he wants,' said Mitchell Warren, executive director of AVAC which sued the government. 'They still acted illegally and immorally,' Mr Warren claimed. 'This process does not change that'. Until it was allowed to expire at the end of March, the US President's Emergency Plan for Aids Relief (Pepfar), which forms the backbone of the world's HIV response, set out in law that 10 per cent of its funds must be spent on orphans and vulnerable children. But since January, projects across Sub-Saharan Africa have not seen any of the promised funds, The Independent has learned, leaving vulnerable children without vital services to prevent HIV, access nutrition and report sexual violence. It's one example of the cuts which look set to become permanent, through claw backs of existing funds and a new budget proposed this month. Based on Trump's proposed budget for next year, the majority of specialised support for orphans and vulnerable children (OVC) aside from basic medical treatment, are likely to be permanently excluded from receiving future US funds. These wider support services have been shown to protect children from contracting HIV and successfully link HIV-positive children to treatment. Project Hope in Namibia, which linked children in rural communities with HIV treatment and prevention, is another programme to have its OVC funding under Pepfar withheld since January. Early data showed children with HIV enrolled in Project Hope Namibia's programme were more likely to have the levels of virus in their blood brought down to undetectable levels – 96 per cent in January compared with 85 per cent the previous September. Suppressing the virus means they won't get sick or be able to infect others. 'They don't understand those programmes are lifesaving,' Leila Nimatallah, vice president of US advocacy group First Focus on Children, said. More than half of children with untreated HIV will die before their second birthday. 'Illegal and immoral' A State Department official said Pepfar continued to support 'lifesaving HIV testing, care and treatment' including for orphans and vulnerable children, but that all other services are currently being reviewed. But that's not how people working on the ground see things playing out. 'We will expect children to be dying who are not supposed to be dying,' said Desmond Otieno, project coordinator at HIV service the Integrated Development Facility in Kenya. The US has withheld money previously promised to IDF Kenya for services including medication counselling and psychological support since Trump took office, and the facility has already recorded deaths of children who were no longer able to access medication. 'That is the most outrageous [thing]' Mr Otieno said. The State Department spokesperson added that all foreign assistance programmes 'should be reduced over time' as they achieve their mission and move countries 'toward self-reliance". Project Hope in Namibia says its plan to make sure its services could be maintained by the local government by 2028 had been scuppered by the programmes abrupt ending, however. The process of transferring responsibility over including training up local staff will now be a lot harder, achieving exactly the opposite of this goal. Ms Nimatallah said she was calling on the Senate to 'reject this cruel rescissions package'. 'By passing this bill, Congress is taking back funding that it had already appropriated for the prevention of suffering and death of children under five from dirty water, infectious disease, and malnutrition,' she said, as well as funds 'set aside to protect Aids orphans from hunger and sex trafficking. 'The long and short of it is that the United States has turned its back on these children that it has promised to care for'.
Eyewitness News
13-06-2025
- Politics
- Eyewitness News
PEPFAR withdrawal has spurred on govt to become more self-reliant
CAPE TOWN - Deputy President Paul Mashatile said the withdrawal of funding from the United States (US) to fund the country's HIV/Aids programmes has spurred on government to become more self-reliant. He said African governments need to use their own natural resources to fund their programmes and should not have to go cap in hand to anybody. Again, responding to questions in the National Assembly on Thursday on the impact of the withdrawal of President's Emergency Plan for Aids Relief (PEPFAR) funding, Mashatile said no HIV/Aids patient would suffer as a result. READ: Godongwana lists PEPFAR withdrawal as one of several spending pressures in his budget Mashatile has reiterated that the R8 billion in lost funding for HIV/Aids programmes in 2025 won't impact the supply of anti-retroviral (ARV) medication nor the target of getting another 1.1 million people on life-saving drugs before the end of 2035. While the South African National Aids Council, which Mashatile chairs, is hoping the National Lottery comes through for it to plug the gap, Mashatile said if it does not, other options like the national fiscus are already being explored. 'I'm not saying we will abandon the US. They remain one of our biggest trading partners, but we must not go cap in hand to anyone.' Mashatile was then involved in a tense exchange with the Freedom Front (FF) Plus's Philip van Staden, who said people were suffering as a result of government 'blunders'. He wanted to know how thousands of healthcare workers who had lost their jobs due to the withdrawal of PEPFAR funding would be compensated, but he refused to clarify his comments when asked by Mashatile. 'People are suffering because of government blunders. I don't know what you are talking about. What blunders are those?' Mashatile said government is looking to the BRICS groups of countries and the African Union (AU) to collaborate in the fight against HIV and Aids.
Yahoo
05-06-2025
- Health
- Yahoo
Trump to slash funding for flagship US HIV programme by 40pc
America is proposing to cut its flagship anti-HIV programme by almost 40 per cent next year, according to new budget details that reveal sweeping reductions to global health spending. Details from Donald Trump's 2026 budget request show nearly a two-fifths fall in funding for the United States President's Emergency Plan for Aids Relief (Pepfar). The long-running programme is estimated to have saved more that 20 million lives in the past two decades, and is often cited as one of the world's most successful public health schemes. A recent analysis published in the Lancet found that as many as half a million more children could die from Aids by the end of the decade because of disruptions to Pepfar. The details on global health funding for the State Department, USAID agency, Centres for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) also show deep cuts elsewhere. Analysis by the San Francisco-based KFF health policy charity found the government departments were planning a 55 per cent cut in separate tuberculosis funding, a 47 per cent cut in malaria funding and a 92 per cent cut in maternal health funding. The proposal also withdraws all £221m ($300m) given to Gavi, the vaccine alliance which provides jabs to children in poor countries. In total, the request for money for the American government's main global health funding account is £2.8bn ($3.8bn) in 2026, down from £7.4bn ($10bn) in 2025. Setting out the cuts, the State Department said the request for money 'eliminates funding for programmes that do not make Americans safer, such as family planning and reproductive health, neglected tropical diseases, and non-emergency nutrition'. Mr Trump's government upended US aid spending days after taking office, saying it would suspend all aid while projects were reviewed. It then proceeded to close hundreds of aid programmes, including Pepfar projects, resulting in lay-offs for thousands of health workers, particularly in Africa. The budget proposals now give a clear indication that Mr Trump intends to continue with sharp cuts and will quash any hopes that the funding taps could be switched back on again. A State Department explanation of the budget request uses the phrase 'America First' 37 times as it explains a new focus on cutting costs and protecting US national interests. For the 2026 fiscal year, which begins on Oct 1, the budget proposals request £2.1bn ($2.9bn) for Pepfar, a 38 per cent reduction from the £3.5bn ($4.7bn) requested in 2025. The State department said that after spending a total of £88bn ($120bn) in the past two decades, it was now focussing on finding a responsible 'off ramp' to hand over responsibility for the campaign against HIV to countries themselves. 'This [budget] request will allow the United States to accelerate the transition of HIV control programmes to recipient countries and increase international ownership of efforts to fight HIV/Aids.' Some projects may still be paid for by other government funds, but overall the KFF analysis found the budget included 'significant reductions in global health funding including the elimination of some programs and activities'. The details will prove a severe disappointment to aid projects who had hoped that despite Mr Trump's rhetoric, there was a chance funding could be renewed in the new fiscal year. Public health officials argue that continuing to fund global health projects to stamp out infectious diseases is still in America's best interests as infections often cross borders. One executive at a major South African anti-HIV organisation said: 'Nobody wins unless we all win. No one can make it out of this alone. This is how we achieve epidemic control.' Protect yourself and your family by learning more about Global Health Security Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
