For African leaders and policymakers, one pressing question arose in the wake of Trump’s sweeping cuts to foreign aid: How could sub-Saharan Africa fill the critical gap left by the sudden withdrawal of the United States Agency for International Development, or USAID?
America is not the first Western country that has slashed foreign aid. Since 2020, France, Germany and Norway have announced varying reductions in their aid to Africa. The UK, for instance, lowered its Overseas Development Aid to 0.5% of its gross national income, down from 0.7%.
Until 2025, however, the US remained Africa’s largest donor, sponsoring a broad spectrum of projects—primarily education, healthcare and social welfare—through agencies such as USAID. For decades, millions of families in Africa have depended on these initiatives for survival.
In 2023, U.S. foreign assistance poured $10.6 billion into tackling HIV/AIDS within the African region. In 2024, the agency provided $6.5 billion in humanitarian assistance to the region.
Nigeria, a notable beneficiary, received $1.02 billion in 2023—much of it helping to finance “health systems and disease control programmes annually for HIV/AIDS and malaria,” says Nnabiget Oke, an official at the Federal Ministry of Health.
But that changed in a stroke of a pen. Hours after assuming office as America’s 47th president, Donald Trump signed an executive order, freezing all US foreign assistance. Health experts warn that the fallout could be damaging on the continent, which “would not only upend decades of progress in public health and human development,” laments Oke.
A fragile system
Nigeria’s HIV population is roughly 1.8 million. While ranking among the top countries for tuberculosis cases, the country also accounts for the world’s highest toll of deaths caused by malaria.
Nigeria’s health allocation is a meagre 4% of its national budget—far short of the 15% benchmark set by African leaders at the 2001 Abuja Declaration. As a result, the country has relied heavily on external funding to support critical health interventions. External aid had long filled in the gap.
Some look at the funding freeze with hope, suggesting that it holds a silver lining. For a continent long dependent on the fickle goodwill of Western donors, the withdrawal of the U.S.’s aid programmes presents an opportunity for Africa to “turn necessity into true independence,” reckons Oke.
“It offers a chance for governments to strengthen homegrown systems, mobilise domestic resources and forge fairer intra-continental partnerships.”
In Nigeria, the government has seized the initiative, rolling out a range of proactive measures. Shortly after Trump’s executive order, the Nigerian Federal Executive Council approved $1 billion for healthcare reforms while allocating $3.2 million for the purchase of 150,000 HIV treatment packs over the following four months.
The country also integrated former employees of USAID—28,000 health workers—into its national payroll.
In the aftermath of USAID’s dismantling, ex-USAID staff launched a matchmaking service to connect abandoned USAID-funded projects with new donors. Several projects deemed critical have received funding to continue their social development in parts of northern Nigeria.
Where Western economists have called for targeted aid programmes to address critical deficits, economists in the region have argued against reliance on foreign aid, which they describe as unsustainable.
“The problem with Africa goes beyond aid”
While he acknowledges the impact of foreign aid in Nigeria’s fight against HIV/AIDS and malaria, Olayemi Olaniyi, a public-affairs analyst based in Lagos, believes that “the problem with Africa goes beyond aid.”
With the cushion of Western aid provided now gone, he fears a collapse. “Our healthcare would definitely suffer greatly,” he says, adding, “Even with aid, it wasn’t that things were great for Africa to begin with.”
Some African countries are demonstrating some measure of resilience. Rwanda’s community-based health insurance scheme has expanded to 90% of the national population in the last decade. Zimbabwe’s Aid levy, started in 1999, has bridged donor resource gaps. Meanwhile, much of South Africa’s HIV programme is funded by its national budget.
Oke, from the Federal Ministry of Health, points to these initiatives as evidence of Africa’s resilience.
“These examples prove that Africa has both the will and capacity to stand on its feet,” he says.
A steep road
It’s hardly likely that this range of domestic programmes will match the huge impacts of USAID’s projects. Investment in healthcare remains poor.
Many African governments spend less than 10% of their GDP on health so that hospitals are unequipped and woefully understaffed. As recently as 2021, half of the countries in the sub-Saharan region depended on external funding for more than one-third of their health expenditure.
With a rising debt profile, Nigeria commits more resources to servicing local and foreign debt, leaving little allocation for essential amenities like healthcare. This financial constraint piles on the agony for millions of its citizens dependent on USAID-funded projects.
The continent’s attempts to break away from aid dependency, Oke admits, “would certainly not be a walk in the park.”
If USAID’s exit from Africa finally offers a shot at independence, it sure leaves millions of vulnerable lives hanging in the balance.
Summary not available at this time.
