The abrupt suspension of USAID funding has sent shockwaves across Africa, leaving critical healthcare services teetering on the brink of collapse. The European Union has clarified that it cannot fill the funding gap left by the United States’ suspension of aid programs as governments across Africa try to keep critical healthcare services running.
The European Union (EU) is a supranational political and economic union of 27 member states primarily located in Europe. It has a total area of 4,233,255 km2 (1,634,469 sq mi) and an estimated total population of over 449 million; the EU has often been described as a sui generis political entity combining the characteristics of a federation and a confederation.
USAID aid freeze: The funding gap widens
The US, the largest single aid donor in the world, disbursed some $72 billion in assistance in 2023, most of it via the US Agency for International Development (USAID). That same year, the EU, the largest collective donor, contributed almost $100 billion.
A European Commission spokesperson said the EU will not retreat from its humanitarian commitments. The bloc’s 2025 humanitarian budget alone is $1.9 billion, with $510 million earmarked for Africa.
The spokesman added that the funding gap is growing, leaving millions in need, and the EU cannot fill the gap left by others. The comments came from the Trump administration’s decision to suspend USAID spending for a 90-day review.
The US government has stopped support for HIV treatment in Nigeria and other developing countries as a result of President Donald Trump’s order. The US State Department stopped the allocation of funds from the President’s Emergency Plan for AIDS Relief (PEPFAR), a program for the treatment of HIV in Africa and developing countries, for 90 days; most of the agency’s budget in the region goes to humanitarian and health aid. USAID spent more than $11 billion in 2024
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Catherine Kyobutungi, head of the Nairobi-based African Population and Health Research Center, warned last week that the health of millions of Africans was at stake without the rapid mobilization of funds to fill the gap left by the US. USAID funds vast and crucial programs on the continent.
Nearly two-thirds of Uganda’s HIV program budget came from PEPFAR, the flagship US President’s Emergency Plan for AIDS Relief. At the same time, in 2023, Nigeria received $600 million in health assistance from the US, around 20% of its then health budget.
Despite the US issuing waivers to continue funding specific lifesaving programs, services remain halted continent-wide. In Kenya alone, 54,000 healthcare workers could lose their jobs if USAID-funded programs stop; programs that support sexual and reproductive health and rights are among those worst hit.
“A lot of people working in this space have lost funding,” Kehinde Ajayi, Director of the Gender Equality and Inclusion Program at the Center for Global Development, said.
Global action call: Who will answer?
Africa’s governments are in crisis mode. Late last week, Nigeria approved a provision of $200 million in its 2025 budget to plug gaps created by the suspension of US aid to its health sector.
In Ghana, President John Dramani Mahama directed his finance minister “to take urgent steps” to bridge the estimated $156 million funding gap, voicing particular concern over malaria prevention and maternal and child health. The emergency unfolding has prompted calls for traditional donors to fill the funding gaps.
Romilly Greenhill, CEO of Bond, a British network of international development organizations, urged the UK and EU “to help mitigate the impact of the USAID freeze.” Last week, two CGD authors wrote that the US’s absence should encourage other provider countries to step up, pointing to countries such as Germany, Sweden, and Japan.
They said that China, whose development assistance to Africa is framed differently from the West, could convert some of its loans into grants. But how likely are other nations to step up?
Zainab Usman, Director of the Africa Program at the Carnegie Endowment for International Peace in Washington, said the US retreat from foreign assistance is part of a “broader trend” among traditional donor nations. Several countries, like Canada and the UK, have reduced development assistance in recent years.
For middle-income countries such as Kenya, Nigeria, and South Africa, this could be a “wake-up call,” said Usman, emphasizing that the sudden USAID freeze was not the best approach.
“I hope this can be the moment where countries think about creating fiscal space, combating corruption and plugging leakages so they can retain enough resources to fund the health and education programs that will lose funding.”
But it will be much harder for lower-income countries: In seven African countries that rely on US assistance, aid averages 11% of their gross national income.
The number and scale of programs funded by USAID in Africa make it unlikely that any one donor could make up for the shortfall. As Ajayi said, this is “for coalition building,” with key roles for other countries, multilateral lenders, philanthropic organizations, and middle-income African nations.
At best, there is an opportunity to delink foreign aid from critical health services. There is undoubtedly growing momentum for alternative models, but that won’t happen at the speed this sudden freeze demands without any time to plan a transition.
The White House is rewriting the rules of US foreign aid, and the effects will be felt for years to come. In a memo last month, US Secretary of State Marco Rubio sent a clear message about the services the new administration is no longer prioritizing.
According to him, the freeze waiver does not apply to activities that involve abortions, family planning conferences, administrative costs, gender or diversity, equity, and inclusion, ideology programs, transgender surgeries, or other non-life saving assistance, Tech billionaire Elon Musk, head of Trump’s Department of Government Efficiency, put it this way on X: “USAID is a criminal organization. Time for it to die.”
A future without USAID
The trajectory of global aid is changing due to the USAID freeze, and the consequences are reverberating. While African governments and international donors collaborate to address these concerns, it is crystal clear that relying on US aid has left a gap yet to be bridged in Africa’s healthcare system.
What should be thought-provoking now is whether this situation would serve as a watershed moment that propels nations into building sustainable healthcare systems or whether millions would suffer without aid.