What We Know About Africa's Healthcare Strain After US Aid Cuts

A report from the Ghana-based Accra Reset initiative warns that healthcare systems across Africa and the wider global south are "under growing strain" following the United States' withdrawal from key aid programs, including the dissolution of the US Agency for International Development, according to the Guardian.

What does the Accra Reset report say?

The report, titled "A Sovereign Future For Health," was produced by Accra Reset, a global health initiative led by John Dramani Mahama, Ghana's president, the Guardian reported. It argues that countries in Africa and the global south should build greater control over their own health development rather than remaining dependent on aid from western governments and international institutions. One figure cited in the report: Africa produces less than 1% of its own vaccines while carrying about 25% of the global disease burden, according to the Guardian.

The report warns that healthcare across the region is "under growing strain," creating "new urgency" for reform.

How much has aid funding actually fallen?

External financing for health in Africa contracted by close to 70% between 2021 and 2025, the report found, per the Guardian. The report links that decline to abrupt shifts in global health financing — chief among them the Trump administration's move to dissolve USAID — compounding pressures already created by the Covid-19 pandemic and rising living costs worldwide.

What happened when USAID work shifted to Nigeria?

Nigeria absorbed 28,000 health workers who had previously been employed by USAID, at a cost of $200m, after the agency's dissolution, the report states, according to the Guardian. The transition illustrates the scale of the workforce and budget gap national governments have had to fill on short notice.

What happened to HIV treatment in South Africa?

The withdrawal of funding from the US President's Emergency Plan for Aids Relief, known as Pepfar, hit South Africa hard, the Guardian reported. Pepfar had provided more than $400m a year to the country and is credited with saving 26 million lives globally since 2003, according to the report. Its withdrawal led to HIV clinics closing across South Africa, a shift the report says has affected 1.4 million people living with HIV in the country.

What does Accra Reset propose instead?

The report frames the current moment as creating "new urgency" for restructuring health financing across the region, per the Guardian. Its central argument is that governments in Africa and the global south should build more self-reliant health systems — including domestic vaccine production — rather than depend on external donors whose funding can be withdrawn abruptly.

What to watch

• Whether African governments raise domestic health spending to offset the reported 70% drop in external financing between 2021 and 2025.
• Whether South Africa restores HIV clinic capacity lost after Pepfar funding ended.
• Whether Nigeria's absorption of 28,000 former USAID health workers proves sustainable at its reported $200m cost.
• Whether Accra Reset's push for domestic vaccine production gains traction among African Union member states.

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