East Africa’s Silent Crisis: From Frontline Pillars to Policy Casualties
The recent withdrawal of USAID support from East African health programs has triggered more than budgetary strain, it has unraveled the lives and livelihoods of thousands of health workers. Across Kenya, Uganda, Tanzania, Burundi, and even relatively insulated Rwanda, the impact has fallen disproportionately on the very people who sustain care: nurses, community health workers, HIV counselors, and outreach officers
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These health workers were once the pillars of community health systems. Today, due to inadequate policy frameworks and a reliance on external funding, many have become casualties of poorly managed transitions.
“We told the state: if you don’t protect the workers, you don’t protect the system.” KMPDU National Executive, March 2025
Disproportionate Impact on the Most Essential
The hardest hit have been community health workers (CHWs), those closest to patients and most disconnected from government payrolls. Across Kenya and Uganda, more than 60% of CHW services have stalled in donor-dependent counties such as Turkana, Garissa, and Mbale. Thousands of CHWs have lost stipends and supervision, as USAID-supported NGOs wound down programs in maternal health, HIV, and malaria.
“These were the people tracing HIV patients, following up on new mothers, educating communities. We lost them overnight,” KMPDU Kisumu Chapter, February 2025
In Uganda and Tanzania, HIV counselors and outreach staff funded under PEPFAR and Tulonge Afya have been terminated without transition plans. In Burundi, where donor funding supports over 70% of rural health staffing, entire clinics are now operating without trained personnel.
Meanwhile, public sector staff in affected regions have absorbed increased patient volumes without corresponding support—fueling burnout, errors, and resignations. In Kenya, some ART clinics report a threefold increase in daily patient loads since January 2025.
A Divided and Fragile Workforce
The crisis has exposed a dangerous two-tier system:
Public health workers, though overworked, remain on payrolls.
Private and donor-funded workers, including CHWs, midwives, and data officers, have no formal contracts, benefits, or legal protection.
This fragmentation has led to widespread displacement, especially among mid-career professionals, many of whom are now seeking employment abroad. KMPDU and licensing bodies report a surge in applications for foreign credentialing in Botswana, the UK, and the Gulf.
“We are watching a quiet exodus unfold. We train them, donors use them, then we lose them.” KMPDU Chairperson, April 2025
Policy Priorities Going Forward
Governments must prioritize formal recognition of community-based and donor-supported health workers, establish stabilization buffers to protect essential staff during donor transitions, and adopt long-term domestic financing strategies that reduce dependency on fragmented project funding.
Conclusion
Health workers are not adjuncts to policy, they are the system. When funding structures prioritize short-term projects over long-term workforce stability, the result is clear: essential health services falter, and those who deliver them are left behind.
East Africa cannot afford to lose its health workforce, not to layoffs, not to burnout, and not to borders.
“Donor aid ends. Human lives continue. The health worker must not be abandoned at the altar of budget cuts.” KMPDU Press Statement, April 2025
Also see
When the Trump administration announced in January 2025 that the United States would scale back USAID funding to "non-strategic partners," the shockwaves hit hard across East Africa. Kenya, Uganda, Tanzania, Rwanda, and Burundi, nations already juggling overstretched health systems, are now grappling with the consequences of long-standing donor dependency.
