Health in the Balance: How the USAID Pullout Exposed East Africa’s Over-Reliance on Donor-Driven Systems
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.
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Essential services are stalling. Clinics are shuttered. And health workers, the backbone of our care—are being dismissed by the thousands.
“When foreign donors pulled out, it was not the programs that collapsed, it was the lifeline of our communities.” Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), March 2025
Budget Commitments vs. Reality: The Abuja Declaration Betrayed—Except in Rwanda
In 2001, African leaders pledged to allocate at least 15% of their national budgets to health under the Abuja Declaration. As of early 2025, only Rwanda has honored that commitment. According to the Rwanda Budget Policy Statement 2025/2026, released by the Ministry of Finance and Economic Planning in March 2025, Rwanda now allocates 15.1% of its national budget to health. It is the first and only country in the East African Community to meet the Abuja benchmark.
Elsewhere, the numbers tell a very different story: Kenya allocates only 7.4% of its budget to health, despite decades of pressure from health unions and civil society; Uganda stands at 6.9%, heavily reliant on donor-backed HIV and maternal health programs; Tanzania has reached 9.1%, but allocations are still insufficient to fully meet rural health needs and, Burundi, at 4.8%, remains the most donor-dependent health system in the region.
These figures are not just administrative indicators, they are political decisions with life-and-death consequences.
The Human Cost: Health Workers on the Frontline
In Kenya, over 3,500 health workers linked to USAID-funded programs have been affected in Q1 of 2025 alone. Over 1,200 have already been laid off, mostly nurses, HIV counselors, and maternal health workers stationed in vulnerable counties like Kisumu, Turkana, and Nairobi’s informal settlements.
“The government has devolved responsibility but not funding. Our people are dying not from disease, but from denial.” KMPDU Protest Statement, February 2025
Outreach services are collapsing. Treatment defaults are rising. Community health volunteers, whose stipends were once sustained by foreign aid, have walked away.
In Uganda and Tanzania, similar stories are unfolding. In Burundi, some rural districts have already suspended antenatal care due to drug shortages and staff attrition. Only Rwanda, by virtue of its sustained public investment, has maintained staffing levels, digital health systems, and insurance coverage across rural provinces.
This Isn’t Donor Fatigue. It’s Domestic Apathy.
Let us be clear: Donor funding was never meant to be the foundation of our health systems. It was a supplement, a bridge. Now that the bridge is gone, the fall is exposing years of underinvestment and political neglect.
“Is it too much to ask that Kenya spends more on hospitals than highways? That it honors Abuja the same way it honors debt repayments?” KMPDU Press Release, April 2025
What Must Be Done: A New Era for Public Health Management
To prevent total collapse, and build resilient systems owned by the people, they serve, countries should consider the following three urgent measures:
Fulfill the Abuja Declaration, Now.
Each country must immediately allocate at least 15% of its national budget to health, with performance tracked via regional peer reviews and public reporting.Reclaim Public Health Management from NGOs.
Governments must stop outsourcing core functions to foreign agencies. It’s time to reinvest in public sector leadership—from procurement to personnel.Guarantee Health Worker Protections During Donor Shifts.
No health worker should lose their job because a donor exits. National stabilization funds must protect frontline jobs and sustain critical service delivery during transition periods.
Conclusion: Health Is Not a Project. It Is a Right!
Across East Africa, our health systems are being tested, not just by pathogens or poverty, but by politics and policy. The USAID withdrawal is not the cause of our crisis, it is the trigger that revealed our neglect.
Let this be the wake-up call. Let us invest in our own health, protect our workers, and take back the management of systems that were never meant to be subcontracted. Donor funding may come and go, but our people are here to stay.
#PublicHealthIsPublicWealth | #AbujaNow | #HealthWorkersMatter
References
Rwanda Budget Policy Statement 2025/2026 – Ministry of Finance & Economic Planning (MINECOFIN); Abuja Declaration on Health Financing – African Union, 2001; Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) – Press Statements; USAID Kenya & East Africa – Health Programs Overview; WHO Global Health Expenditure Database – East Africa; East African Community – Health Sector Investment Priorities 2024–2028; UNICEF Eastern and Southern Africa – MCH Service Tracker, Q1 2025; Global Fund – Transition & Sustainability Guidance (2024 Update); Kenya Health NGO Network (KHEN) – Impact of Donor Transition on County Health (March 2025); Uganda Ministry of Health – Community Health Worker Sustainability Brief (Feb 2025); Tanzania Health Equity Network (THEN) – Health Worker Budget Review Q1 2025; Rwanda Biomedical Centre – NHSSP Mid-Term Review (Jan 2025); Burundi Civil Society Health Platform – Alert on Service Disruption (March 2025)
