Experts warn that rather than cutting aid completely, the United States should focus on reforming its assistance strategy to maintain influence and counterbalance China’s growing dominance in Africa.
President Donald Trump’s administration has suspended almost all USAID aid programs, significantly reducing its workforce.
Jakkie Cilliers, Head of African Futures and Innovation at the Institute for Security Studies, emphasized the far-reaching consequences of these reductions.
“Following the 20 January executive order on Reevaluating and Realigning United States Foreign Aid, USAID began issuing Notices of Suspension, instructing recipients to halt work on awards and avoid incurring new costs.
“However, emergency food assistance and associated administrative expenses received a 90-day waiver. Additionally, life-saving humanitarian aid for countries such as the Central African Republic (CAR), Chad, South Sudan, the Democratic Republic of the Congo (DRC), Uganda, and Rwanda was also exempted.”
Jakkie Cilliers
Cilliers warned that scaling down aid should not mean abandoning it altogether.
“Compared to gradual reductions—which are problematic in their own right—the abrupt nature of these cuts will severely impact attitudes towards the US, deepen poverty, and slow economic growth. While China may welcome the US’s diminishing influence in Africa, the continent’s people will not.
“If US policymakers genuinely want to counter China’s growing presence, they need to reconsider their approach before the damage becomes irreversible.”
Jakkie Cilliers
Cilliers further estimated that Trump’s aid cuts could push an additional 5.7 million Africans into extreme poverty within a year.
Rudi De Koker, a Public Health Specialist and Project Management Professional (PMP), also stressed the devastating impact on healthcare services, particularly HIV/AIDS programs.
“South Africa operates the world’s largest HIV treatment program. Over 1.1 million people risk losing access to antiretroviral therapy (ART) due to these funding cuts. The resulting strain on healthcare facilities will cause treatment interruptions, increase transmission rates, and undo progress in controlling the epidemic.
“USAID’s focus in South Africa has been to support NGOs working alongside the Department of Health. Key affected programs include HIV testing, ART provision, tuberculosis (TB) screening and treatment, and maternal and child healthcare services.”
Rudi De Koker
Struggles for Health Systems
De Koker noted that without sustained financial support, health systems will struggle to distribute ART and continue prevention efforts like pre-exposure prophylaxis (PrEP) and harm reduction programs.
“The most vulnerable populations—including people living with HIV, pregnant women, children, sex workers, and men who have sex with men (MSM)—will be disproportionately affected. The loss of USAID support will deepen health disparities, leaving marginalized communities with fewer healthcare options.
“When treatment is interrupted, families will face increased financial burdens, leading to worsening overall health outcomes. Rising cases of opportunistic infections will drive up absenteeism, impacting economic productivity. Reduced screening and treatment will also likely increase TB and malaria cases.”
Rudi De Koker
Dr. Munya Saruchera, Director at the Africa Centre for Inclusive Health Management at Stellenbosch University, provided further context, emphasizing the financial burden on South Africa.
“South Africa spends R44.4 billion annually on HIV counselling, testing, and treatment, with PEPFAR contributing 17% of this budget. The remainder is covered by domestic funds and organizations such as the Global Fund to Fight AIDS, TB, and Malaria. The implications of these cuts are immense, considering South Africa’s HIV prevalence rate of 12.7% and infection rate of 19%.”
Dr. Munya Saruchera
Saruchera further pointed out that African nations must see this crisis as an opportunity to reduce their dependence on foreign aid.
“While South Africa should ideally be capable of financing its healthcare system entirely, corruption and mismanagement have made this challenging. For poorer nations such as Malawi and Mozambique, achieving self-sufficiency in health funding remains a long-term goal.
“Governments must face pressure — both internally and externally — to build strong economies capable of generating tax revenues to invest in health infrastructure. In a world increasingly shaped by nationalist populism and geopolitical tensions, African nations must act decisively to seize opportunities and secure sustainable healthcare solutions.”
Dr. Munya Saruchera
As such, the abrupt USAID funding cuts threaten Africa’s healthcare stability, deepen economic disparities, and demand urgent reforms or alternative funding to prevent long-term humanitarian setbacks.
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