The United States’ retreat from key international aid programs has left healthcare systems across Africa and the Global South “under growing strain”, according to a new report.
The report says cuts by the Trump administration to programs including the US Agency for International Development (USAID), combined with the Covid-19 pandemic and a global cost-of-living crisis, have created “new urgency” around the need to reform healthcare across the region.
Titled A Sovereign Future For Health, the report was produced by the Accra Reset, a global health initiative led by Ghana’s president, John Dramani Mahama. The initiative argues that African countries and nations across the wider Global South should have greater control over their health policies and development, rather than relying heavily on aid from western governments and international institutions.
One statistic highlighted by Mahama and the Accra Reset is the stark imbalance between Africa’s health needs and its manufacturing capacity: the continent produces less than 1% of the world’s vaccines while carrying about 25% of the global disease burden.
The report describes how sudden shifts in global health financing, including the US withdrawal from several international health initiatives, forced countries in the Global South to rapidly restructure their budgets. It points to the Trump administration’s decision to dissolve USAID, after which Nigeria had to absorb 28,000 health workers previously employed by the agency, at a cost of $200m.
External health financing for Africa fell by nearly 70% between 2021 and 2025, the report says. The sharp decline forced countries that had historically relied on foreign aid to adapt their health systems and finances at speed.
The withdrawal of funding from the US President’s Emergency Plan for Aids Relief (Pepfar) in South Africa has also had serious consequences. The program provided more than $400m annually and is credited with saving 26 million lives worldwide since 2003. Its loss led to HIV clinics closing across South Africa, leaving 1.4 million people living with HIV facing uncertainty over access to treatment.
Research presented at the 26th International Aids Conference in Brazil earlier this year described the impact of the funding cuts as “severe and devastating”, with disruption reported across global health programs.
Speaking at the World Health Assembly in May, Mahama said Ghana had lost $78m after the closure of USAID programs supporting maternal healthcare, malaria treatment, nutrition and HIV/Aids interventions.
The latest Accra Reset report, published on Monday, arrives as international aid faces major reductions and governments are under increasing pressure to take responsibility for their own health systems. Mahama has described the cuts as evidence that long-term dependence on donors is not sustainable.
“The Accra Reset is not an argument for traditional donors to do less on global health. It is an argument for doing it differently and doing it better. As countries take greater ownership of their health futures, donor countries should step up to support that transition – following the lead of countries that set their own priorities, and work alongside them to determine where outside support is most valuable,” said Naveen Rao, senior vice-president of the health initiative at the Rockefeller Foundation. “The Accra Reset shows how we can evolve to back country-led solutions while advancing our shared health and economic interests.”
In the report, Mahama says the “past few years have shaken global health cooperation to its foundations”.
“The Covid-19 pandemic exposed the risks created by concentrated production and unequal access to essential health products; rising debt and fiscal pressures have constrained national health budgets; and declining development assistance is placing programs and services under growing strain,” he continued. “These shocks have brought new urgency to reform debates that have continued for years with limited progress. It was in this context that we launched the Accra Reset and its Sovereign Health Agenda – to give renewed political force to the reform agenda and place the agency of countries of the Global South at its centre.”
The report was published alongside a new survey showing that many Americans hold broadly supportive views on foreign aid. About 75% of US adults – including more than half, or 52%, of those who primarily support Donald Trump – said the US should restore disease-prevention aid to help contain Ebola, according to polling of more than 2,000 adults commissioned by the Rockefeller Foundation.
The survey also found that 65% of US adults support international cooperation even when it requires compromising some national interests. In addition, 64% believe Americans share a responsibility to help others, including people in countries they do not know.
The Guardian has contacted the Department of Health and Human Services (HHS) for comment.
