Aid-less Future? How USAID Cuts are Reshaping the Greater East Africa
The aid sector has been rattled to its core facing increasing pressure from the United States’ move towards cutting down government expenses by decreasing their foreign aid spending. It began with a 90-day pause on all US foreign aid a day after President Trump’s inauguration to office when an audit of the expenses was called for. This was followed by an Executive Order, now commonly referred to as stop-work orders, issued on January 24th, 2025, that stopped USAID workers from working and placing them on mandatory administrative leave. These disruptions have had the development world plummeting into a frenzy with estimated far-reaching effects in the health care, education, and agricultural sectors. Given these changes, what does this mean for East Africa?
The US is the world’s largest aid donor. They contributed $71.9 billion in the 2023 fiscal year towards humanitarian and development projects. In 2024, US aid accounted for 40% of all the humanitarian aid received in 2024. In relation to the US federal budget, foreign aid accounts for less than one percent of the total government spending - a percentage that many have argued to be a sliver in comparison to the potential far-reaching effects of the freeze. Despite its small share of the federal budget, U.S. foreign aid plays a critical role in key sectors. According to the Pew Research Centre, a significant share of US foreign aid was allocated – 21.7% to humanitarian assistance, 22.3% to health, and 27.0% to economic development – the sectors that will be affected most by the freeze. Non-governmental organisations working in these sectors and recipient countries have been left grappling with profound uncertainty.
Wider Effects on the East African Region
Africa received about $12 billion in 2024 making it the third largest recipient of aid. According to the Centre for Global Development, South Sudan, Uganda, DRC and Ethiopia have been identified among the eight most affected countries by the cuts. Their economies on average receive about a fifth of their total aid from the US. This leaves a significant gap in funding of development projects in these countries and a shortfall in the gross national income at large. It is worth acknowledging that the above countries, save for Uganda, are currently experiencing war and therefore are limited in building their capacity to respond to such a huge shock.
The healthcare sector in East Africa has been hit hard with USAID-funded programs bearing the brunt of the freeze. The agency, since its inception in 1961, has provided key support in the fight against virulent diseases such as malaria, HIV/AIDS and Ebola – diseases prevalent in the region. Around 20 million people depend on the US President’s Emergency Plan for AIDS Relief (PEPFAR) funded programs to access the anti- retroviral drugs worldwide. Since the funding cuts, 150 clinics in Kenya have shut down and others have started rationing the drugs they give to patients due to limited stock. Currently, Kenya has only six months of ARVs stock left. Patients are likely to discontinue their drug dosage which consequently may increase the virus’ resistance towards the drug, greatly sabotaging the physiological progress made thus far. This has left a sense of helplessness and hopelessness among patients and healthcare workers.
In Uganda, the Ministry of Health has announced plans to close HIV/AIDS and tuberculosis clinics following the freeze of funds as the US was the main financer of these specialised clinics. The reduction of HIV infection rates from 19% in the 1990s to 5% in 2024 has been attributed to the services offered by these specialised clinics.
Beyond the negative health outcomes, there is a looming loss of hundreds of thousands of jobs in East Africa. Uganda alone has 20,809 PEPFAR supported healthcare workers. In Kenya, an estimated 40,000 jobs are expected to be lost due to the halting of USAID funded projects. The reduction in the USAID workforce from 10,000 employees to around 300 has left only about a dozen employees to focus on Africa. This raises a critical question: how can twelve people manage responsibilities across 54 different countries while still maintaining efficiency.
Additionally, USAID funded programs also provide key support to child and maternal care programs in East Africa whose efforts have reduced child and maternal mortality rates. The agency supported several immunisation programs for children against diseases such as polio and measles. In Ethiopia alone, since 1998, the agency has committed $17 million towards non-governmental organisations that are at the frontline of the eradication of polio. The cuts will potentially result in lower immunisation rates ultimately affecting child development and health in general. An estimated over 70 sites in DRC for testing and treating malnourished children are to be shut down. This will reverse the hard-earned gains that have been made on this front.
From a global health security perspective, the funding cuts pose a significant risk of jeopardising response to health crises. The USAID funding has been integral in containing disease outbreaks in the region. They were actively engaged in treatment and contact tracing of patients during the Ebola crisis that affected Uganda and the DRC hence mitigating its spread to other neighbouring countries. The current ‘stop-work’ orders have disrupted the treatment of marburg disease in Tanzania putting not only the affected country at risk but adjacent countries and the world at large. If the country’s healthcare systems are not able to contain the disease, the likelihood of having disease outbreaks in the region are high.
Moreover, according to an anonymous USAID worker, an estimated 8 million people may die of starvation due to these stop-work orders. About 500,000 metric tonnes of food aid are stuck in ports all over the world with no one to distribute them as the workers are out of office. The perishable nature of food further exacerbates the potential waste if the current uncertainty continues to prevail. Conflict-stricken countries will be affected most. The US was the largest aid donor to Sudan community-run kitchens that fed over 800,000 people until the freeze. 434 out of the 634 volunteer community kitchens have already shut down. Thus, close to a million people in Sudan alone are at risk of malnutrition and starvation.
"Why are You Crying?": A Wake-Up Call
The resulting chaos has unearthed important questions and considerations. Former Kenyan president Uhuru Kenyatta virally decried the widespread panic that followed the freeze. "Why are you crying?" he asked at the East African Regional Global Health Security Summit. "It's not your government; it's not your country... [It] has no reason to give you anything." The former president, laughingly adding that the lamenters do not pay US taxes, urged Africans to gear themselves toward economic self-reliance. Notably, President Kenyatta called for a reprioritisation of African resources.
An informative analysis by CNBC Africa argues that African governments do have the bandwidth to do this and gives practical ways with the example of Tanzania. In 2023 USAID assistance in the country stood at $630 million. Their total budgets cost for 2024/2025 was $18.94 billion. Completely cutting off the US aid from Tanzania would leave the country with a 3.3% shortfall in their budget, a percentage that the government can find creative ways to fill. This goes to show that with careful analysis and reconsideration, African governments, to varying extents of course, have the potential to mitigate the estimated effects.
For example, defence spending is one area where East African governments may have room for reconsideration. Last year, the DRC and South Sudan were reported as having the two highest-growing year-on-year military spending in the world, reporting an increase of 105% and 78% respectively. This seems to have been a regional trend, with Kenya increasing its spending by 15%, Tanzania by 8.7% and Rwanda by 1.3%. Governments justifiably argue that these expenditures are necessary to secure borders and maintain stability in volatile regions, especially amidst a rise in internal conflicts in the area. However, this is not without its cost – advancements in education, infrastructure, and healthcare often take a backseat, perpetuating the very vulnerabilities that predispose national instability.
National security is and should be a key budgetary item. However, is military expansion the most effective long-term strategy for national stability? Perhaps not – poor health outcomes such as unchecked outbreaks of preventable diseases and malnutrition are a significant grievance that can cause civil unrest and lead to a cycle of violence. In South Sudan, underfunded healthcare systems have caused devastating health outcomes; it has, for example, highest maternal mortality rates in the world. The USAID freeze may only worsen this crisis, as South Sudan has been identified as the most "exposed" country to the adverse effects of the freeze - more than a fifth of its healthcare budget apportions aid from the US. Meanwhile, billions of dollars continue to be spent on military procurement, and often with limited transparency. The freeze is likely to cause a serious shock, revealing that a more balanced approach to budgetary allocation may be the answer to a more resilient and stable society in the long-term. Instead of reactively pumping money into the defence sector in the face of conflict, for example, preventively investing in healthcare may encourage civil stability. Otherwise, the EAC may be stuck in the oscillation of underdevelopment, instability and justified militarisation.
The economic order created by the dependency on aid also merits further discussion. In an interview with CNN, Winnie Byanyima, Director of Oxfam International offered an interesting nuance to this conversation saying, “we have the disease they have the profits”. US engagement with the continent through aid gives their companies direct access to local markets thus creating business opportunities and jobs for them - it is more than just about charity to Africa. It is worth questioning who benefits from these businesses and the long-term effects of having such enterprises that are fundamentally supported by power imbalance created by the donor-recipient dynamic.
Looking Forward
Ultimately, the USAID freeze should serve as a wake-up call for the East African community. While the loss of funding may create some immediate difficulties, it presents an opportunity to reassess national priorities and reduce dependence on aid. The freeze, then, presents a challenge to East Africa to rethink the status-quo and explore long-term strategies for self-reliance and resiliency against the whims of foreign governments and aid institutions. Rwanda’s President Kagame affirmed this in an interview with BBC Africa stating that it was time for African nations to look within and make their internal systems work for them to build their capacity to be self-sufficient. He said, “I think from being hurt we might learn some lessons.” His statement reflects the sentiment on ground that acknowledges that aid is not a sustainable source of income. The unprecedented freezing and potential withdrawal of funds will definitely hurt economies and people’s lives as discussed above. The challenge therefore lies in figuring out how to combat the daily dark realities that are and will exist between now and when we are eventually able to stand on our feet. Realities coloured with weakened systems and punctuated with preventable deaths.
Moreover, it is clear that the reduction in aid from the US will leave a vacuum. Drawing from the laws of physics, vacuums must be occupied. Who fills this gap matters. If the national governments fail to take up this space, other global powers who are already present in the region such as Canada, Russia and China can well position themselves to fill the gap. Increasing engagement with East Africa would increase the 'soft power’ they hold in these countries. This challenge presents a unique opportunity for governments to step up and explore potential channels of collaboration and leverage the synergy of Pan- Africanism to break the cycle of dependency.
