The future of US health aid to SA hangs in the balance after the Trump administration released a new “America first” global health strategy that seeks to strip out nongovernment organisations (NGOs) and transition recipient countries to being self-reliant.
It focuses on HIV/Aids, tuberculosis, malaria and polio.
The strategy positions US foreign aid as a political tool, saying it offers an important counterweight to China’s influence, particularly in Africa. But its only detailed reference to African countries is a table outlining the number of faith-based organisations operating in some, and it is silent on SA.
Relations between SA and the US have been strained for months, and SA faces tariffs of 30% on many goods it exports to the US.
While SA has for the past two decades funded the lion’s share of its HIV/Aids programmes from the fiscus, it historically received generous support from the US government in recognition of the extent of its epidemic.
SA has the world’s biggest HIV/Aids burden, with about 8-million people living with the disease, and was generously supported by the bipartisan US President’s Emergency Plan for Aids Relief (Pepfar) from its inception in 2003.
US President Donald Trump’s sweeping cuts to foreign aid shortly after he assumed office in February sent shock waves around the world and forced many Pepfar-funded NGOs in SA to retrench staff and terminate the services they offered.
The Treasury has provided emergency funding to provincial health departments to ensure HIV/Aids patients can maintain their treatment, but some of the specialised services provided by NGOs to key populations have not been sustained.
‘Inefficient and wasteful’
In an introductory note to the strategy, released last week, US secretary of state Marco Rubio laid out the rationale for the change in US policy, saying: “Our health foreign assistance programmes ... have become inefficient and wasteful, too often creating parallel healthcare delivery systems and a culture of dependency among recipient countries.
“Many of the NGOs who support these programmes have committed many times to helping transition the work to local governments, but little progress has been made.
“This is often not because of a lack of willingness on behalf of recipient countries, but rather because of our broken foreign aid system and the perverse incentives that encourage NGOs to self-perpetuate,” he said.
While implementing partners initially were necessary, they had become inefficient and wasteful, with many executives drawing salaries of more than $500,000 a year, it said.
The list of NGOs with executives remunerated at this scale does not include any of the implementing partners operating in SA with Pepfar support.
The US will negotiate bilateral, multiyear agreements with recipient countries in which funding will go directly to front-line healthcare workers and commodities instead of to NGOs.
The state department aims to finalise these agreements by the end of the year, and begin implementing the new arrangements in April.
Various US media, including the New York Times and Reuters, have reported that state department officials will start negotiations with their counterparts from various countries this week, on the sidelines of the UN General Assembly taking place in New York.
It is not clear which countries will be prioritised, or whether SA will be included in these first talks.
It places US companies at the heart of the new approach, saying the programmes it supports will be expected to source commodities such as diagnostic tests and medicines from US manufacturers and use US logistics companies to transport supplies.
Ian Sanne, director of the Wits clinical HIV research unit, said the plan to use US donor funding to support US companies in logistics and information systems offered potentially wider economic benefits.
“If big companies like IBM and Amazon are given opportunities it may have a spillover beyond health,” he said.
The department of health had not responded to Business Day’s request for comment at the time of publication.
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