The United States Agency for International Development (USAID) has played a significant role in South Africa's development across various sectors, including health, economic growth, and education. However, recent funding cuts have posed challenges to the sustainability of these programs. This article examines the impact of USAID's initiatives and the potential consequences of reduced financial support.
Health Programs
South Africa has the world's largest population of people living with HIV and AIDS. USAID has been instrumental in supporting the country's efforts to combat the epidemic.
Structure of HIV.
Launched in September 2016, the USAID Global Health Supply Chain - Technical Assistance, South Africa (GHSC-TA-SA) program aimed to improve medicine availability across all levels of care in the country. The program supported the National Department of Health's (NDoH) Accelerated Medicines Delivery (AMD) sub-programme, which is responsible for developing systems to ensure access to essential pharmaceutical commodities.
Key accomplishments of the GHSC-TA-SA program include:
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- Increased capacity and skill at a national and provincial level in demand planning.
- Implemented a demand planning process and appropriate tools in all nine provinces.
- Conducted a proof of concept in South Africa’s North West province to test the informed push approach using the Stock Visibility System (SVS) and RxSolution.
- Assisted AMD to revise regulations relating to pharmacy support personnel published in terms of the Pharmacy Act.
- Developed the online Master Health Product List forming part of the Medicine Master Data System.
- Improved data visualization by creating and refining the dashboards that comprise the National Surveillance Centre (NSC).
- Assisted with the development of pharmaceutical budgets for all nine provinces for the 2020-2021 budget cycle.
The GHSC-TA-SA program has shown marked progress and success in the development and implementation of supply chain reforms at the national and provincial levels. At the end of 2019, GHSC-TA South Africa support was further strengthened by the introduction of the Provincial Support Team (PST).
Impact of Funding Cuts on Health Services
However, recent funding cuts have disrupted prevention and care efforts. On February 26, about 40 USAID-funded health projects in South Africa received termination letters, leading to the cancellation of these projects. This has resulted in the cessation of services provided by approximately 8,493 PEPFAR-funded staff who were involved in HIV response activities.
The halt in funding has led to the closure of many clinics and a significant reduction in services such as HIV testing, care, and treatment. Key populations, including adolescent girls, young women, and pregnant women, are at risk of losing access to critical HIV prevention tools like PrEP. There are also disruptions in data management, mobile clinics, and drop-in centers.
The funding cuts will affect specific healthcare services, including limited support for advanced HIV disease services, reduced HIV testing, diminished treatment literacy, and increased stigma and discrimination for key populations.
In response to these challenges, the South African Ministry of Health, in collaboration with the South Africa National AIDS Council (SANAC), UNAIDS, WHO, and other stakeholders, launched a national campaign to close the 1.1 million HIV treatment gap by December 2025.
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UNAIDS has called on the private sector to help address the funding gap resulting from the US funding freeze and proposed the creation of a South African Solidarity Fund against HIV, similar to the one set up during the COVID-19 response.
Economic Growth and Trade
USAID has also supported economic growth and trade in South Africa. The Agency for International Development (USAID) Southern Africa Trade and Investment Hub (USAID TradeHub) engaged with partners across the region to increase sustainable economic growth, global export competitiveness, and trade in targeted southern African countries.
It supported these objectives by increasing exports from southern African countries to South Africa and the United States (under the AGOA), boosting capital and technology flows from South Africa to other southern African countries, and providing targeted trade facilitation support to Zambia.
The USAID TradeHub was based in Pretoria, South Africa, with resident representatives in Eswatini, Lesotho, Malawi, Mozambique, and Zambia. In fiscal year 2022, it facilitated $173 million in agricultural and non-agricultural exports to South Africa and the United States, representing 394 percent of the target of $44 million.
Pursuant to the African Growth and Opportunity Act (2000) USAID established several investment hubs across the region. For the region to maintain its economic growth without USAID support, countries should support local entrepreneurship and investment in agricultural, infrastructural, and technological development.
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Education
Harambee partners with USAID to create jobs in SA
USAID investment in education in sub-Saharan Africa has been instrumental in improving primary and secondary education, enhancing English language proficiency, and preparing the region's growing youth population for the workforce. Top aid recipients Ethiopia and Somalia have received $17 million and $14 million toward basic education, respectively.
Without USAID, efforts to improve education for young leaders in sub-Saharan Africa should continue to prevent negative consequences for economic growth and political stability. Empowering local educational institutions can help maintain access to education for African youth. Additionally, leveraging public-private partnerships in the education sector is essential.
Students at the University of Johannesburg.
One example is the Vodacom e-School, a flagship initiative between Vodacom and the South African government that provides free, online education content learners from the first year of formal schooling to grade 12. Philanthropic contributions will be crucial for advancing education, particularly higher education.
Historical Context: USAID and Anti-Apartheid Efforts
During the 1980s, the American public increasingly resented the South African system of apartheid and urged the United States government to take major action. This led to bipartisan Congressional action to override President Reagan’s veto of the Comprehensive Anti-Apartheid Act [CAAA] of 1986. This act imposed broad economic sanctions against South Africa to pressure the government to end the system of apartheid.
In the summer of 1987, Stickel arrived in South Africa as USAID’s Assistant Director. Stickel made sure to listen to the South African communities on the type of support they needed from USAID, including an education program, community outreach and leadership development, a private enterprise program, labor union training program, and human rights and legal assistance fund.
The CAAA was invaluable as authorizing legislation because it enabled USAID to demonstrate distance from the Embassy and convey a genuine commitment to support South African objectives.
Challenges and Future Directions
The USAID downsizing marks a pivotal moment in sub-Saharan Africa's history. Although the agency's contributions have been instrumental in the region's development over the past few decades, African nations should now prioritize regional collaboration, investment in local institutions, and strategic partnerships with the private sector to sustain progress in health, economic development, and education.
Strengthening organizations such as the Africa CDC, fostering entrepreneurship, expanding agricultural investments, and leveraging philanthropic and private-sector contributions will be essential in navigating this transition.
Map of South Africa with provinces highlighted.
Ultimately, six months on from the emergency hustling to concoct some semblance of plans, there does not appear to have been significant progress in developing and implementing longer term solutions - at either the national and continental level.
Amid plenty of talk of domestic resource mobilisation, public-private partnerships, expenditure rationalisation, diversified funding sources, innovative financing models and localisation strategies, there is a glaring lack of detail around the practicalities.
Table of USAID Impact and Challenges in South Africa
| Sector | Impact | Challenges |
|---|---|---|
| Health | Improved medicine availability, increased HIV testing and treatment | Funding cuts leading to clinic closures, reduced services, and staff layoffs |
| Economic Growth and Trade | Increased exports, boosted capital and technology flows | Need for local entrepreneurship and investment to maintain growth |
| Education | Improved primary and secondary education, enhanced English language proficiency | Need for public-private partnerships and philanthropic contributions to sustain progress |
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