What Cuts to U.S. Aid Mean in Africa
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You're listening to State of the World from NPR. We bring you the day's most vital international stories up close where they're happening. I'm Greg Dixon. The Trump administration has moved to aggressively stop aid programs the U.S. provides overseas, especially aid delivered by the U.S. Agency for International Development, USAID.

Trump has said the aid is rife with fraud and the people delivering it are radical or anti-American. His administration has tried to cancel aid contracts already in progress, a move that is being fought in court. NPR's Michelle Martin has been looking into what this abrupt halt in funding actually means to those providing aid on the ground.

We wondered what the consequences have been, so we called three programs operating in Africa, where about a quarter of USAID funds were allocated. My name is Carol Nyerenda. I live in Lusaka, Zambia, and I'm the executive director of a community-based organization called Seton Plus, which was set up in 2007 by TB survivors, people who had TB, and people living with HIV. Nyerenda is HIV positive and a tuberculosis survivor.

She says U.S. humanitarian aid saved her life. Which is the main reason she was able to set up an NGO to help others like her.

We work with people living with HIV who can in turn help take in to other people, but we also work with TB survivors and we also have malaria change agents. Miranda's NGO leverages U.S. dollars by identifying areas with high rates of illness to persuade people to get treatment at clinics run by their own government and to encourage them to keep taking their medicines, which is often necessary to keep disease in remission.

So when Nyerenda received a letter last month saying her organization's grant had been terminated, she was shocked and frightened. For one of our main projects, we had about 500 volunteers across about 40 districts in six provinces of the country. We were told to lay them off. My worry is that we might have a super bag.

Even for HIV, for TB, we might have more of what you call drug-resistant TB because drug-resistant TB is brought on by not taking your medicine properly.

In Tanzania, Dr. Peter Bujari is also worried. I am a medical doctor, public health specialist. I lead a non-government organization called Health Promotion Tanzania. Dr. Bujari also got a letter cutting off substantial aid to his organization. USAID plays a significant role in the health sector in Tanzania.

leave alone the HIV part, but it does play a significant role into community mobilization, which is important to getting people to go to health services. Counseling and testing, supporting the frontline health workers who are meeting patients. U.S. funding cuts across all those areas, including pharmacy,

family planning, for example, including the reproductive maternal newborn child health

including nutrition programs. Critical care programs were allowed to continue, but work that supported those programs have stopped. Things like getting TB tests from remote areas to the lab, counseling to make sure people know their status and how to take their medications. What it means is that the transmission of TB is going to continue because transmission occurs until one starts treatment.

So if treatment is not started because diagnosis was not made on time, which means this person continues to spread TB. Dr. Bajari says the government of Tanzania is trying to do what it can to continue these services. But since his NGO supported that work, clinical services are paralyzed. Everybody's in panic. Everybody's confused. People are laid off.

Nobody knows what to do. We are now discussing, so what are we going to do? For example, he says TB tests are no longer being collected, and those that have been collected are being thrown away. Diagnosis is not happening. Mobilization of people is not happening. Some people were to be given drugs in the community because of the distance from where they stayed at the facility. That cannot be done. There's a

an environment where nobody knows what to do. Even projects that are mostly funded by private sources say they are being affected, like the NGO that Dr. Ayoda Ureda helps to run.

Dr. Roreta has just returned from delivering sonogram machines to the northernmost region of Ethiopia. I am an internist by training, practicing in Maryland, but I'm also the co-president of Health Professionals Network for Tigray. Her organization is privately funded, but her partners on the ground in Ethiopia were largely supported by the State Department. She says they have the medications they need. But a lot of the other funding that's needed, like, for example, transportation, warehouses,

how do you protect these supplies from being stolen or looted or stuff like that, that kind of support is not there anymore. So they're worried about delays and getting these medications where they're needed the most, right? And they're also worried about what this means for next year. And while the fears about the potential spread of disease are real, another impact of the funding freeze is already being felt by the families who depended on the jobs created by U.S. funding. In Africa particularly,

The dependence ratio is something like 80%. So staff whose job were ended abruptly, it has not only affected them, but it has affected everybody who was depending on them.

This therefore means there are people whose insurance was paid by these staff who were on pay. They are now going to be off treatment. It also means children who are being supported and paid for school fees by these staff are going to stop going on school. It also means that this is likely to be causing, you know, mental health challenges.

that we are unable to even quantify at this point in time. The people we spoke with all talked about ways they're trying to help leaders in Zambia, Tanzania and Ethiopia fill the gap left by the U.S.'s deep cuts to humanitarian aid. But no one knew how. These are enormous sums for developing countries.

I asked Dr. Bujari if he could speak directly to decision-makers in Washington what he would say. He was blunt. I would say that they have done an amazing work to approve PEPFAR and USAID funding that have saved millions of lives. And such an abrupt disruption, it is telling those people you can now die. The Trump administration officially canceled 83% of U.S. foreign aid contracts on Monday.

NPR's Michelle Martin. And that's the state of the world from NPR. Thanks for listening.

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