The US government has nailed a six-inch nail on the lingering hope Uganda and other African governments still had of salvaging the United States Agency for International Development (USAID) with its decisive closure.
The Trump administration's decision has sent ripples across Uganda’s health sector, where the American agency has been a critical funder of lifesaving programmes for decades.
The shutdown, finalised on Tuesday after months of huge cuts under President Donald Trump’s administration, has left Uganda scrambling to fill a yawning financial gap in key health interventions.
USAID’s exit follows a decision to wind down over 80% of its programmes earlier this year, with the remaining activities now absorbed into the US State Department.
The Minister of Health, Dr Jane Ruth Aceng, recently revealed that the country now faces more than Shs400 billion shortfall in its health budget following major reductions in donor funding—most significantly from the United States.
“Most of our critical programmes—especially those in HIV/Aids, malaria, maternal health and immunisation—have historically relied on USAID support,” Dr Aceng said at a health stakeholders’ meeting in Kampala last month.
“We are now forced to reallocate domestic resources or risk losing the progress we’ve made over the last 20 years.”
Since its inception in 1961, USAID has been a cornerstone of Uganda’s healthcare and development systems.
In 2022 alone, USAID contributed over $500 million to Uganda, with significant allocations to the Presidential Emergency Plan for AIDS Relief (PEPFAR), child immunisation campaigns, family planning, nutrition, and refugee support.
Its programmes reached millions of Ugandans each year. According to the Ministry of Health, USAID-supported initiatives have helped reduce HIV prevalence, increase contraceptive use, and lower maternal and infant mortality rates.
But with the agency now shuttered and personnel placed on administrative leave since February 23, local NGOs and public health facilities are already reporting disruptions in service delivery.
“We’ve seen stock-outs of antiretrovirals and malaria test kits in some regions, and that’s just the beginning,” said Dr Richard Kalema, a regional coordinator for a USAID-funded HIV/Aids programme in western Uganda. “We depended on those supply chains.”
Global Outcry, Local Consequences
The dismantling of USAID—ordered by Trump and overseen by allies like Secretary of State Marco Rubio and former adviser Elon Musk—has drawn condemnation from former US Presidents George W. Bush and Barack Obama, as well as global health advocates like Bono.
Speaking during a video conference with USAID alumni, Bush, whose administration launched PEPFAR in 2003, defended the programme’s legacy.
“Is it in our national interests that 25 million people who would have died now live? I think it is, and so do you,” he said.
The Lancet medical journal recently warned that the global aid cuts—particularly from the US—could result in over 14 million additional deaths by 2030, a third of them children.
The report was dismissed by the US State Department, which claimed it was based on “incorrect assumptions,” but Ugandan officials are seeing the real-time consequences.
“The gap is real. The suffering is real,” said Dr Aceng. “We cannot continue with business as usual.”
The Trump administration’s rationale for eliminating USAID centred on its push for “efficiency” and alignment with the “America First” doctrine.
Secretary of State Rubio declared on Tuesday, “This era of government-sanctioned inefficiency has officially come to an end.”
But for countries like Uganda—where USAID supported everything from Ebola response to maternal delivery kits—the decision is being felt as abandonment.
Humanitarian organisations warn that Uganda may now see a backslide in gains made under global partnerships.
In Gulu, where USAID funded a trauma recovery centre for war-affected women, local leaders say operations have halted.
“There’s no money, no supplies, and no staff left. We were told to wait for new arrangements, but we are still waiting,” said Christine Akello, a community health officer.
Can Uganda Fill the Gap?
Dr Aceng has said the Ministry is working on alternatives, including increasing domestic health funding and lobbying Parliament for emergency support.
However, the fiscal pressure comes at a time when Uganda is already grappling with rising debt obligations and competing budgetary priorities.
“We are in talks with partners including the Global Fund, Gavi, and the World Bank. But replacing what USAID did in Uganda is not a small task,” she warned.
Meanwhile, Parliament’s Health Committee has called for a special session to address the unfolding crisis and review how aid-dependent health programmes can be sustained without external funding.
Uganda’s experience mirrors a broader crisis across Africa, where aid-dependent countries are reeling from reduced support.
Following the US lead, the UK, France, and Germany have all scaled back international aid spending.
The United Nations has described this as the “deepest funding crisis ever to hit the humanitarian sector.”
For Uganda, the USAID closure is not just the end of an era—it is a moment of reckoning.
“This is not just about numbers or politics in Washington,” said Dr Kalema. “This is about lives. Real lives.”
