Protect progress - a call for urgent solutions to the USAID/PEPFAR funding gap

The Western Cape Government (WCG) welcomes the measures announced by the National Department of Health to ensure that HIV/AIDS services and treatment can continue uninterrupted following the announcement of the 90-day suspension of some foreign aid by the United States of America. These measures, including the implementation of a 6-month antiretroviral treatment (ART) dispensation and a 28-day late collection allowance for clients refilling ARTs, will help reduce pressure on both clients and clinics. To add to this, the province will implement ART automatic chronic dispensing unit script renewals to ensure that we minimise the need for facility visits.

The suspension of this foreign aid will further add pressure to an already overburden healthcare system. And while the provincial government will work with the national government to implement rollout strategies for both HIV/AIDS and TB, clarity will be needed on how these measures will be sustainably funded. These stop-gap measures will provide temporary relief but addressing the long-term financial strain that the suspension of foreign aid could impose on the healthcare system should foreign aid from both the United States Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) not be reinstated, is important.

While a waiver has been issued for certain life-saving services, there is still uncertainty regarding the full scope of affected programmes. Given these challenges, the WCG has called on national government to provide a coordinated funded strategy in the face of the uncertain future of funding from these critical programmes.

Last week, both Provincial Ministers of Health and Wellness, and Finance, Mireille Wenger and Deidré Baartman, wrote to their national counterparts requesting a coordinated strategy with other provinces to safeguard service delivery and to fiscally mitigate the substantive risks that have emerged after the suspension was announced by the United States.

In the Western Cape, USAID and PEPFAR funding supports both non-profit- and non-government organisations as well as provincial government programmes to address the burden of HIV/AIDS and TB. The Western Cape Department of Health and Wellness (WCDoHW) uses this funding for technical services and health systems strengthening which includes data analysis and research, testing, mobile X-ray services and community-based support staff.

The purchase of antiretroviral treatment (ART) and clinical staff are mainly funded through the province’s own budget. Essential healthcare services, including ART provision, will therefore continue but it has meant adjustments in how and where patients access services and will increase pressure at already overburdened clinics.

The partnership with the USA, through initiatives such as PEPFAR and USAID, has been significant in contributing to improving healthcare outcomes. Our support partners including non-government- and non-profit organisations provide vital community-based support, ensuring that individuals living with HIV/AIDS and TB receive the care and treatment they need, while also offering crucial services like health education, counselling, and outreach. The dedication of these NGOs and NPOs has made a tangible difference in the lives of residents, providing not only medical assistance but also emotional and psychological support. The WCDoHW is working with partners to gain a comprehensive view of the impact this suspension of funding will have NGOs and NPOs. 

Minister Wenger said, “It is our mission to build a healthier Western Cape where residents can thrive, and a healthy workforce is able to fully participate in a thriving provincial economy. Although the WCG has endeavoured to reduce our reliance on foreign aid, the funds received from USAID and PEPFAR have been vital in the fight against the HIV/AIDS epidemic and TB, which often present together. Without urgent action as a sector, we could face losing some of the gains made in our fight.”

Unpacking the financial implications of this suspension of funding, Provincial Finance Minister Deidré Baartman added, “The USAID and PEPFAR funding freeze has cross-cutting implications for the Western Cape Government’s fiscus, particularly in healthcare, social development, and economic growth initiatives. The financial risks include a funding shortfall for health services in the 2025/26 financial year and a potential loss in funding for child services over the next three years.”

“The sudden withdrawal of financial support means that difficult decisions lie ahead for departments at a time where the Western Cape’s financial resilience has been stretched to its limits. We urge the national government to provide a unified strategy for provinces as they navigate this financial uncertainty.”

Premier Alan Winde concluded, “The Western Cape Government works hard to develop and grow relations with key international partners, such as the USA, towards the apex priority of helping businesses create jobs and helping our residents get those jobs. Our partnerships have also proven crucial to supporting programmes which have been hugely beneficial to the most vulnerable in our province. The USA has been an important partner to the Western Cape, and we look forward to engaging with Washington to find common ground and certainty on this important matter.”