The 2025 World Aids Day theme “Overcoming disruption, transforming the Aids response” refers to HIV funding cuts, mainly by the US, reflecting broader global geopolitical change. With this abrupt cessation of US funding through Pepfar (US President’s Emergency Plan for Aids Relief), Usaid (US Agency for International Development) and other agencies, we have lost a massive resource that aligned with government to strengthen the HIV/TB programme. World Aids Day 2025 is being used to advocate for more funding, but it is also the opportune time to rethink donor funding across the continent.
Funding is fickle — this is the lesson we have learnt so bitterly in 2025. Some of us in the development sector already recognised this vulnerability to politics and expected NGO leadership to build sustainability into their work plans, considering the scale of funding over the past 25 years. The lesson here is for leaders of donor-funded organisations to adopt public health principles such as equity, quality, sustainability and systems-thinking when negotiating with funders.
Public health medicine specialist physicians in SA possess the specific training, skills and expertise to lead, manage and operationalise population-level interventions and programmes. One gaping need is for NGOs to be more accountable to the provincial departments of health, but this requires the capacity to manage and regulate NGO partnerships. Regardless of size, NGOs and other funded initiatives such as corporate social investment (CSI) projects should be transparent about how they spend their money in health, so their work aligns with the needs of SA’s health system.
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Unifying among all countries in the post-Usaid and Pepfar funding withdrawal is that sustained funding will be necessary to eliminate HIV/TB as a threat. A major question is whether governments of low- and middle-income countries can provide for such medicines and services in their fiscus to avoid donor dependence.
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