Not surprisingly, the math during our denial phase did not add up. USAID provided $59.2-billion in health and humanitarian assistance across the continent in 2023 alone. In contrast, development aid from US foundations totalled $8.3-billion, with the Gates Foundation contributing 60% of that amount.
With our hopes resting on the Gates Foundation to help bridge the funding gap, we were encouraged when, after absorbing its shock, it announced increased funding for maternal and child health and climate mitigation initiatives in various countries. However, the reality is that foundations alone cannot sufficiently close the financial gap. Our response step was to cautiously turn to our national governments for assistance in addressing the financial gaps caused by cuts in foreign aid.
Our governments are cash-strapped, but we also know that much more money is wasted through corruption than we lost through foreign aid cuts. In 2024, widespread protests across Africa, recognising the impact of political corruption and the increased cost of living on our daily lives, were met with swift repression. Obtaining a clear response from our governments on how they plan to bridge these financial gaps has been depressing, to say the least.
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For individuals who rely on life-saving medication, this situation has become a nightmare. After some performative soul-searching, we argued that Africa should never have relied on foreign funding in the first place. This led to a range of proposed solutions, few of which address the immediate impact of the withdrawal of funding on health and humanitarian services throughout the continent.
The African Development Bank, in a working paper released in March 2025, argued that remittances—private transfers made by migrants to relatives in their home countries—could potentially solve our problems. While this may hold true in the long term for some nations, it certainly does not address the short-term needs. Between 2018 and 2022, a total of US$90-billion in remittances flowed to Africa, with the majority going to Nigeria and Egypt.
However, when considering remittances as a percentage of a country’s GDP, they can make a notable difference; for instance, remittances account for up to 10% of GDP in Zimbabwe and 20% in Lesotho. It is important to remember that remittances are seldom used for investment and often occur through informal channels, primarily aimed at covering families’ daily living expenses. Some have proposed implementing an HIV tax, referencing Zimbabwe’s 3% AIDS levy introduced in 1999.
After 25 years, this levy has provided only a small contribution compared to the significant investment needed to improve a health system beleaguered by inflation. As of April 2025, inflation rates reached 16.5% in Zambia, 30% in Malawi, and 85% in Zimbabwe.
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