The abrupt withdrawal of American foreign aid has left healthcare systems across Africa and the Global South teetering on the brink, according to a damning new report that paints a stark picture of widening vulnerability and growing dependency on dwindling external support.
Published this week by Accra Reset — a global health initiative spearheaded by Ghanaian President John Dramani Mahama — the study underscores how the Trump administration’s dismantling of key aid programmes, compounded by the lingering effects of the pandemic and soaring living costs, has created an urgent imperative for structural reform in one of the world’s most fragile regions.
The Collapse of USAID and Its Immediate Fallout
In early 2025, protesters gathered outside the headquarters of the U.S. Agency for International Development (USAID) in Washington, D.C., voicing concern over what many saw as a catastrophic shift in global health policy. Their fears were soon validated as the agency was systematically wound down, triggering ripple effects felt far beyond American borders.
Among the hardest hit was Nigeria, where the sudden closure of USAID operations necessitated the absorption of approximately 28,000 health workers previously funded through the programme. This emergency measure came at a staggering cost of $200 million — funds that could otherwise have supported critical public services. Across the continent, external financing for health plummeted by nearly 70% between 2021 and 2025, forcing governments long reliant on donor support into uncharted territory.
Impact on HIV Treatment and Maternal Care
Nowhere has the fallout been more devastating than in South Africa, where the withdrawal of funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) — which had allocated over $400 million annually — led directly to the closure of numerous HIV clinics. More than 1.4 million people living with HIV now face uncertainty regarding access to life-saving antiretroviral therapy.
At the 26th International AIDS Conference in Brazil earlier this year, researchers presented findings describing the disruption as “severe and devastating,” with similar patterns emerging across sub-Saharan Africa. In Ghana alone, President Mahama revealed that his government lost roughly $78 million following the shutdown of USAID programmes, funds that had underpinned vital initiatives in maternal care, malaria prevention, childhood nutrition, and HIV/AIDS intervention.
A Call for Sovereign Health Development
The Accra Reset report, titled A Sovereign Future For Health, argues that these crises should serve as catalysts for change rather than temporary setbacks. Central to its thesis is the assertion that Africa contributes less than 1% of global vaccine production while bearing close to 25% of the worldwide disease burden — a disparity that highlights both systemic inequity and immense untapped potential.
“The past few years have shaken global health cooperation to its foundations,” Mahama wrote in the report. “The Covid-19 pandemic exposed the risks posed by concentrated production and unequal access to essential health products; rising debt and fiscal pressures have constrained national health budgets; and declining development assistance is placing programmes and services under growing strain.”
He went on to frame the Accra Reset not merely as a response to failure but as a proactive effort to “renew political momentum behind reform” and place African leadership at the heart of future health strategies. The initiative calls upon traditional donors to reorient their approach — not to reduce engagement, but to align it more closely with locally defined priorities and sustainable models of cooperation.
Renewed Momentum or Retreat? Public Sentiment Shifts
Despite mounting criticism, recent polling suggests a surprising degree of public sympathy towards renewed U.S. involvement in global health. Commissioned by the Rockefeller Foundation, the survey found that 75% of Americans — including 52% of those who supported Donald Trump — favour restoring disease prevention aid aimed at containing outbreaks like Ebola.
Moreover, two-thirds of respondents endorsed continued international collaboration even if it meant compromising elements of national interest. These sentiments resonate strongly with Naveen Rao, Senior Vice-President of Global Health at the Rockefeller Foundation, who emphasised that the Accra Reset represents not a retreat from partnership, but an evolution toward smarter, country-led solutions.
“It is not an argument for traditional donors to do less on global health. Rather, it is an argument for doing it differently and doing it better,” Rao stated. “As countries assume greater ownership of their health futures, donor nations must step up — following the lead of sovereign states and working alongside them to identify where external support remains most needed.”
Why it Matters
This moment marks a pivotal juncture in the history of global health equity. With the erosion of Western aid threatening millions of lives across Africa and the Global South, the stakes could not be higher. The Accra Reset offers a vision rooted in self-determination — one that challenges outdated paradigms of dependency and champions locally driven innovation. Yet without swift action to bridge funding gaps and rebuild trust between donors and recipients, the consequences may be irreversible. How the international community responds will define whether we move closer to a more just and resilient global health order — or retreat further into fragmentation and inequality.