by Ben Taylor
Coping with USAID cuts?
Tanzania is grappling with significant challenges following the abrupt cuts to USAID funding in early 2025, particularly impacting the 1.6 million Tanzanians reliant on antiretroviral (ARV) medications for HIV management. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which provided USD $450 million annually, was a cornerstone of Tanzania’s HIV response, funding ARVs, testing, community outreach, and healthcare workers. The funding freeze has disrupted this lifeline, threatening lives and reversing decades of progress.
Widespread fear of ARV shortages has led to hoarding and some patients dropping out of care, exacerbating risks of treatment failure and resistance.
On January 20, 2025, an executive order from the Trump administration imposed a 90-day pause on all US foreign assistance, including PEPFAR, for a review of programmatic efficiencies. This was followed by a stop-work order on January 24, halting existing grants and contracts, effectively freezing PEPFAR operations. USAID, the primary implementer of PEPFAR, faced severe cuts, with over 80% of its programs cancelled by February 2025.
Ten days later, US Secretary of State Marco Rubio granted a limited humanitarian waiver allowing PEPFAR to resume “life-saving HIV services,” specifically HIV treatment and care, prevention of motherto-child transmission (PMTCT), pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women, and HIV testing.
Despite the waiver, many PEPFAR contracts, particularly those managed by USAID, remain terminated or scaled back. Programmes in Tanzania providing HIV treatment to hundreds of thousands, including children, were shuttered. Payments for some intact contracts, such as those for HIV drug supply, are not flowing, keeping services effectively frozen. The Trump administration’s move to dissolve USAID and integrate its functions into the State Department as well as reductions at the Centres for Disease Control and Prevention (CDC), which handles 37% of PEPFAR funding, add additional strain.
In Tanzania, the USAID cuts have strained ARV supply chains, with reports of patients being told that free ARVs are no longer available, forcing them to purchase costly. Current ARV stocks are expected to last until the end of 2025, but the 2026 forecast is uncertain, risking stockouts. The loss of funding has led to clinic closures, job losses for healthcare workers and disruptions in testing services, reducing access to care. Community-based services, including counselling and home delivery, have been hit hard, increasing risks of treatment interruptions, drug resistance, and HIV transmission.
The Tanzanian government, through the Ministry of Health and the Tanzania Commission for AIDS (TACAIDS), has pledged to reallocate budget funds to maintain ARV supplies, with the Medical Stores Department (MSD) assuring availability to quell public fears. A webbased Care and Treatment Centre (CTC) database, integrated with DHIS-2, is being launched to mitigate the loss of USAID-funded data clerks, enabling healthcare workers to manage records directly.
Meanwhile, the Global Fund to Fight AIDS, Tuberculosis and Malaria is exploring reinvesting savings from its HIV grant to secure ARV commodities, while UNAIDS and WHO are engaging TACAIDS to assess impacts and explore fundraising. Civil society is advocating for expanded Global Fund implementation to bridge gaps.
The annual cost of ARVs for 1.6 million people in Tanzania is estimated at TSh 5.7 trillion (~£1.6bn), far exceeding the Ministry of Health’s 2024/25 budget of TSh 1.3 trillion, making it impossible to fully cover without external aid. Experts warn of 30,000 additional HIV-related deaths in two years if the crisis persists, along with risks of increased infections due to interrupted prevention programmes.
Tanzania is exploring alternative donors and private-sector partnerships, though these are unlikely to match PEPFAR’s scale. The government’s commitment to absorb healthcare workers and enhance digital systems shows proactive steps, but the scale of the crisis demands urgent international support to prevent a public health catastrophe.
Beyond HIV/AIDS, USAID’s support for maternal, newborn, and child health, including antenatal care and vaccinations, has been cut, with crucial elements of ante-natal care programmes unbudgeted in national plans. This risks increased maternal and neonatal mortality, especially in rural areas.
The termination of USAID-backed malaria prevention (e.g., insecticide-treated bed nets) and TB programs threatens a resurgence of these diseases. The loss of logistics for TB sample transport and vaccine storage security has paralysed diagnostic and treatment efforts.
It has been reported that around 5,000 healthcare workers, many in HIV and malaria programmes, have lost their jobs, particularly in rural clinics.
Over 60 NGOs, particularly those supporting agriculture and health, face collapse due to USAID’s funding halt. Health-focused NGOs like ICAP have shut down, leaving thousands of medical professionals jobless and disrupting community-based services like counselling and ARV home delivery. Amref Health Africa, a major NGO, lost 20% of its budget. Smaller NGOs, reliant on USAID for HIV and TB programs, face immediate financial crises, with many unable to secure alternative funding quickly.
The Africa CDC (a public health agency of the African Union) has stepped in with $2 million for Tanzania’s Marburg outbreak response, but its $1 billion annual budget target is insufficient to fill USAID’s void across health programs.
“The disruptions to HIV programs could undo 20 years of progress,” WHO Director-General Tedros Adhanom Ghebreyesus said at a press conference. He added that this could lead to over 10 million additional HIV cases across Africa and three million HIV-related deaths. He said that the US government has “a responsibility to ensure that if it withdraws direct funding for countries, it’s done in an orderly and humane way that allows them to find alternative sources of funding.”
The US’s plans to exit the WHO have also forced the UN agency, which typically receives about a fifth of its overall annual funding from the US, to freeze hiring and initiate budget cuts.
It is no exaggeration to say that Tanzania’s health sector is in crisis due to USAID cuts, with HIV/AIDS programmes, maternal health, and TB/malaria efforts facing severe disruptions. NGOs are collapsing, healthcare workers are unemployed, and patients are struggling to access ARVs and services. The government’s mitigation efforts and support from the Global Fund and Africa CDC are insufficient to bridge the funding gap. Without rapid intervention, Tanzania risks a public health catastrophe, with millions facing life-threatening consequences.
Tanzania declares end to Marburg Virus outbreak
The government on March 13, 2025 formally declared the end of the outbreak of the Marburg Virus after 42 days of monitoring with no new cases reported.
The outbreak of Marburg virus was declared on January 20 this year by President Samia Suluhu Hassan after two cases were confirmed in Biharamulo District, in the Kagera Region, which borders Uganda to the north, Rwanda to the west and Burundi to the southwest. Both patients lost their lives while on treatment.
The last confirmed MVD case was reported on January 28, 2025. This second case (which occurred after the previous issue (No.140) of Tanzanian Affairs went to press), came after both President Samia and the World Health Organisation celebrated Tanzania’s swift actions to contain the outbreak and limit the number of infections to a single case.
This is the second outbreak of Marburg virus, with the first having occurred in 2023.
“Since the declaration of the outbreak the government in collaboration with stakeholders and partners jointly took stringent measures to contain and control the outbreak,” said Minister for Health, Jenista Mhagama.
She urged the public to remain vigilant and continue observing all recommended measures and adopt positive behaviours including hand washing using running water, soap or hand sanitizer and timely report all rumours and unusual events in the community using toll-free hotline number 199 or nearby health facility.
“We should also be aware that the country remains at risk of other highly infectious diseases, including Ebola which has been reported in neighbouring countries and Mpox which has recently been declared in our country and continues to be reported worldwide,” Ms Mhagama said.
In a similar statement the World Health Organisation said it worked closely with Tanzanian health authorities to rapidly scale up key measures such as disease surveillance and trained more than 1000 frontline health workers in contact tracing, clinical care and public health risk communication to contain the second outbreak of MVD in Tanzania. “The Organisation also delivered over five tonnes of essential medical supplies and equipment,” WHO said in a statement.
Auditors criticise dependence on poorly-regulated traditional medicine
Criticism of traditional medicine came from an unusual source in April, with the presentation to Parliament of the annual Controller and Auditor General (CAG) report.
The audit report exposed significant public health risks due to unregulated traditional and alternative medicine practices. From 2020 to 2024, at least 16 deaths were linked to unsafe traditional remedies, with seven fatalities in 2023 alone in Simiyu and Lindi regions. The report highlights systemic weaknesses in oversight by the Ministry of Health and the President’s Office – Regional Administration and Local Government (PO-RALG). The Tanzania Traditional and Alternative Health Practice Council (TAHPC) lacks a system to track incidents, leaving many cases unreported and hindering effective response.
The audit revealed that only 12 of 21 practitioners visited in four Local Government Authorities (Dodoma, Arusha, Temeke, and Bariadi) were registered, with Temeke having 71% unregistered practitioners. Inadequate registration data, missing details like street or ward information, and an outdated Health Practitioners Registration System (HPRS) exacerbate enforcement challenges. Overburdened coordinators struggle to monitor remote areas, and the sector’s 2022/23–2027/28 strategic plan remains unapproved, stalling progress.
“The continued operation of unregistered practitioners and use of unsafe remedies not only poses serious health risks but also undermines public confidence in the traditional medicine sector,” the report cautions.