At Shirati KMT Hospital in rural Northeastern Tanzania, 50% of the hospital's HIV/AIDS clinic personnel and support staff were let go in recent months due to the Trump administration's dismantling of the U.S. Agency for International Development (USAID) and freezing of funds earlier this year.
The consequences could be devastating in a country where 1,548,000 adults are living with HIV1, and many depend on antiretroviral therapy provided at clinics like the ones at Shirati KMT Hospital. The hospital, located in a rural part of the country, serves the Rorya district with a population of roughly 355,000 people, and has one of the oldest and most comprehensive HIV programs in the country.
"The number of people and children with HIV will likely increase and the number of deaths will increase," said Dale Ressler, executive director of Pennsylvania-based Friends of Shirati, which raises funds for the hospital and its clinics. In his role, Ressler keeps apprised of the latest developments at the hospital.
Loss of staff and services is a refrain being heard at many faith-based aid organizations and the myriad health care communities they serve in regions where government systems can be overwhelmed, underdeveloped, or in some cases, nonexistent. In sub-Saharan Africa, faith-based organizations provide roughly 40% of health services, according to the World Health Organization.2
Funding for these services often comes from a mix of private donations, partnerships with local governments, and support from international aid agencies, many of which get portions of their funding from the U.S. government. Organizations count on these monies to hire and train staff, stock their clinics, and launch mobile outreach programs, which often provide services in rural areas far from hospitals. But the recent disruption by the current administration has meant some of these programs, many of them crucial and many of which are focused on HIV prevention and treatment, are being shrunk or, in worst case scenarios, have to be shut down.
Mary Beth Powers, CEO of Catholic Medical Mission Board (CMMB), was on a work trip to Africa when many of the cuts were announced. One of CMMB's USAID-funded projects was canceled, while two others are still running. "We feel very fortunate to have the support from the U.S. government to continue that work. It is lifesaving," said Powers. She also feels fortunate to have funding from other sources, including individual donors and organizational donors, foundations and partner corporations. "[They] really complement the funding that's provided by the U.S. government for our health programs around the world," she said.
The project that was canceled, an AIDS support program for adolescents affected by HIV, had only seven months to go when it was shuttered. Powers would have liked to see it run its full course until this September and not see the staff let go. But there was no way to continue it as it was funded through a USAID grant, and the people working on it were contracted through the agency.
Powers isn't surprised that there have been changes. "We expect changes with every administration," she said. "There are often changes in focus." What has surprised her is the speed at which the changes have taken place. Like others in similar positions, Powers is waiting to "get more clarity" on the new directions for humanitarian assistance under the revamped State Department.
People also need to realize that it isn't just the U.S. government rethinking its foreign assistance priorities, according to Powers. European governments are also making changes. "So that's another reason why people are quite concerned about how these programs will be continued and how much local governments can take on," she said.
Doug Fountain, executive director of Christian Connections for International Health (CCIH), says it is difficult not having a timeline for when and if programs might come back and only being told that there will be a review for determining which programs are returning. "They are tearing apart USAID, and you don't know whether there will be a new version of USAID that will be put back together again," said Fountain, interviewed this spring.
"The President's budget just submitted to Congress calls for some global health funding, but only half of what was there before. We don't know the structure, process or type of funding that includes. Congress, of course, may fund differently, but at least there is a glimmer of hope that they are not eliminating global health."
WITHSTANDING CHANGE, GOOD AND BADFountain was on a call earlier this year with a dozen CEOs from CCIH member organizations. Of the 12 on the call, three had lost USAID or other U.S. government funding. It has been especially hard on countries that counted on U.S. assistance, said Fountain. "If you've got a limited budget, and you're told that you now have to spend a bunch more money on something that you didn't plan for, something else is going to get cut," he said. "So, they are still trying to figure that out."
Many of the local organizations are fearful of speaking out, said Fountain. "They're scared to death. They fear that if they complain or say that this has been very difficult for them, that there could be retribution against them. They are being advised by a variety of people from their government and even the U.S. government staff in local offices that they probably should not complain too much."
For Fountain, it's important that people understand that many faith-based organizations are "not purely dependent on U.S. government support" for their funding, instead receiving assistance from numerous sources. He finds hope in the "local leaders who are resilient, strong people and will come up with some good ideas."
The entire development field has been going through some major changes over the past couple of years, according to Fountain. "We've known, for example, that there needed to be a major shift toward what they call localization, which is the local control over who gets funding for what purposes," he said. "Right now, up until this year, a lot of the international assistance was being doled out by USAID or other agencies through U.S.-based partners who then dole out funds locally." The desire is to move toward getting more funds handled locally. The other big change, according to Fountain, is the recognition that the entire way that procurement is done needs to be thought through more carefully. "Up until now, there has been an emphasis on really big actors who can comply with all of the U.S. government regulations and rules, and so it's been very complicated for organizations to get access to the funding," he said.
What's going on in Washington, D.C., has made this desire for change and localization even more timely.
He also says it is important to remember what came long before any governments and has withstood many changes, both good and bad. "All Christian health care started with Jesus, the healing ministry of Jesus, and you can trace back to the first and second century the advent of health within the Church," said Fountain. "So, in reality, Christian health ministry predates every single modern government that exists, and Christian health ministry has never been dependent on U.S. government support for its existence."
REBUILDING HOPE, TRUST
Fountain says the recent changes do not diminish the great strides that have been made in the last 25 years, particularly on the President's Emergency Plan for AIDS Relief, and alignments with the government that have led to rapid progress. "What we're now mourning is the risk of the potential losses. But it has never been solely dependent on U.S. government assistance. There are great things that we do as a Christian community globally to care for people. And so as tough as the U.S. government story is, it's vital to keep that in perspective."
Still, says Fountain, it will be a long road to gain the trust back that the U.S. once enjoyed with many of these organizations and countries.
"Trust is the hardest thing to earn and the easiest thing to lose."
ELIZABETH GARONE is a freelance writer who has covered a wide range of health, business and human-interest topics. Her writing has appeared in The Wall Street Journal, The Washington Post, BusinessWeek and The Mercury News, among other publications.
NOTES
- Tanzania HIV Impact Survey 2022-2023, National Bureau of Statistics Tanzania December 2023, https://www.nbs.go.tz/nbs/takwimu/THIS2022-2023/THIS2022-2023_Summary_Sheet.pdf.
- Multi Country Study of Medicine Supply and Distribution Activities of Faith-Based Organizations in Sub-Saharan African Countries, World Health Organization and Ecumenical Pharmaceutical Network, 2006, https://iris.who.int/bitstream/handle/10665/69347/WHO_PSM_PAR_2006.2_eng.pdf.