While it is premature to estimate the effects of US President Donald Trump's decision to freeze US foreign aid to various health programmes, experts believe if there is a complete withdrawal of funding, the South African government should put in place measures to mitigate the impact.
After his inauguration, Trump signed an executive order temporarily suspending foreign assistance for 90 days pending a review that affects the US Agency for International Development (USAID).
USAID is a critical partner for South African health programmes.
University of the Witwatersrand dean of the faculty of health sciences Prof Shabir Madhi said there hasn't been a complete withdrawal of funding.
“I think it will be premature to speculate, and at the same time I think it is essential that the government put in place measures that will mitigate [the gap left by the withdrawal of funds] should there be a complete withdrawal of funding,” he said.
Madhi said their understanding was that about 20% of the HIV/Aids and TB programmes are funded by grants from the US government, which are received by a number of non-governmental organisations and university entities.
“If all 20% is withdrawn, it will leave a major gap in terms of treatment and care, but that is not the case currently,” he said.
“What we do know is that many of these programmes which are grant-funded are integrated into public health services. There are a few stand-alone clinics which are only funded by the grant, but those are usually targeted to specific demographics of the population,” he said.
He said those receiving treatment through the US programmes would still access government facilities.
“The only difference will be that it will place an additional workload on staff that are employed by government,” he added.
Wits confirmed there has been a stop-order communication issued regarding some of the USAID-funded programme being run by staff at Wits Health Consortium.
It said at this stage the impact of the stop order on patient care is being reviewed, and mitigation plans are being developed.
Most of the people funded by Pepfar are the ones who told us that they have received letters that funding has been stopped. We, as the government, have not received any communication, either through Dirco, health or Treasury, where the money is going. We hear from the clinics, especially Wits, which runs some of the clinics, that funding has been stopped
— Dr Aaron Motsoaledi, health minister
“There is ongoing communication and engagement with the programme leads on the implications of the stop order, and we are hoping to get more clarity on the full extent and scope of the stop orders in the next few days,” said Madhi.
Engage Men's Health, funded by the President's Emergency Plan for Aids Relief (Pepfar) through USAID, said it regretted to announce that due to an immediate 'stop-work order' issued by their funder, they cannot provide any services until further notice.
“We understand the urgency of your health needs and urge clients to seek care and access ARVs or PrEP at their nearest public health facility or healthcare provider. For PEP (following potential HIV exposure), please visit your local clinic or consult a Dis-Chem pharmacist within 72 hours.
“We deeply value our clients and remain committed to safeguarding your health. We sincerely apologise for the inconvenience and disruption this may cause. Unfortunately, we are unable to provide further details at this time,” it said.
Prof Khangelani Zuma from the Human Sciences Research Council said it started a partnership with Pepfar in 2005 on their surveillance work.
He said the HIV surveillance work looks specifically at generating strategic information, which they use to measure the impact and the extent of HIV.
“The information that we use identifies areas that are worse affected than others and those that require particular intervention. Also, it helps with questions related to the kind of interventions that could be put into place. So since that time, we have been doing that using the funding.
“To date, one of our big studies on HIV surveillance and a national survey on HIV prevalence survey are fully funded through Pepfar,” he said.
He said the suspension and withdrawal, which he hopes doesn't happen, will severely affect the work that the HSRC does in generating information which helps them plan interventions.
“This poses a very big risk to the country, people living with HIV and to the global community, as South Africa holds a very unfortunate record of being the country that has the largest number of people living with HIV.
“You can imagine the impact of curtailing funding that has been earmarked to deal with the effects of the epidemic and how much devastation it would leave,” he said.
He added that even if the decision is reversed after 90 days and it reverts to the status quo, that will be too long. “That is a quarter of a year that has been lost in research in putting in place interventions. That will be too long a time,” he said.
Madhi said the funding complements and supports that provided by the government in terms of patient care.
“If the government is unable to bridge the gap that might emerge if there is a complete withdrawal of all the funding, that could affect patient care and there might be a reversal of the gains that have been achieved when it comes to the number of individuals living with HIV that are on treatment as well as the quality of life of people living with HIV,” he said.
Meanwhile, health minister Dr Aaron Motsoaledi said the government has not received any formal communication from the US government.
“Most of the people funded by Pepfar are the ones who told us that they have received letters that funding has been stopped. We, as the government, have not received any communication, either through Dirco, health or Treasury, where the money is going. We hear from the clinics, especially Wits, which runs some of the clinics, that funding has been stopped,” Motsoaledi said.
Motsoaledi said the health department will meet the National Treasury to map a way forward on the financial implications. According to Motsoaledi, patients who were receiving treatment through the US-funded programmes will be able to receive treatment from government programmes. He said so far, they don't know the exact number of people affected, and they were still trying to consolidate information.
He said Pepfar was funding 27 of the 52 districts in the country, contributing about 17% to the R44.4bn budget spent on the various HIV/Aids and TB programmes.
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