Minister of Finance Enoch Godongwana and director-general of National Treasury, Duncan Pieterse, addressing a media briefing on 2025 Budget Speech Postponement at Imbizo Centre.
Image: GCIS
SOUTH Africa needs a robust, long-term plan that is sustainable and makes provision for the country to invest in its own healthcare and disentangle itself from its dependency on the US and other foreign donors, especially in the context of US self-interest.
In her editorial in the latest edition of the SA Medical Journal, Acting Editor and founder and former Director of the Steve Biko Centre for Bioethics at the Wits Faculty of Health Sciences, Ames Dhai said the lives and livelihoods of vulnerable South Africans should not lie in the hands of foreign funders.
Finance Minister Enoch Godongwana is expected to address how the government will plug the gap left by the withdrawal of US funding, particularly for HIV and TB treatment programmes, in his budget speech on Wednesday.
US President Emergency Plan for AIDS Relief (PEPFAR)-funded HIV organisations in the country received communication on February 27 that their grants had been permanently terminated because they were not aligned with US Agency for International Development (USAID) priorities, and their programmes were not in the US national interest. They were told to immediately cease all activities and terminate all subawards and contracts.
“There is no guarantee that other donors will not follow suit,” Dhai said, adding that the state’s “lack of urgency in yet another crisis is appallingly woeful.”
She said funding from foreign donors is not without conditions and strings attached.
“The history of how international development took off is worth noting. In the wake of the Second World War, global powers competed to establish a new world order, and international development started to be built up. International agreements and multilateral institutions were created. Major industrialised nations emerged as the primary donors of foreign aid. The development has been guided by international initiatives such as the Millenium Development Goals and the 2030 Agenda for Sustainable Development. However, it is important to recognise that the governments of main donor countries have their own interests in mind when providing aid, and these can be influenced by ideological, geopolitical, economic and social agendas, as has been seen by the latest Trump directive on USAID.”
Dhai referenced a February 11 circular issued by the Director General of Health outlining the health department’s contingency plan to respond to the temporary suspension of support by PEPFAR and its implementing partners, which included the redeployment of trained Department of Health staff to fill gaps left by PEPFAR-funded personnel.
However she said “with the massive staff shortages in healthcare throughout most of the country, it becomes evident again that the department remains far removed from the realities on the ground”.
Other measures include facility-level task shifting and prioritising enrolment in repeat prescription collection strategies (RPCs), 3-month antiretrovial therapy (ART) and PrEP dispensing and HIV testing. To reduce clinic visits and ease the burden on health facilities, 6-month ART refills are to be provided to the patients on ART returning for prescriptions who have two consecutive suppressed viral loads <50 copies/mL and meet criteria for RPCs, including clinician-confirmed stability and voluntary patient opt-in.
Dhai said that while much of the focus in the country has been on the PEPFAR programme, health research has been negatively impacted by the funding cuts as well.
The South African Medical Research Council (SAMRC) receives about one-third of its funding from US federal sources, mostly for HIV and tuberculosis research, but also for other areas, including maternal and infant mortality and antimicrobial resistance.
The African-led BRILLIANT study, aiming to develop capacity to produce vaccines on the continent, is funded entirely by a USD45-million grant from USAID.
“The CEO of the SAMRC is pessimistic that funding for the study will resume. Hence the vaccines that are ready for clinical trials will probably remain in storage,” Dhai said.
Studies on other infectious diseases, gender-based violence, health systems strengthening and disease-burden monitoring are also affected by the funding cuts, which have major repercussions on staffing as well.
Universities are affected, with Trump’s halting order being felt across a range of research and academic sites.
“Furthermore, research participants could be put at risk of harm. Studies with research participants already enrolled and on interventions cannot be halted abruptly, or prematurely terminated. Sponsors have ethical obligations to monitor these participants for adverse events and manage them accordingly.
“While prioritising how to address the current issues, it is also necessary that we embark on the journey to self-sufficiency, and reflect on the dependency created by our over-reliance on foreign funding. In addition, we need to see our government stepping in and showing leadership in addressing this calamity," Dhai said.
Cape Times