The Impact of USAID shutdown on Fragile Countries: Moseka's Health or the context of the Democratic Republic of Congo
On January 20, 2025, an executive order (ED) signed by the President of the United States sent shockwaves around the world. The ED , effective immediately, ordered a “90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy. “
A few days later, on February 3, 2025, Elon Musk, senior advisor to President Trump, announced that he and the president were in the process of shutting down the United States Agency for International Development (USAID).
Reactions
The decision to shut down USAID has sparked widespread concern about its potential consequences on various sectors, including health.
It goes without saying that the health sector will be severely impacted in all countries that receive USAID support, particularly in fragile nations like the Democratic Republic of Congo (DRC). Ranked 5th in the 2024 Fragile States Index, the DRC is also the largest Francophone African recipient of USAID funding.
In 2023, the DRC received $935,766,445 USD through USAID, of which about 25% were allocated to the health sector in various areas, from pandemic management to nutrition.
Potential Impact on Moseka's Health
A quick analysis of the figures in the above image gives an idea of the impact of USAID's shutdown on the Congolese population.
Consider Moseka, a hypothetical Congolese woman whose name means "young girl" in Lingala. She is seropositive, pregnant, and a mother of a 2-year-old child. The potential consequences for her could be:
Lack of Access to Maternal and Child Health Care: USAID invested $21,568,636 to strengthen the capacity of Congolese institutions and communities to provide quality integrated health services, focusing on reducing maternal and child mortality through the Integrated Health Program - DRC.
Lack of Access to Antiretroviral Drugs: In 2023, USAID contributed $7,678,138 to strengthen continuity of care for quality HIV/AIDS services in Kinshasa Province, particularly through projects such as Integrated HIV/AIDS Project in Kinshasa and DRC PEPFAR Assistance.
Lack of Access to Immunization Services: USAID, through various programs, contributed $11,821,835 to vaccination programs in the DRC, including projects Momentum 3B and WHO: Polio & Immunizations.
Many other implications can be drawn if Moseka lived in the eastern regions of the DRC, where a humanitarian crisis has been ongoing for several years.
Recently, a judge blocked the freeze on U.S. foreign aid funds ordered by President Trump, and another blocked the administration's decision to dismantle USAID for at least a week. But what will happen in the long term?
Will this situation present an opportunity for African countries to rethink their approach to health system financing, as suggested by Dr. Jean Kaseya, Director of Africa CDC? Or will it create space for other actors to step in, as seen in Nepal, where China has expressed interest in providing humanitarian, health, and education support?
According to you,
What will happen?