(Photo by USAID U.S. Agency for International Development via Flickr/CC BY-NC 2.0)

Is foreign aid a form of charity? Apparently, it is in the eyes of the givers.

On January 20, President Trump signed the executive order that calls for a 90-day pause on foreign aid funding and a 90-day review period. The executive office follows with an immediate freeze of the U.S. Agency for International Development (USAID). USAID is a billion-dollar aid fund that has been operating since the 1960s. Despite multiple opposing legal cases and decisions, the cut left 97% of the workforce fired, and many programs in a vulnerable position.

In the most recent development, the U.S. State Department has announced the official elimination of the USAID. The State Department now fully absorbs all USAID functions. This development means there would no longer be an independent agency for U.S. foreign aid. The State Department now has full authority over American foreign aid activities.

The Trump administration’s push for USAID cuts exposes the hypocrisy behind humanitarian and development aid. The cut in foreign aid also reveals fatal flaws in Africa’s healthcare systems. Yet, we shall see in this article that the sudden and sloppy USAID cuts mark a critical turning point for African nations and their healthcare systems.

What is USAID, and What Happened to It?

In 1961, President John F. Kennedy created the U.S. Agency for International Development (USAID). The agency oversees non-military foreign assistance. Since its establishment, ongoing debates have ensued over USAID’s operation and funding, and whether it is legitimate and effective. The Trump administration has had USAID as its main target, with Elon Musk calling it a “criminal organization.” Secretary of State Marco Rubio claims that USAID is inefficient and “in discord” with the foreign policy and foreign relations of the U.S.

“America First” and Foreign Aid

Rubio says that when assessing the American foreign policy programs, he would ask whether the aid makes America “safer, stronger, and more prosperous.” This aligns with Trump’s “America First” policy, which prioritizes the wealth and security of the United States. The American public also expresses negative viewpoints over the efficiency of U.S. foreign aid. Surveys have shown that 6 in 10 U.S. adults believe the government spends “too much” on foreign aid.

However, the USAID’s original mission suggests that the agency has always been “America First.” From the beginning, President Kennedy was influenced by new theories on foreign assistance, leaning toward non-military assistance. Kennedy envisioned a new form of diplomacy to sustain economic growth in the free world. USAID supporters believe that other nations’ economic progress and stability have an impact on American security. In the end, it has always been in the national interests of the United States.

The agency’s independence from the U.S. State Department was important. The State Department has goals similar to those of the USAID, both advancing American interests across the globe. However, while the State Department mitigates short-term foreign relations tasks, the USAID oversees much longer-term missions, whether extremism or food security. Taking away the independence of the USAID leads to a more overlapping and ineffective U.S. foreign policy.

USAID and its Cut are Neo-Colonial Behavior

U.S. foreign aid has been focusing on the following regions: Africa, Asia, the Near East, and Latin America. Over the years, there have been shifts in funding focus from technical assistance to basic human needs, to economic stability, and then to democracy in recent decades. In the African continent, USAID has been a major supporter of crucial health programs. Notable ones include the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI), the infant mortality program, etc. PEPFAR not only provides life-saving treatment for 20.6 million people (2024), but the program also prevents infections and works systematically to prevent the global spread of HIV.

By dismantling USAID, the critical supporter of development and humanitarian aid in Africa, the Trump administration is neglecting Kennedy’s fundamental ideas. In other regions, stability, not disruptions and confusion, is needed for American security and prosperity. In pursuing the “America First” policy, the Trump administration disregards the agency’s human-oriented missions.

USAID’s sudden cuts give the U.S. the leverage to renegotiate strategic agreements with African nations. A historical example would be the American trade embargo placed on Vietnam in 1975. The U.S. justified its action using Vietnam’s invasion of Cambodia (which was a response to Pol Pot’s genocidal acts); yet, within the context of the global Cold War, Hanoi’s alignment with the Soviet Union must have played a critical role. The country, devastated by the 20-year U.S. intervention, had financial assistance from the International Monetary Fund and the World Bank blocked by its former rival. The relationship only got normalized after Vietnam adopted reformist, market economy policies.

Through its massive economic and political power, the U.S. coerces less-wealthy nations into vulnerable positions—all to gain economic advantages. This is no transactional foreign policy, but mere neo-colonial behaviors.

Why is the USAID Cut a Threat to African Nations?

The U.S. dedicates 70% of its aid to the health sector in the African continent. HIV/AIDS assistance is the largest category among other critical programs. The consequences of USAID cuts include less access to lifesaving treatments, the development of health programs (reproductive healthcare, family planning), and negative impacts on research and innovation. While Trump has restored funds for critical USAID programs in South Sudan, Sudan, and Congo, the messy handling of the USAID has stopped many other programs, leaving their future uncertain.

CFK Africa, an NGO that fights extreme poverty in Kenya, is one of the first to experience the consequences. The organization’s executive director, Jeffrey Okoro, reports that there are more than 1,000 patients who have lost access to lifesaving HIV treatments. Treatment for tuberculosis and contraception to prevent teen pregnancies are also no longer accessible.

Ethiopia, the largest beneficiary in Africa, also experiences extreme disruption. Aid agencies in the country have had to stop food distributions to over 1 million people, leaving them vulnerable to extreme hunger amid Ethiopian politically unstable situation. “We will just die in silence,” said Tsege – one among millions of Ethiopians depending on humanitarian grain. The cut has negative impacts on both the people and local health workers.

These are just the immediate consequences—without even mentioning the long-term ones. While USAID may have begun with a geopolitical mission, that was never its sole purpose. By abruptly abandoning USAID and leaving their beneficiaries extremely vulnerable, the U.S. is saying that access to healthcare, and the support of it, is merely a geopolitical tool. The Trump administration disregards decades of work by its healthcare workers and supporters who believe in the American role as a human rights protector. Access to healthcare is a human right, not a tool for economic or political gains. 

A Unique Opportunity

There have been two dominant views on the impact of USAID cuts on African countries: the consequences of USAID aid cuts and the impact of USAID cuts as a wake-up call. While focusing on consequences is necessary, it implies that African nations are passive and desperate recipients. On the other hand, USAID cuts as a wake-up call, not just without acknowledging the responsibility of the U.S. and other former colonial powers.

We need to make a distinction between humanitarian and development aid. Sid Peruvemba, Speaker of the Board of action medeor e.V., Europe’s largest medical aid organization, describes humanitarian aid as “the non-negotiable humanitarian imperative” and “the moral obligation to save lives.” On the other hand, development aid aims at wider economic, social, and political development. The nature of development aid results in a dependency curse. Zambian writer Dambisa Moyo, in her book Dead Aid, argues that aid has actually made the continent worse off.

Aid cuts pose an important question for African nations: How can they ensure a sustainable and independent healthcare system? South African Health Minister Motsoaledi says that South Africa needs to take responsibility and “stand on our own.” There are similar calls for independence and solidarity across the continent. The challenge now lies in identifying the right strategies to turn that vision into reality. 

Reclaiming Healthcare Ownership

The first concern is addressing the crisis at hand. South Africa is home to the world’s largest HIV epidemic. As the country faces massive cuts in foreign aid, millions of people are losing access to HIV treatment. The government must take immediate action with emergency funding, absorb affected health workers into public systems, and increase domestic HIV financial resources. 

Reclaiming healthcare independence post-USAID cuts is now a priority for African countries, with Nigeria being one of the leading actors. Prof Ali Pate, Nigeria’s Coordinating Minister of Health and Social Welfare, notes that the country has prepared for autonomy long before the change in U.S. policy. Efforts include increasing domestic resources and national ownership, improving the healthcare value chain, and fortifying resilience through production and research systems. Such actions provide both short-term relief and long-term solutions.

Financing is another critical issue in the African healthcare crisis. After decades of relying on external actors for financing, African nations are now looking within. Dr Chikwe Ihekweazu, the new acting regional director for WHO Africa Alternative, suggests more regional cooperation to lower financial dependence. Alternatively, funding sources could come from collaborations between public and private actors. For example, the African Development Bank Group provides financial support and insights for local entrepreneurship. Such investments contribute to the advancement of agriculture, infrastructure, and technology across the region.

Cooperating and Digitalizing

National leaders should also focus on “empowering regional and local institutions,” such as the African Union’s support for the Africa CDC, a public health agency for the African Union. Dr Sabin Nsanzimana, Rwanda’s Minister of Health, outlines the country’s plan for building a sustainable healthcare system: “investing in people, infrastructure development, advanced equipment and technology, effective systems and governance, and innovation.”

Furthermore, there are plenty of possible collaborations in Africa’s healthcare landscape, not limited to humanitarian or development aid. Digital health tools have the potential to yield large impacts on Kenya, Nigeria, and South Africa, boosting their healthcare systems’ efficiency. These technologies include smartphone connectivity, data management policies, and data infrastructure. 

The digitalization of healthcare in Africa can improve care and lower costs by improving disease surveillance, offering remote consultations, and providing local health workers with training and education. The need to build healthcare infrastructures, both general and digital, provides investment opportunities with mutual benefits for the public and private sectors. 

“No Trump, No Problem”

The USAID and its abrupt elimination are all means of neocolonialism—the control over developing countries by developed countries through socio-economic and political means. Neocolonial behaviours aim at reinforcing capitalism, which is the exact goal of Kennedy’s vision and Trump’s “America First” approach to USAID. But the USAID, as well as humanitarian and development aid as a whole, carries more than just (geo)political missions. It is a global collaboration in the name of humanity.

USAID’s sudden cuts have revealed fundamental flaws within the healthcare systems of many African countries. Yet, when it comes to healthcare, African nations are the most impactful actors in their own region. Now is a critical time for African leaders and societies to focus on capacity building, infrastructure development, and cross-sector partnerships. Or as the Kenyan talk show host Yvonne Kawira names one of her podcasts: “No Trump No Problem.”

Edited by Lubaba Mahmud