If you cut "secondary" healthcare programs, even the life-saving treatments you kept will eventually stop working.
When US aid was cut in Uganda and Zimbabwe, a 'humanitarian waiver' was meant to protect life-saving HIV drugs. However, because the 'prevention' and 'testing' infrastructure around those drugs was cut, even the 'protected' treatment delivery crashed by 29%, proving you cannot surgically separate essential medicine from the bureaucracy that supports it.
HIV Service Delivery Disruptions Following the PEPFAR and USAID HIV Funding Withdrawal in Uganda and Zimbabwe: An Interrupted Time-Series Study
SSRN · 6426315
Background: In January 2025, the US government froze foreign aid and dismantled USAID, abruptly halting PEPFAR, the largest external funder of HIV services globally. A narrow humanitarian waiver preserved ‘lifesaving’ services, but prevention, testing, and treatment programmes were severely impacted, particularly for key-populations. Quantitative evidence of real-world impacts on non-governmental organisations (NGOs) that directly lost funding has been absent. We aimed to estimate the effect of