Pressure mounts on Health Minister Motsoaledi to remedy ‘catastrophic consequences’ of US aid freeze

A group of health and human rights organisations issued a joint letter on Wednesday calling on the South African government to provide a “coordinated emergency response” to the healthcare crisis created by the US government’s actions in relation to foreign aid.

Signatories stressed the need for an increased budget for healthcare services, as the temporary suspension of the US President’s Emergency Plan for Aids Relief (Pepfar) continues to affect the work of key health programmes in SA.

“The current situation has sowed incredible chaos and confusion as Pepfar-supported programmes remain ‘paused’, jeopardising the health, lives and livelihoods of thousands of people, especially key at-risk populations with HIV, TB and cancer,” stated the letter.

“We do not know what steps you have taken to start to remedy the catastrophic consequences of the Executive Order, if any. Minister Motsoaledi … what is the plan, both for now and the future?”

The letter was addressed to Minister of Health Aaron Motsoaledi, Minister of Finance Enoch Godongwana, Minister of International Relations and Cooperation Ronald Lamola and President Cyril Ramaphosa.

Among the organisations behind the letter are the Health Justice Initiative, the Treatment Action Campaign, SECTION27, Sweat, African Alliance, Cancer Alliance and the Public Service Accountability Monitor at Rhodes University.

The letter comes just over two weeks after US President Donald Trump signed an executive order, “Reevaluating and Realigning United States Foreign Aid”, which triggered a 90-day freeze on almost all US foreign development assistance, pending a review to determine whether programmes were “fully aligned” with US foreign policy. This included Pepfar, the global health programme started by George W Bush, and all US foreign assistance funded by or through the State Department and the US Agency for International Development (USAid).



Read more: 

• ‘I’m breaching my Hippocratic oath’ – Trump’s foreign aid freeze halts key HIV programmes


• US State Department grants waiver on aid freeze for ‘life-saving humanitarian’ assistance

Severe consequences

On 28 January, US Secretary of State Marco Rubio issued a waiver on the 90-day freeze for “life-saving humanitarian assistance”, stating that implementers of existing life-saving programmes could continue or resume work.

While the waiver permits the continuation of “core life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs”, it excludes “activities that involve abortions, family planning, gender or [diversity, equality, and inclusion] ideology programs, transgender surgeries, or other non-life saving assistance”.

“Despite the Waiver, we understand that most Pepfar implementing partners have not received any direct or complete communications from the United States Government about the implications of the Executive Order and the Waiver, leading to ongoing uncertainty. News reports also indicate that senior USAID officials have resigned or been placed on leave,” stated the letter from civil society stakeholders.

“These developments are likely to delay communication to implementing partners and lead to legal challenges against the decisions taken by the Trump administration.”

The organisations estimated that the orders to stop work issued to SA health programmes as a result of Trump’s executive order directly affected at least 900,000 patients living with HIV in four districts, while the livelihoods and jobs of several thousand healthcare workers were at risk.

“We are aware of the temporary closure of multiple organisations and facilities providing essential healthcare services to, among others, sex workers, members of the LGBTQI+ community, transgender persons and other marginalised communities seeking sexual and reproductive health support. These facilities have been instrumental in delivering HIV prevention, treatment and care services,” stated the letter.

Read more:

• Trump’s executive orders spark chaos — South Africa’s vital HIV programmes face uncertain future


• Trump’s freeze on HIV/Aids foreign aid is troubling news for the US — here’s why

While South Africa self-finances the majority of its HIV services, it is the largest recipient of Pepfar funding globally. These funds account for about 17% of the national HIV budget across 27 districts.

In the long term, the funding shortfall caused by the loss of Pepfar may affect antiretroviral therapy (ART) for adults and children; HIV prevention programmes; the livelihoods and jobs of direct clinical and care providers; and linkage to care for communities affected by HIV, TB and even cancer, warned the organisations behind the letter.

“Beyond HIV services, South Africa receives additional US foreign assistance for academic institutions and several NGO programmes, all of whom are now severely affected by the Executive Order, and who work in the following areas, among others: clinical research on key diseases; screening and counselling for HIV, TB, and cervical cancer; educational programmes on health; and patient data collection,” stated the letter.

The signatories called on the South African government to:

• Establish an intergovernmental task team to develop a coordinated urgent emergency healthcare services plan to mitigate the adverse immediate-term effects of the executive order;


• Allocate sufficient budget to ensure that all people not included in the waiver — including LGBTIQ+ people, sex workers, men who have sex with men, and other vulnerable and marginalised groups — receive emergency healthcare services;


• Develop an emergency communications plan to notify patients and others who rely on healthcare services affected by the executive order;


• Engage with healthcare organisations and facilities to enable open communications and information-sharing;


• Ensure that accurate information is collected and disclosed to the public; and


• Revisit and develop existing policies and budget allocations to plan for the consequences of the suspension or cancellation of foreign assistance awards after the 90-day review.

“We also call on President Cyril Ramaphosa to address this issue in his State of the Nation Address to adequately inform all affected parties and assert government’s commitment to ensure uninterrupted access to life-saving medication, testing and care for all key populations; and to uphold the rights of all individuals to access non-discriminatory healthcare services,” stated the letter.

“We also need to start planning for the suspension or cancellation of foreign assistance awards from the U.S., should that be the result of the 90-day review period. We cannot wait until then to get our affairs in order.”

Motsoaledi briefs portfolio committee

On Wednesday, Motsoaledi briefed the portfolio committee on health about the withdrawal of Pepfar funding, noting that the programme supported 15,374 workers in the health sector at a cost of R4.6-billion. A further R2.9-billion goes towards the running costs for offices and direct payments for NGOs and mobile units, among other initiatives.

“[The National Department of Health] hosted a meeting with provincial heads of HIV and TB … to discuss this issue. The department also conducted an assessment of the immediate impact of the executive order — what impact it will have if everything happens the way it was announced in the beginning,” said Motsoaledi.

He added that provinces had been instructed to develop “contingency plans” for the short- and long-term impacts of the funding freeze. The national department had also engaged with People Living with HIV and Aids, one of the civil society sectors of the South African National Aids Council.

Philip van Staden, a Freedom Front Plus MP, asked Motsoaledi whether the department had plans to support the thousands of Pepfar-funded health workers affected by the funding freeze.

Motsoaledi said, “I want to appeal to members that we also need to [slow] down when we are doing the assessment. It’s not that we are waiting for 90 days, but I don’t think a fast knee-jerk response will help. For instance, when we look at the number of people affected, you have got to review, can I do the same work with fewer staff members?

“Our assessment as a country is going to … look at those. Can we, for the time being, do without this and that category? Those are the things that we have to do, and they take a little bit [more] time than the few days for which we have been living with this problem.”

https://www.youtube.com/watch?v=Phvd7nk_MDc&ab_channel=ParliamentoftheRepublicofSouthAfrica

US-SA relations

On Monday, 3 February, Motsoaledi met with Dana Brown, chargé d’affaires for the United States Mission to South Africa, to discuss bilateral health cooperation and new US policies on assistance.

This meeting came after Motsoaledi’s statements last week that the National Department of Health had not received any communication from the US government about the suspension of aid, and had instead learned of the funding freeze from NGOs, according to a News24 report.

Motsoaledi told members of the portfolio committee that he couldn’t provide any more details about the outcomes of Monday’s meeting with Brown, beyond the information that was provided in a joint press release issued by the Department of Health and the US embassy on Tuesday, 4 February.

The press release stated, “The Minister and the Chargé d’Affaires noted the importance of the assistance that South Africa has received from the United States since the start of the HIV and AIDS pandemic, over two decades ago. The Minister conveyed his thanks for this support.

“This assistance has been consistent and crucial to the drastic reduction in maternal-to-child transmission of HIV, infant deaths and the increase in life expectancy generally. Communication channels are open between the Ministry and the Embassy, and we continue to discuss our life-saving health partnership moving forward.” DM

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