US funding freeze jeopardises 15,000 jobs and key healthcare programmes in SA, Parliament hears

Health Minister Dr Aaron Motsoaledi has laid bare the impact of US President Donald Trump’s “temporary” freeze on funding for the US President’s Emergency Plan for Aids Relief (Pepfar), including near-catastrophic effects on patient care, worsening health outcomes and reducing the availability of vital staff for HIV and TB treatment.

Pepfar contributes 17% towards South Africa’s HIV response, which amounts to more than R7.5-billion and could severely affect the country’s healthcare system and its economy.

In a detailed presentation to Parliament’s portfolio committee on health, Motsoaledi revealed that more than 15,000 people, including nurses, pharmacists and directors, were paid with Pepfar aid.

South Africa has the largest Pepfar portfolio in the world, Daily Maverick has reported. For the US financial year spanning October 2024 to September 2025, Pepfar’s SA budget was about $440-million.

In a breakdown of Pepfar’s funding for that period, Motsoaledi said R4.639-billion was allocated for staffing, while an additional R2.908-billion was spent on office operations, payments to NGOs, the people living with HIV sector, mobile units, youth organisations and the Dreams programme, among other functions.

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

Gauteng will be the hardest hit by the 90-day halt and potential withdrawal of all aid — with the jobs of 6,090 HIV response staff affected — followed by KwaZulu-Natal and Eastern Cape. A total of 15,154 workers would be affected, said Motsoaledi.

Motsoaledi’s presentation came after Trump signed an executive order on 20 January suspending all US foreign development assistance for 90 days, pending a review to determine whether they were “fully aligned” with US foreign policy.

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

However, many Pepfar-funded programmes in South Africa have yet to receive instructions from funders that would allow them to resume their work and health experts have noted that the waiver is very limited.

On Friday, 7 February, Trump signed an executive order to cut financial assistance to South Africa, accusing the government of racial discrimination against Afrikaners, whom he offered asylum in the US. The order was based on the recently enacted Expropriation Act.

Read more: Ramaphosa fires back at Trump’s executive order, rejects claims of ‘race-based discrimination’ in SA

Crucial programmes disrupted

The funding freeze would disrupt prevention methods like pre-exposure prophylaxis, crucial to the Last Mile project, which aims to eliminate HIV as a public health threat by 2030, said Motsoaledi.

He said the vital oversight and community participation programme which is led by Ritshidze through Community Led Monitoring would also be affected. The programme provides tuberculosis testing for high-risk groups, access to treatment for patients with drug-resistant TB, mobile clinics, and outreach teams to support TB/HIV community-based work.

With an estimated 7.8 million people in SA living with HIV, Motsoaledi said 90% of antiretroviral (ARV) medication was paid for from the country’s purse and 10% from Pepfar.

Health Minister Aaron Motsoaledi. (Photo: Frennie Shivambu / Gallo Images)

Former rural doctor and now DA MP Dr Karl le Roux said: “We really hope that the American government can reinstate the funding and services as quickly as possible. We hope and trust that they can see that the services they are providing are essential humanitarian support for millions of South Africans in need and that withdrawing these funds will only increase instability in South Africa and Africa.”

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

Emergency plan needed

Following the funding freeze, a group of NGOs warned that a crisis was looming that demanded immediate attention.

In a letter addressed to Motsoaledi, President Cyril Ramaphosa, the National Treasury and Minister of International Relations Ronald Lamola, the group said a task team to create a coordinated emergency healthcare plan needed to be established no later than 15 February.

This plan should address the immediate effects of the executive order, ensure emergency medical care for at-risk and vulnerable groups and issue directives to all provincial health departments.

“The task team should ideally include partners from civil society with a history of fighting for adequate access to healthcare and documenting access on the ground, and at the very least include the Treatment Action Campaign (TAC). Thereafter it should be circulated for public comment,” said the NGOs.

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

The group wants the government to take urgent interim measures, including allocating a sufficient budget, to ensure that all people not included in the waiver, including LGBTIQ+ people, transgender people, sex workers, men who have sex with men, and other vulnerable and marginalised groups, receive emergency healthcare services, including for HIV prevention.

“Develop an emergency communications plan to adequately notify patients and others who rely on healthcare services affected by the executive order and ensuing chaos on steps being taken to mitigate the effect of the executive order, and guidance on where healthcare services are now available to them. Proactively engage with healthcare organisations and facilities to enable open communications and Information-sharing.”

NGOs say the effects of the funding freeze include:

• The temporary closure of clinics and programmes affecting hundreds of thousands of patients and especially at-risk populations;


• A climate of fear and censorship stemming from instructions to US-funded staff not to speak publicly about the executive order;


• Mass notices of retrenchments and instructions to thousands of healthcare workers not to return to work;


• Instructions to patients not to return for repeat prescriptions, or to obtain counselling, screening and testing;


• The mass referral of patients to government clinics as a result; and


• A knock-on effect on national health programming including HIV prevention, screening, testing and treatment, and for TB and cancer screening and treatment.

Le Roux echoed the NGOs’ concerns, stressing the urgent need for a meeting to address the critical services being compromised. He said while funding was a huge challenge, the biggest obstacle was the lack of fiscal flexibility as government funding had already been allocated.

Motsoaledi said South Africa had not received any formal communication from the US government. However, the Department of Health had begun meeting with provincial heads of HIV and TB programmes, conducting assessments of the immediate impact of the order, and discussing short- and long-term plans.

Parliamentary committee chairperson Dr Sibongiseni Dhlomo said the withdrawal of Pepfar funding should serve as a wake-up call for SA to develop sustainable healthcare solutions independent of external influences.

MPs urged Motsoaledi to prioritise the local production of essential medications, such as ARVs, and to explore innovative funding mechanisms that could support health initiatives without depending on foreign aid. DM

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