Stalled US funding halts construction of remote Eastern Cape clinic

A community health worker performs growth monitoring during a home visit in Nqileni Village, Eastern Cape. (Photo: Supplied / Bulungula Incubator)

By Tamsin Metelerkamp

31 Mar 2025

A years-long effort to build a clinic in the rural Xhora Mouth Administrative Area in Elliotdale, Eastern Cape, has hit a wall as US aid to South Africa stalls.

The adverse impacts of the recent cuts in US foreign development assistance have reached even the remote, rural areas of South Africa. In the Xhora Mouth Administrative Area in Elliotdale, Eastern Cape, a years-long effort to construct a clinic for the community has stalled, right on the brink of breaking ground.

The construction of the clinic was due to begin in April, supported by $795,372 (about R14.5-million) in funding from the US Africa Command’s Overseas Humanitarian, Disaster and Civic Aid programme, in coordination with the US Embassy in Pretoria’s Office of Defense Cooperation, according to a US Embassy official.

The Eastern Cape Department of Health was providing a further R25-million for the project, said Nosintu Gwebindlala, deputy senior traditional leader at Jalamba Traditional Council in Elliotdale and wife of the Bulungula village chief.

xhora mouth health worker A community health worker during a routine home visit in Xhorha Mouth, Eastern Cape. (Photo: Supplied / Bulungula Incubator)

However, the US funding for the project has been suspended, leaving local community leaders uncertain of when – or if – construction will go ahead.

“We’ve been stuck, we’ve been fighting for this clinic for close to 15 years now… and eventually we thought that we had found a breakthrough. So, we are back to square one, in a way,” said Gwebindlala.

“[The clinic] was going to have a very big catchment area. About four administrative areas were going to benefit from this clinic. It’s not only us in our area, but even our neighbouring villages [that] were also going to benefit.”

The US funding was suspended after President Donald Trump issued his executive order, “Addressing Egregious Actions of the Republic of South Africa”, on 7 February, said the US Embassy official.

In this order, it was claimed that the recently enacted Expropriation Act was enabling the South African government to “seize ethnic minority Afrikaners’ agricultural property without compensation” – an accusation that President Cyril Ramaphosa has since refuted.

antiretrovirals bulungula A community health worker delivers antiretrovirals to a patient through the Central Chronic Medicines Dispensing and Distribution system. (Photo: Supplied / Bulungula Incubator)

“When Trump… said he’s cutting funding, you would never think that it would affect the deepest rural [areas]... Yissus, the impact is big. It might be downplayed, but if it can even go down to us, it is big,” noted Gwebindlala.

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

Read more: ‘The axe has fallen’ — Trump’s USAid issues notices to terminate funding for key health programmes across SA

Community health struggles

There is no government clinic in the Xhora Mouth Administrative Area, according to Gwebindlala, and reaching health facilities in neighbouring communities is far from easy.

“There are three scenarios to get to a clinic. One, we have to travel 20km to the next clinic. The other option is to cross a very big river... with a [home]-made canoe. If it’s raining, it means you can’t. And then the other option is to cross a very big forest to another clinic,” she said.

Gwebindlala said she hoped the Eastern Cape Department of Health would come up with a plan to ensure construction of the clinic could continue, but she had yet to receive a decision.

Daily Maverick asked the Eastern Cape Department of Health, but had not received a response at the time of publishing.

The Bulungula Health Point in Xhora Mouth Administrative Area, a fixed outreach site of Nkanya Clinic in the Eastern Cape. (Photo: Supplied / Bulungula Incubator)

The Bulungula Incubator, a nonprofit organisation based in the Xhora Mouth Administrative Area, started the Bulungula Health Point to assist the local community in 2012. While it began as a central pickup point for HIV medication, it has since grown to employ one part-time and two full-time professional nurses, according to Sigrid Kite-Banks, spokesperson for the Bulungula Incubator.

“A lot of people weren’t able to get to the clinic, so a lot of non-communicable diseases and chronic diseases were going unchecked. We had a very high rate of strokes, lots of people with diabetes, people who were HIV-positive who weren’t on medication. We just had a whole host of really poor health outcomes, just because of the distance to the nearest clinic,” said Kite-Banks.

About 70% of the Bulungula Incubator’s funding for its health programme comes from the Eastern Cape Department of Health, continued Kite-Banks. The nonprofit also has a team of 20 community health workers who travel between four villages to provide primary healthcare within homes.

A community health worker performs growth monitoring on an infant during a home visit in Nqileni Village, Eastern Cape. (Photo: Supplied / Bulungula Incubator)

Kite-Banks said that the construction of the US-funded clinic would have made a big difference in serving health needs in the Xhora Mouth Administrative Area.

“Even if we have the health point in one village… it’s such a vast environment that it’s really difficult to be able to cover so much ground,” she said.

“Having this other clinic would have been massive, just in terms of sharing capacity and workload, but also in making it more sustainable. The Bulungula Incubator’s purpose is always just to fill the gap and then try to make all of the projects stand on their own two feet, whether it becomes its own business, or it gets integrated within the Department of Health, and so this would have been a huge step in sustainability for our community.

“It just would have helped with health access hugely.” DM

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Community health struggles