Business
USAID’s exit compounds Nigeria’s healthcare system woes
Donald Trump’s re-election has not only threatened to create a new order in the United States, but has led to immense uncertainty across the world. His return to the White House, it was widely speculated would lead to many seismic shifts in global policies, especially foreign aid.
He has not disappointed analysts of a doomsday scenario. Among other moves President Trump has made, his cancellation of the United States Agency for International Development, USAID, according to analysts, has huge implications for the healthcare system in Nigeria.
Around the globe, Trump’s isolationism has forced countries to recalibrate their strategies, and their citizens are beginning to brace for what lay ahead. In Germany for example, the government has increased defence budget to $540 billions, the highest since the Second World War, because of Trump’s reluctance to continue to fund the North Atlantic Treaty Organisation, NATO .
Nigeria, according to analysts, can not be an exception – a country that relies on foreign aid to strengthen its healthcare system.
Many organisations in the healthcare ecosystem are beginning to think of recalibrating their goals and methods. Aaron Sunday, leader of the Association of Positive Youths with HIV in Nigeria (APYIN), is worried about what could change and how this might affect him. His fear is the withdrawal of USAID assistance in the area of healthcare.
Trump’s executive order brought about a 90-day freeze on foreign aid, and the USAID became a target in the attempt to slash foreign assistance.
Three days after the executive order ushering in a 90- day freeze, an email reached Mr. Sunday’s inbox: the Lift Equity project, a successful initiative set up to improve adolescent access to HIV care in Nigeria, had been halted . The inroads and progress they had made – engaging local authorities, advocating for policy reforms – came to an abrupt halt.
“The age of sexual debut in Nigeria is often below 18, so policies must recognize this reality to ensure effective HIV prevention and control,” Mr. Sunday explained.
“We had begun building momentum, holding meetings with local authorities, parents, and health commissioners across states. Then, suddenly, everything stopped.”
Mr. Sunday’s case is not a one-off or isolated. It was learnt that a lot of civil society organisations and leaders of CSO networks across the country had received emails suspending ongoing projects with the agency. It was gathered that the development has left beneficiaries, many of whom rely on them for healthcare, education, and livelihoods with uncertain futures.
Rupture across the health sector
The suspension of foreign assistance and the halt of USAID-funded projects created a sense of uncertainty in Nigeria, it triggered a heated debate. One of the highlights is the debate it has triggered around dependency. Some see the development as an opportunity for the government to reduce dependence on foreign aid and take greater ownership of healthcare funding. Others are of the view that the sudden stoppage would cripple essential services and put vulnerable populations at risk.
The effects according to reports are becoming clear across national, state, and local levels, as a lot of non-governmental organisations have seen their activities come to a halt.
Reports have it that many USAID- assisted clinics and research centres have shut down, while some interventions programmes were abruptly suspended. Some community health workers have also reportedly lost their jobs, and health workers deployed by USAID to hard-to-reach areas were recalled. Humanitarian aid has dwindled, leaving vulnerable groups without essential support.
Dr. Abayomi Adekunle, a consultant gynaecologist, told Business Hallmark that “For many Nigerians, this translated to more than just policy shifts – it meant empty clinics, halted treatments, and a growing sense of uncertainty about the future of their healthcare.
“Like many other developing countries, Nigeria relies heavily on foreign aid to address critical issues, particularly in the provision of healthcare to millions of her citizens.
“The country’s dependence on foreign aid created room for USAID – an organisation responsible for disbursing most U.S international aid – and left a huge gap in its absence.
He noted that the ” U.S is the world’s largest international aid donor and the largest contributor of Official Development Assistance (ODA) to developing countries.
“In 2023, for instance, the U.S disbursed close to $72 billion as aid and about $44 billion – nearly 61 per cent of this – came from USAID.
The agency is also a key implementation partner in the President’s Emergency Plan for AIDS Relief (PEPFAR), the primary source of funding for anti-retroviral therapy, testing, and HIV prevention services in Nigeria.
The Chairman of the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) Bauchi chapter, Abdullahi Ibrahim, was quoted as saying the halt of USAID is a serious threat to HIV control efforts in Nigeria.
Healthcare services most hit
It was learnt that although USAID maintains strong presence in developing countries and gives assistance for issues across sectors, a significant portion of its funding is dedicated to health interventions.
For instance, in 2024, the U.S provided $3.7 billion in humanitarian aid to sub-Saharan Africa, with Nigeria among the top recipients. About $2.7 billion, 73 per cent of the fund, was spent on health programmes.
It was gathered that due to the agency’s strong influence on the health sector, the gap created in its absence is most felt in healthcare services.
Dr. Kayode Oni, chairman of the Kogi CSO Networks, told Business Hallmark that most of the intervention programmes suspended in the states focused on addressing health issues.
“The impact has been mostly on healthcare. It affected other sectors directly and indirectly, but the agency contributes significantly to healthcare.”
USAID services are said to range from addressing infectious diseases to epidemics and public health emergencies. USAID provided Nigeria with vaccines during outbreaks.
Business Hallmark’s investigations showed that in 2024, USAID donated 10,000 doses of the Mpox vaccine to Nigeria, making it the first African country to receive the vaccine – ahead of the Democratic Republic of Congo, where the disease is more endemic. This was when many African nations struggled to get the vaccine.
The agency eventually donated one million doses of vaccines to African countries.
It also played a major role in the effort to contain COVID-19 between 2020 and 2021, by supplying Nigeria with vaccines at intervals.
The agency has partnered with other health organisations, such as the WHO and the GAVI alliance, to provide vaccines for endemic diseases like measles, cholera, and tuberculosis.
Health professionals said Nigeria may not get vaccine donations this year without USAID.
Dr. Oni noted that with limited access to vaccines, Nigeria risks higher infection rates, increased mortality, and greater strain on an already fragile healthcare system.
Despite waiver, HIV control efforts suffers
In spite of the U.S waiver to exclude “lifesaving” humanitarian assistance from the aid freeze, such as funding for HIV control, the provision of this assistance in the country has dwindled.
It was learnt that many HIV clinics and research organisations in many states, including Akwa Ibom, Sokoto and Bauchi, have closed shop.
Also affected are local contractors and sub-grantee organisations for HIV programmes, who have had to suspend work, and workers deployed to ensure implementation in hard-to-reach areas have returned.
In a report by the Council of Foreign Relations, no money has been disbursed due to a lack of clarity on interpreting the waivers, and the freeze has continued to cause mass layoffs and suspensions.
The situation in Nigeria is likely to worsen over time, disrupting healthcare for the almost two million people in the country living with HIV/AIDs.
However, most people are still able to receive treatment and anti-retroviral drugs.
In Zamfara, it was learnt, USAID’s nutrition advocacy and caregiver empowerment programmes have been halted. These initiatives are set up to guide caregivers with an understanding of the essential micronutrients their wards need.
Musa Umar, the lead CSO for the Zamfara Network of CSO, told journalists that the local staff assigned to execute the project in different communities were called back in January.
Health advocates said the suspension of these programmes means the support and guidance provided to parents and caregivers under the initiative are currently unavailable.
According to the United Nations Children’s Fund (UNICEF), about 250,000 children are suffering from severe acute malnutrition in Zamfara.
Humanitarian assistance for IDPs has also declined. U.S-funded CSOs, known for providing necessities like food to displaced families, have scaled back their services.
Mr. Umar said, “In a case where there are normally five or six non-profits providing different forms of humanitarian assistance to displaced persons, you can only find one or two.”
In Ebonyi, Tuberculosis intervention projects were grounded alongside other major projects following Mr. Trump’s stop work order.
Ajah Oliver, executive director of Cooperation Social Responsibility, a non-profit organisation in Ebonyi, disclosed that the state relied heavily on USAID funding. As a result, the policy ended interventions statewide.
It grounded education interventions alongside Water, Sanitation, and Hygiene (WASH) programmes.
Mr. Oliver said the agency was also primarily involved in revitalizing PHCs in Ebonyi through a statewide Integrated Health programme.
The programme’s major goal was to improve maternal health by ensuring better access to quality care.
Increasing domestic funding
In the wake of Mr. Trump’s policy, the Nigerian government began trying to bridge the huge funding gap. On 3 February, the Federal Executive Council (FEC) approved $1.07 billion to finance the healthcare sector reforms under the HOPE programme and N4.8 billion for HIV treatment.
A week later, the Nigerian Senate increased health sector funding in the 2025 budget by an additional N300 billion, aiming to strengthen programmes targeting tuberculosis, HIV, malaria, and polio.
However, these allocations are insufficient compared to the USAID’s interventions in the country over the last 10 years.
According to data from the U.S Department of State website, USAID has provided Nigeria with $6.39 billion in foreign aid in the last decade.
Tayo Fatinikun, Executive Director of Life Helper Initiatives, a non-profit in Sokoto, said the U.S policy should be a wake-up call to the government to strengthen domestic funding for key sectors.
“We can’t be dependent forever. The government, both at the state and federal level, needs to step up,” he said.
Meanwhile, some organisations are seeking alternative donors outside the U.S to sustain their work. Some others are waiting for the aid freeze to be lifted after 90 days.