How one country became perilously dependent on USAID – and what has happened since U.S. withdrawal
When USAID aid was cut to her country, Ugandan lawmaker Dr. Eunice Apio was shocked to learn how heavily dependent her nation had become on American aid and management of fundamental life-saving programming. Apio won her seat in parliament on an anti-corruption platform, boldly opposing corruption schemes. She and colleagues are committed to ending the country’s dependency on U.S., but advocate for a more phased approach which could save lives that are now perishing in the abruptness of the new reality. For the U.S. State Department, a phased approach in Uganda could bolster American security interests with the partner nation as it shifts to the America First foreign policy footing.
The author in Lamwo Uganda with women Acholi elders
According to U.S. foreign assistance data, U.S. aid to Uganda amounts to $710 million (Shs2.5 trillion) per year—the bulk of it going to HIV/AIDS treatment— with over 700,000 Ugandans receiving lifelong ARV therapy through the President’s Emergency Plan for AIDS Relief (PEPFAR). The USAID funding of health activities in Uganda is almost double what the health sector was allocated in the 2024/2025 budget at Shs1.3trn.
1). Impact on health;
12,551 community health workers in Uganda directly affected;
The health ministry in Uganda has announced its intention to shut all dedicated HIV/AIDS and TB clinics in the country. Stand-alone pharmacies supplying antiretroviral drugs will also be closed. ‘People will die’: chaos and mounting fear in Uganda as USAID cuts lead to ‘total panic’ and HIV clinic closures. The rich are said to be buying out ARVs and hoarding them.
A USAID initiative called the President’s Emergency Plan For AIDS Relief – or PEPFAR – has bankrolled much of Uganda’s HIV/AIDS relief plan and it’s an initiative that has wielded impressive results.
Specially trained staff and dedicated clinics are credited with bringing infection rates down from 19% in the late 1990s to 5% in 2024.
What’s behind the U.S. supplied budget:
USAID funding has been instrumental in combating infectious diseases, improving maternal and child health, and strengthening health systems. Programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) provide antiretroviral therapy (ART) to thousands of HIV-positive individuals. The withdrawal of funding will lead to interruptions in treatment, putting patients at risk of drug resistance and increased mortality. There are currently more than 1,416,800 people on ARV treatment across 2,051 health facilities. The suspension of services will mean immediate disruptions in care for thousands of individuals dependent on consistent medication.
Among the most affected are pregnant women living with HIV, who rely on PEPFAR for treatment to protect their health and prevent mother-to-child transmission. In Uganda alone, 41 newborns are estimated to contract HIV every day during the stoppage. Over a 90-day period, this could lead to more than 3,690 babies being born with HIV, many of whom will also go undiagnosed due to the suspension of infant HIV testing services. These infants face a significantly higher risk of mortality if they do not receive immediate treatment.
Beyond direct beneficiaries, Uganda’s healthcare workforce is also severely impacted. The country has 20,809 PEPFAR-supported healthcare providers, including 923 doctors, 1,622 nurses and midwives, 756 laboratory staff, and 12,551 community health workers. With stop-work orders in effect, many facilities will be left understaffed, making it difficult to provide even basic medical care. This will not only affect HIV services but also disrupt the broader healthcare system, straining already limited resources.
USAID has supported immunization, malaria and TB campaigns. Rural clinics will likely face shortages of vaccines, essential medicines, and health care staffing, resulting in a resurgence of preventable diseases. Maternal and child health services also face disruptions, potentially increasing maternal mortality rates.
2). Education
Firstly, universities now suffering severe financial shocks considering the sector’s dependence on US aid for research (especially critical research program such as HIV/AIDS at Makerere University have come to an abrupt end). Secondly, scholarships have been disrupted, and current beneficiaries are now in a financial crisis. Thirdly, infrastructure projects to improve learning environments have been halted. Fourthly, USAID has supported the construction of schools, provision of learning materials, and teacher training programs. Digital learning tools provided to schools in remote regions have improved access to education for many children. A work stoppage order means schools are under-resourced and unable to meet the growing demand for quality education. Programs addressing barriers to girls’ education, such as early marriage and menstrual health, are also at risk and hard-fought efforts to improve gender equity in education will be lost.
3). Food security: Food security is a critical concern, especially for Uganda’s refugee population of over 1.3 million people. USAID has funded food aid programs that provide life-saving assistance to refugees in settlements like Bidi Bidi and Nakivale. The cessation of funding jeopardizes these programs leading to increased hunger and malnutrition. USAID’s agricultural development initiatives, such as the Feed the Future program, have helped smallholder farmers improve productivity and adopt climate-resilient practices. Without these interventions, communities reliant on agriculture will struggle to sustain their livelihoods, particularly in the face of climate-related challenges.
4). Economic development and livelihoods
The withdrawal of funding also affects economic development and livelihoods. USAID has supported programs that empower women through financial literacy and entrepreneurship training. Initiatives with women in Kampala’s slums have enabled many to start small businesses and improve their household incomes. Youth vocational training programs funded by USAID have equipped young people with skills that have reduced youth unemployment. The funding halt limits these opportunities, exacerbating poverty and increasing the risk of social unrest.
Humanitarian assistance is another area where the impact of USAID funding withdrawal is already being felt deeply. In times of natural disasters, such as floods in Kasese or droughts in Karamoja, USAID has provided emergency aid, food, shelter, and medical supplies. The absence of such support in future crises leaves communities vulnerable and less prepared to respond effectively. Access to clean water and sanitation, particularly in rural areas and refugee settlements, has been bolstered by USAID projects like borehole drilling and hygiene campaigns. The risk of waterborne disease outbreaks can only increase with funding withdrawals.
5). Strain on Civil Society and Governance Initiatives
Civil society and governance programs are also at risk. Many local organizations in Uganda rely on USAID funding to advocate for child protection, gender equality, and education. These organizations face significant challenges in sustaining their work without external financial support. USAID’s efforts to promote good governance, transparency, and institutional strength may stall and hinder progress toward accountable and effective public sector management.
The most prominent local NGO, FAPAD, whose police reform programming receives support solely from the National Endowment for Democracy (NED). All of FAPAD’s police reform projects have come to an abrupt end. Moreover, NED support had ensured the retention of key management and technical staff to run the project. The very existence of this 20-year-old human rights organisation, the only one of its kind in war affected Northern Uganda, is now threatened.
The past is prologue
The impact of the funding withdrawal is evident in past crises. During a temporary funding shortfall in 2022, refugee clinics in northern Uganda reported overcrowding, drug shortages, and increased mortality rates. Similarly, in Karamoja, USAID-supported resilience programs helped farmers adapt to drought, but without funding the region’s food insecurity increased. These examples highlight the ripple effect of reduced aid on Uganda’s most vulnerable populations.