USAID’s Rollback Threatens Ethiopia’s Healthcare System

After returning to his second term in office, US President Donald Trump signed an Executive Order halting almost all international spending for ninety days. One major target of Trump’s spending cuts includes the United States Agency for International Development (USAID), a federal agency that has financed humanitarian programs around the world for over six decades. As part of its humanitarian initiatives, USAID has dedicated a considerable pool of its budget to addressing critical health issues in recipient countries, including long-standing USAID partner Ethiopia. As the largest recipient of US aid in Sub-Saharan Africa and fifth largest in the world, Ethiopia receives extensive funding that helps millions of people through diverse programs addressing infectious diseases, medication deployment, and refugee assistance. Now, with USAID indefinitely dismantled, the country must scramble to locate alternative funding in light of a substantial and sudden loss of financial support. The future of USAID looks grim. The website went offline with no explanation and nearly all of the agency’s staff are on indefinite leave or have been fired. In fact, over 90% of USAID’s contracts for humanitarian and development work around the world are terminated, and staffers in DC are forced to clear out their life work in a fifteen minute window.

The healthcare sector has been USAID’s top priority in Ethiopia, with the agency funneling nearly $200 million annually into disease surveillance and prevention programs, HIV response, funding cold storage for medicines, and the purchase of basic supplies. As a result of USAID’s termination, many of these activities have come to a halt, and thousands of health ministry employees hired with US help are at risk of losing their jobs. Programs that are currently on pause include a “Five-year project that trains doctors, nurses, midwives, and surgeons;” polio vaccination, which means that vaccines may go to waste  as they expire before being delivered to children; and initiatives that deliver medications for HIV, tuberculosis, and malaria to rural clinics. Without USAID’s support, Ethiopia may need to seek alternative funding sources, rely more heavily on non-profit organizations and private sector initiatives, or possibly even expand community-based healthcare training programs to improve local capacity to reduce reliance on outside aid. Critically, funding cuts have occurred at a time when communicable diseases, many of which have been eradicated for years, are surging in Ethiopia. The number of domestic malaria cases, for instance, has skyrocketed from 900,000 in 2019 to over seven million in 2024. With about 10% of total health expenditure going toward malaria prevention, the government must adjust to the new financial conditions.

 Without access to programs that work to monitor and control disease spread, Ethiopia is at risk of facing continuous health epidemics. Already experiencing a low budget compared to other Sub-Saharan and lower-middle income countries, Ethiopia lacks the financial resources to fund disease eradication itself. As of 2020, health per capita expenditure in Ethiopia measured in US dollars stood at $28.7, significantly below the Sub-Saharan average of $73.74. Additionally, this is less than one-third of the average expenditure of lower and middle income countries. Along with the already inadequate funding, inflation places a significant strain on budget allocation and eroding levels of investment into health is negatively impacting access and quality of care. USAID helped fill the gaps in basic health needs, and without their assistance the financial deficiencies will be exacerbated and the government unable to fund health initiatives, such as those that address eradication.  

USAID’s eradication also threatens comprehensive social and mental healthcare in Ethiopia. Part of USAID’s operations include crucial trauma-informed care for victims of conflict, including Ethiopia’s growing refugee population. Ethiopia absorbs a large number of refugees fleeing war and repression in neighboring countries such as South Sudan, Sudan, Eritrea, and Somalia. Consequently, USAID funds contribute to housing victims of conflict in Ethiopia, reaching a total of about  $240 million in 2022 and 2023 combined. This aid goes beyond providing basic necessities such as food, tents, vaccination, water, and cooking supplies; it also  supports critical social work such as that of the Center for Victims of Torture (CVT). Before the funding freeze, the organization operated nine sites across Ethiopia, serving survivors of torture, sexual violence, displacement, starvation, and devistating loss. In the past year alone, CVT was able to provide services to 11,000 people ranging from trauma rehabilitation to addressing mental health struggles such as anxiety, depression, and PTSD. These services take months to effectively and adequately address the depth and severity of the trauma victims experience. When USAID support abruptly stopped, Medhanye Alem, head of the CVT, reported that employees were in disbelief, experiencing moral shock due to the inability to conduct proper and ethical closures. Alem also commented on the past generosity of American aid in helping victims regain a sense of self-dignity and rehabilitation.   This has all changed overnight. Trump’s “America First” doctrine has left Ethiopia’s healthcare system vulnerable and rattled as the country searches for financial alternatives. For communicable diseases like malaria, this means swiftly locating and deploying funding toward monitoring and treating cases, as well as preserving support for comprehensive treatment plans. For mental trauma and social care, those on the ground, like workers at the CTV, must grapple with diminished funding for refugees and victims of conflict, which also threatens Ethiopia’s social fabric. As Almen explains, there are tangible effects to care work; people who heal can then “take care of their children and function in the community.” 

In the face of uncertainty and chaos, Ethiopia must turn toward new aid partners, or toward greater economic self-reliance. Rather than permanently replacing the U.S. aid, scholars have noted that Ethiopia and its continental partners could look to implement policies that would promote more independence and self-sufficiency, such as unfolding plans for intra-Africa trade, the introduction of a sovereign currency, and bringing more technical and scientific training to the continent. In the meantime, however, Ethiopia will have to rapidly deploy external funding to mitigate deeper economic and social impacts and keep its strained healthcare system afloat.