The United States has been a long-term supporter of the health sector in Africa through multiple programs run mainly by the U.S. Agency for International Development (USAID) and the U.S. Department of State. With a total annual budget of around US$8 billion of aid per year for the African continent, 70% of this, or around US$5.6 billion, is dedicated to health sector programs. With this level of aid, it is no surprise that the USAID global health programs significantly impact poor and developing states in sub-Saharan Africa.
In the financial year 2022, U.S. funding for health assistance in sub-Saharan Africa reached US$5.84 billion with HIV/AIDS assistance being by far the largest category of aid for the region.
Fig.1. USAID and US Department of State health assistance for Africa in FY2022
Source: Congressional Research Service
The health-related programs consist of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative, the Global Health Security (GHS) program, the infant mortality program, and Feed the Future.
USAID’s global health objectives
The main USAID health-related objective is to strengthen health systems across developing nations. To achieve this, the agency strategically focuses on:
- Preventing HIV/AIDS by implementing prevention and treatment programs
- Reducing the growing prevalence of emerging infectious diseases by developing disease surveillance and response systems
- Promoting child and maternal health
- Investing in health systems in developing countries
- Increasing access to family planning and reproductive health services
- Reducing infant mortality rates
- Addressing the main causes of hunger and malnutrition via the Feed the Future Program.
USAID sub-Saharan health programs
🔹 Preventing HIV/AIDS through the PEPFAIR program
PEPFAIR is the U.S. government’s health program that supports developing nations around the globe to mitigate the impact of HIV/AIDS. The program offers anti-retroviral therapy to millions of people, reducing HIV-based mortality rates. For instance, in Kenya, since 2003, through the PEPFAIR program, the U.S. has invested at least US$8 billion, enabling the program to focus solely on controlling HIV/AIDS. Thus, the PEPFAR program has transformed lives by ensuring that at least 1.1 million pregnant women accessed testing and more than 67,000 were provided with anti-retrovirals (ARVs).
🔹 Fighting Emerging Infectious Disease (EID) outbreaks through the GHS program
The GHS program under USAID aims to mitigate the prevalence and severity of pandemics and other threats arising from EIDs. Through partnerships with nations and global, regional, and local organizations, it builds measurable and sustainable capacity to rapidly detect EIDs. In sub-Saharan Africa, particularly Tanzania, the agency has funded the development of laboratory and surveillance infrastructures that are capable of accurately and safely testing, detecting, and analyzing EIDs. Supporting the systems of the Tanzanian government to attain the 7-1-7 metric for the timeliness of outbreak response is also an objective under GHS.
🔹 Improvement in maternal and child health
Initiatives aimed at decreasing maternal and infant mortality include nutritional support, vaccination drives, and improved healthcare services. Since 2000, significant progress in improving maternal and child health has been achieved with a 58% decrease in below-five child deaths and a 42% decrease in maternal mortality in the USAID’s 25 priority developing countries.
See also: Child mortality rates are on the decline but challenges remain
🔹 Preventing and treating malaria through the U.S. President’s Malaria Initiative (PMI).
Launched in 2006, PMI began as a five-year program to halve malaria deaths in 15 African nations. The program is co-implemented with USAID which enables the delivery of cost-effective, life-saving malaria interventions and the provision of operational assistance to empower partner nations to eradicate malaria. For example, PMI has donated US$530 million to Kenya to implement the Kenya Malaria Strategy, create awareness of the significance of diagnoses and treatment for suspected malaria, and promote insecticide-treated net use. Thus, malaria prevalence in Kenya has decreased by 50% from 38.1% to 18.9% in the high-burden lake-endemic region.
🔹 Strengthening infants nutrition health through the Feed the Future Program.
In sub-Saharan Africa, the Feed the Future initiative has been in place for 14 years having begun in 2010 in response to the 2007/2008 global food crisis that increased food prices for vulnerable communities. The program aims to support nutrition-specific activities such as micronutrient supplementation, breastfeeding promotion, and offering aid to women farmers. To achieve its objectives, via the program USAID has funded sub-Saharan African countries with US$6.2 billion financing from 2011-2022. The implementation of the Feed the Future program has transformed lives having reduced undernutrition by a 4% point relative decrease in stunting among infants less than five years in 12 nations in sub-Saharan Africa.
Investing in health infrastructures in developing nations
Financing the construction and renovation of health facilities and the provision of essential medical resources and supplies account for a considerable share of the USAID investment in health systems in developing nations. The agency also invests in the training and capacity-building of healthcare workers to facilitate sustainable healthcare delivery. For instance, according to the Closing the $2 Billion Gap report by USAID, community health workers in sub-Saharan Africa will receive US$2 billion to fund training and better services. This strategic funding will increase resource efficiency and create integrated community health infrastructures and platforms.
Final word
USAID’s strategic financing of health interventions has had a significant impact on transforming the lives of those in developing nations in sub-Saharan Africa by enabling the training of hundreds of thousands of health workers, the building and renovation of medical facilities, the provision of vaccines, improvements in maternal health and a reduction in child mortality rates.
