US aid cuts could wipe out 29,000 health jobs

This could lead to a threefold increase in new infections if sufficient domestic funding is not secured. “The United States, being the biggest funder, caused earthquakes in our response,” said Dr Vincent Bagambe, Director of Planning and Strategic Information at the Uganda AIDS Commission (UAC). “The challenge of limited domestic financing has been exacerbated by the executive order issued by the US President.

We need to develop and implement a plan to accelerate and sustain the gains made.” Addressing the Parliamentary Committee on Presidential Affairs in Kampala on Wednesday, Dr Bagambe revealed that up to 80 percent of Uganda’s HIV/ Aids response is funded by external donors such as the US government and the Global Fund.

 According to the 2023 Joint Aids Review report, of the total $836,030,000 (Shs3 trillion) allocated for the HIV/Aids response in the 2022/2023 financial year, the Government of Uganda contributed $81,189,593 (Shs298 billion), roughly 10 percent of the total funding. Information from the Commission indicates that these funds cover the purchase of antiretroviral drugs and other medical supplies, such as laboratory equipment for HIV testing and patient monitoring.

They also support social services and salaries for health workers involved in HIV/Aids response, particularly those employed by implementing partners. “The US President’s Emergency Plan for AIDS Relief (PEPFAR) has been supporting 29,000 health workers, including doctors, pharmacists, nurses, and laboratory technicians,” Dr Bagambe stated.

 “The executive order stipulated that health workers and contractors funded by PEPFAR or the US government should cease work until the three-month review period is over. We later received communication about a waiver.” Dr Bagambe noted that while some of the 29,000 health workers have ceased working, others have been granted waivers and continue to serve in clinics.

However, concerns remain regarding what will happen after the review period if funding is not reinstated. “The majority of these 29,000 workers are foot soldiers—non-medical personnel who engage communities, encourage HIV testing, follow up on patients, counsel individuals hesitant to seek treatment, and even deliver medication to those unable to reach health facilities,” he said.

High disease burden

Despite a significant decline in HIV/ Aids prevalence, Uganda still records around 38,000 new infections annually, alongside approximately 20,000 Aids-related deaths. The epidemic has had severe social and economic consequences, affecting families and hindering economic growth.

 These infections and deaths persist despite biomedical interventions and campaigns funded by both the government and donors. Preventative measures such as condom use, pre-exposure and post-exposure prophylaxis, and adherence to antiretroviral therapy (ART) significantly reduce transmission rates and improve the quality of life for people living with HIV.

Can Dr Ruth Senyonyi, the UAC board chairperson, stressed the need to address behavioural and structural barriers contributing to new infections and poor adherence to ART. “Regarding HIV financing, I request you, honourable members, to support our appeal to revamp and prioritise the budget. We propose increasing government contributions to cover critical areas such as care, treatment, and support,” she told MPs.

“As we work on HIV, we are not merely providing ARVs; there is much more that people living with HIV require. We suggest establishing a basket fund, which, if well conceptualised, will be a self-sustaining fund benefiting other health programmes as well,” she added. She also called on MPs to increase and ring-fence HIV mainstreaming funds for sectors and local governments.

CSOs Speak Out

The meeting between MPs and UAC officials came a day after leaders of Civil Society Organisations (CSOs) in Uganda urged the government to provide emergency funding to fill the gaps left by the US aid cuts.

In a joint statement released on Tuesday, the CSOs noted that “many of the programmes that had obtained ‘waivers’ from the 24 January funding freeze were also terminated, including life-saving HIV, tuberculosis, Ebola, and emergency food aid initiatives.” Speaking at a press conference in Kampala, Mr Kenneth Mwehonge, the Executive Director of HEPS-Uganda, called on the government to “wake up and massively scale up investment in our health priorities.”

“We are calling for an emergency supplementary appropriation by Parliament to close the severe gaps and ensure uninterrupted access to evidence-based and human rights-supporting testing, prevention, and treatment for HIV, tuberculosis, malaria, mpox, Ebola, and other pressing health concerns.

The government must act swiftly,” he said. Ms Lillian Mworeko, the Executive Director of the International Community of Women Living with HIV/Aids Eastern Africa, criticised the US administration’s decision to withdraw foreign aid. “This is nothing short of a crime against humanity. By cutting funding, the US government is jeopardising the HIV response and will be responsible for preventable deaths, illness, and devastation in our communities,” she stated.

Ms Immaculate Owomugisha, the Executive Director of the Centre for Women Justice Uganda, commended the government’s proposal to integrate HIV/Aids services with tuberculosis, malaria, and chronic disease care. “This is a crucial step in addressing service gaps caused by the termination of USAID funding.

 If effectively planned and resourced, this integration could help maintain essential health services for millions, including people living with HIV, pregnant women, children, and other vulnerable groups,” she said.

President’s message

Mr Alex Byarugaba, the chairperson of the Parliamentary Committee on Presidential Affairs, relayed President Museveni’s stance on the US funding freeze. “At our last caucus, His Excellency the President assured us that we will not let our people die.

If necessary, other expenditures will be halted to ensure we address these gaps. He is determined to keep us on track to achieve our goals,” Mr Byarugaba told UAC officials. He added that Parliament would present its recommendations in a forthcoming meeting with the President to discuss Uganda’s HIV/Aids response.