USAID funding may have stopped but not localisation
Geofrey Kasumba
What you need to know:
- Localisation is not just about transferring knowledge; it is about transforming power. While the STOP work order brings the localisation initiative to a pause, this vision is alive, and we have to keep working to make it a reality.
Recently, the Ministry of Health, together with its partners, convened a National Dialogue on Health Financing for Uganda. This was themed “Sustainable Health Financing Strategies for Universal Health Coverage and Resilient Health Systems in Uganda”.
Mr Symerre Grey-Johnson, the African Union Development Agency (NEPAD) director for human capital and institutional development, in his remarks said: “Donor funding for health is declining, with projections indicating a 25 percent decrease over the next five years.” “As concerning as this may sound, it presents a unique moment and opportunity for Africa to accelerate homegrown solutions, especially on our continent.
The era of business as usual cannot continue. Development, as we know it, must be reimagined and reshaped. Africa must define its own path, and that’s why we are gathered here today,” he added. Uganda’s health financing system continues to face serious challenges that threaten progress toward achieving Universal Health Coverage.
A recent assessment reveals that despite ongoing efforts, the country still grapples with limited fiscal space and persistent weaknesses in how health services are funded and managed. Key issues include high out-of-pocket expenses borne by households, low insurance coverage of less than five percent, and a fragmented system of resource pooling and management. These problems are further compounded by an over-reliance on inconsistent donor funding, missed investment opportunities, and inefficient use of available resources. This is the essence of sustainability. Localisation is not just about transferring knowledge; it is about transforming power. While the STOP work order brings the localisation initiative to a pause, this vision is alive, and we have to keep working to make it a reality. Interest from humanitarian and development partners underscores a sector-wide recognition that localisation must be accompanied by investments in platforms that connect, elevate, and equip local leaders not only to participate but to shape the future of aid delivery.
The 2010 World Health Report estimated that between 20 percent and 40 percent of global health expenditure is wasted. Major sources of inefficiency include poor allocation of resources, with too much emphasis placed on hospitals instead of more cost-effective primary health care. Additionally, a mismatch in the mix of health inputs—such as imbalances in staffing, medicines, infrastructure, and equipment—undermines service delivery. Inequities also persist due to limited public funding and the high cost of private care, leaving many without affordable access to health services. Independent analysis finds that localising aid can improve funding efficiency. Before the end of the Biden administration, USAID publicly recognised major lags in its efforts to increase direct local funding, though it announced new momentum in Financial Year 2024.
The Government of Uganda needs to conceptualise localisation by setting out a clear initial framework, then revising its goals and locally-led indicators. Local organisations should now demonstrate a strong appetite for financial independence, long-term growth, and systems that enable them to sustainably manage funding, and influence service delivery agendas. Lastly government should give space for local actors to be part of decision-making processes, including them in the planning of humanitarian strategies; moving away from a system dominated by international actors to a system where local actors can take the lead and mutually share decisions and power.
The author, Geofrey Kasumba is a communication and knowledge management specialist. Email: [email protected]
