The Cervical Cancer Screening and Prevention Clinic at Helen Joseph Hospital in Johannesburg was forced to shut down in mid-May after losing all its funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). Photos: Elna Schütz
Hundreds of cervical cancer patients will likely be referred to overburdened hospitals following the closure of the Cervical Cancer Screening and Prevention Clinic at Helen Joseph Hospital in Johannesburg.
Following over 20 years of operations, the clinic was forced to shut down in mid-May after losing all its funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). It relied on some financial reserves to taper its activities over several months. Most clinic staff have been let go.
The clinic served women who were referred from across Johannesburg and as far as Springs. A significant part of that group lives with HIV.
“Many of these women are from underserved communities with limited access to specialist care,” says Dr Mark Faesen, Specialist Gynaecologist with the Clinical HIV Research Unit (CHRU).
The clinic offered critical cervical cancer screening and follow-up services, including Pap smears and colposcopies – a cervical examination for abnormalities. The clinic was managing around 1,400 patients annually. “It served as a clinical and research hub, preventing many cancers,” Faesen says.
We spoke to Zinhle (name changed) who was screened at the clinic after feeling ill for a year and who sought help at four different hospitals.
“When I got [to this clinic], I was received with a warm welcome,” she says, emphasising that every step of the process was explained to her and she was made to feel comfortable. “Where else are we supposed to go?”
Zinhle says she is deeply upset that she can no longer be treated at the clinic if she needs it again.
Faesen says the clinic’s closure will put immense pressure on other public hospitals offering these services, like Rahima Moosa or Chris Hani Baragwanath. This is likely to lead to longer waiting times for screening, diagnosis and treatments. “Early detection is important,” Faesen says. “Without timely diagnosis, outcomes are far poorer.”
Lorraine Govender, the National Manager of Health Programmes at the Cancer Association of South Africa (CANSA) says they are deeply concerned by the closure, as it is a serious setback in the ongoing fight against the disease.
Cervical cancer is the second most common cancer in women in South Africa, and results in the most deaths. It is curable if diagnosed and treated early. A Human Papillomavirus (HPV) vaccination also reduces the risk of cervical cancer. While low screening rates and backlogs in treatment have been long-standing across the country, Johannesburg appears to be particularly burdened. The shutdown of this clinic adds to a larger shortage of screening and treatment in Gauteng.
The Department of Health has previously stated that while it has improved vaccination efforts against cervical cancer, “screening and treatment are lagging behind”. The national health policy calls for women aged 30 to 50 to be screened at least three times in their lives. Women living with HIV should be screened at least every three years.
Cervical cancer screening services are limited and overwhelmed at most public hospitals, Faesen says. “The funding cuts have a knock-on effect: increasing patient loads at the few remaining colposcopy clinics.”
Lorraine Govender, the National Manager of Health Programmes at the Cancer Association of South Africa (CANSA) says they are deeply concerned by the closure, as it is a serious setback in the ongoing fight against the disease.
“Cervical cancer is both preventable and treatable when detected early, making continued access to screening services vital … The closure of this Johannesburg clinic must be a call to action,” Govender says.
Faesen stresses the urgent need for increased funding for decentralised screening services to fill the gaps created by clinics like the one at Helen Joseph Hospital. “Equipping more public sector sites with colposcopy capability and training personnel is also essential.”
The international community must protect global responses to HIV, tuberculosis (TB), and malaria to serve humanity’s collective interests, according to an opinion article published May 14, 2025, in the open-access journalPLOS Global Public Health by Gorik Ooms from the Institute of Tropical Medicine, Belgium, and colleagues.
Within days of starting his second term as President, Donald Trump ended most United States (US) contributions to global health. Global responses to HIV, TB and malaria are not the only programs affected but were particularly dependent on US support. The US withdrawal from global health could result in 3 million additional HIV deaths and 10 million additional HIV infections, 107 000 additional malaria deaths and 15 million additional malaria infections, and 2 million additional TB deaths, all in 2025.
HIV, TB and malaria are global health security threats that require international collective action. The Global Fund to fight AIDS, TB and Malaria (Global Fund) entered its replenishment cycle for 2027–2029, with a target of $18 billion. A failure of this replenishment would make it impossible for many countries to compensate for decreasing US funding and decreasing Global Fund support.
The abrupt end of most US funding for global health comes at a crucial moment for the fight against the three epidemics. For HIV, funding cuts are disrupting treatment and prevention, and increasing morbidity, mortality and infections especially among marginalised groups. The transmission of TB remains high due to insufficient access to treatment, urbanisation and undernutrition. Control of malaria remains elusive due to emerging resistance to treatments, and insecticides, gaps in prevention, and limited access to healthcare.
According to the authors, the reduction of US bilateral aid calls for re-prioritisation and enhanced coordination of the global fights against HIV, TB and malaria. Currently, the Global Fund is uniquely positioned to undertake this endeavour, as it financially supports HIV, TB and malaria programs in most, if not all, countries affected by US spending cuts. This requires a successful replenishment, which seems improbable given uncertainty about the US position and considering the aid spending cuts announced by other high-income countries. Low- and middle-income countries need to step in, which necessitates an overhaul of the Global Fund governance.
The authors outline four action points. First, all countries, regardless of income level, should support the current replenishment of the Global Fund. Second, the replenishment mechanism should move toward agreed and fair assessed contributions, such as 0.01% of the annual gross domestic product of all countries. Third, the Global Fund should commit to overhauling its governance structures to promote equal representation among geographical constituencies. Fourth, the Global Fund should commit to adhere to the Lusaka Agenda, which captures consensus around five key shifts for the long-term evolution of global health initiatives and the wider health ecosystem.
As noted by the authors, these four actions would save essential elements of the global responses to HIV, TB and malaria and set a central and collaborative mechanism for global health security on a path toward the principles of global public investment.
Dr Gorik Ooms adds: “Richer countries still view global health cooperation primarily as aid, from them to poorer countries. They do not seem to realise how this cooperation also protects their own interests. We must not only find enough funding to sustain it; but also rethink how we work together. Through genuine international cooperation between equal partners.”
Co-author Dr Raffaella Ravinetto concludes: “It is not only a matter of keeping life-saving programs alive. It is also a matter of building and maintaining a solid ecosystem, encompassing health infrastructure, policies and human resources, to make quality health care feasible everywhere. Through solidarity we can serve common interests.”
Image Caption: A person holds medications. Limited access to diagnostics and medicines will worsen treatment quality, inducing resistance to antiretrovirals and medicines for infections.
Johannesburg, 15 May 2025 – South Africa’s healthcare sector faces mounting pressure as international funding withdrawals threaten critical research and services.
Without the financial support, medical advancements are being jeopardised and access to care for vulnerable communities is limited.
With leading universities bracing for losses exceeding R800 million annually, experts warn of setbacks in disease treatment and public health initiatives. As foreign aid recedes, South Africa must look inward for sustainable solutions to safeguard its healthcare future.
At Adcock Ingram Critical Care (AICC), newly appointed Operations Executive Lucelle Iyer is part of a new wave of industry leaders focused on local solutions. Rather than relying on global models, she is driving efforts to strengthen domestic production and innovation. As public health programmes face uncertainty, the role of private-sector initiatives in sustaining healthcare access is becoming increasingly critical.
South Africa’s ability to bridge healthcare gaps and extend services to underserved communities increasingly depends on local innovation and resourcefulness. As AICC expands its investment in modernising plants and developing local talent through 2025, its initiatives could serve as a model for sustainable pharmaceutical manufacturing in South Africa and potentially across the continent. By focusing on innovation and homegrown expertise, the company is contributing to the broader effort to strengthen self-sufficiency in African healthcare.
The push towards localisation addresses the country’s significant dependence on imported pharmaceutical products and active pharmaceutical ingredients (APIs). In 2024, pharmaceutical imports to South Africa were valued at approximately $2.42 billion USD.1 Even though more than 60% of pharmaceutical products sold in South Africa are formulated locally, approximately 98% of APIs2 used in local formulation are imported.
This reliance exposes the healthcare system to risks like exchange rate fluctuations and supply chain disruptions, highlighting the need for increased local production. “We’ve seen the impact of the fragility of local supply chains on our hospitals, especially in rural and under-resourced areas,” says Iyer. “South Africa needs a manufacturing base that is resilient, scalable, and locally relevant.”
Iyer’s leadership is shaped by a philosophy of resilience, innovation, and strategic execution. As the first woman to lead operations at AICC and one of the youngest professionals to hold such a pivotal role, she has broken barriers in a traditionally male-dominated industry. Her success is driven by a solutions-focused mindset, tackling challenges with a commitment to progress and impact.
Building a future-proof pharma ecosystem
The shift to a local-first strategy is part of a broader sector-wide call for policy support and investment into the domestic pharmaceutical value chain. Experts argue that localisation is not only a health security imperative, but an economic opportunity — capable of generating skilled jobs and retaining healthcare spending within national borders.
“Pharma manufacturing has long been seen as too complex or too costly for the local context,” says Iyer. “But technology has changed that. Smart factories, digital quality control, and automation can make local production competitive.”
AICC’s comprehensive strategy includes:
Digitisation of production and regulatory compliance systems
Building local expertise in pharmacy, engineering, and biotechnology
Collaboration with stakeholders to streamline regulatory frameworks
Incorporating sustainability and circular economy principles into packaging and plastics manufacturing
Leveraging compliance for competitive advantage
AICC also challenges the common perception that regulatory compliance limits innovation. Instead, the company integrates compliance strategically into its digital transformation, embedding quality assurance and regulatory preparedness from the outset.
“When systems are designed with compliance in mind from the beginning, it greatly reduces rework and crisis management, turning quality into a driver of efficiency,” says Iyer, who brings extensive experience in regulatory affairs, quality management, and pharmaco-economics to her role.
A pivotal moment for the industry
South Africa’s pharmaceutical sector stands at a crossroads, with the potential to become a regional hub for essential medicines, medical devices, and biosimilars. Realising this ambition, however, hinges on coordinated efforts across public, private, and academic sectors to drive innovation, expand capacity, and ensure long-term sustainability.
“Our goal isn’t to replicate models from Europe or the US,” says Iyer. “It’s about creating a pharmaceutical ecosystem designed specifically for our unique needs – efficient, ethical, and sustainable.”
Sex workers in Vosloorus, Johannesburg and Springs talked to GroundUp about their struggle to access health services, particularly antiretroviral treatment, since the closures of US funded clinics. Photos: Kimberly Mutandiro
It’s afternoon on Boundary Road in Vosloorus. Sex worker Simangele (not her real name) hopes to secure her next client.
Making enough money to pay rent has always been a concern for Simangele. But now she has a new worry: how to keep up with her antiretroviral treatment.
Two months ago the closure of a mobile clinic — where Simangele and other sex workers in Vosloorus went for checkups and to collect their treatment — left her without access to the life-saving medication.
The mobile clinic was run by the Wits Reproductive Health and HIV Institute (WITS RHI) which heavily relied on US funding. The institute has been providing critical sexual and reproductive health services since 2018. The programme was one of many health facilities forced to halt services at the end of January in the wake of US funding cuts for global aid.
Speaking to GroundUp, Simangele says she ran out of antiretroviral medicines (ARVs) over a month ago and has resorted to borrowing a few tablets from a friend. “I don’t know what I will do because the tablets my friend gets give me side effects,” she says. (Antiretrovirals treat HIV. They have to be taken daily for life.)
She says the clinic closed without any warning or before they could give them transfer letters to public healthcare facilities. She is now dreading having to go to a public facility where she says sex workers are frequently discriminated against, particularly those who are undocumented.
We spoke to a dozen other sex workers in Joburg and in Springs who are worried about defaulting on their antiretroviral treatment following the closure of the Wits RHI clinics. The clinics also provided pre-exposure prophylaxis (PrEP) (to prevent HIV-negative people contracting HIV), and treatments for sexually transmitted infections, TB, sexual reproductive health services, and counselling.
A sex worker shows the last few ARVs she has left.
Another sex worker said, “The minute we go to public clinics, they will need documents, which some of us do not have … Wits made time to listen to our problems as sex workers. Even when we faced challenges with clients, they never judged us.”
Sisi (not her real name), who rents rooms and assists sex workers in Vosloorus, said she’s aware of several sex workers who have defaulted and no longer have access to condoms, lubricants, and treatment for sexually transmitted infections. “The Wits clinic did not discriminate against people without documents and would sometimes provide food, branded T-shirts, caps, and even jobs,” she said.
“Many of us will die”
We visited Zig Zag Road in Springs, where several sex workers said they were out or almost out of ARVs. When asked why they didn’t just go to a local clinic, they told GroundUp about instances where they experienced stigma while trying to access treatment at public clinics.
“I used to receive PrEP to help prevent HIV (from the Wits clinic). We would also receive birth control services. Now I can’t go to a public clinic because we are mocked for being sex workers,” said Siphesihle.
Ntombi, who waits for clients along End Street, attended one of the Wits clinics in Hillbrow which closed down. She said those on PrEP were given transfer letters before the clinic closed.
Other workers nearby told GroundUp that they now pay up to R250 for PrEP, which is more than they can afford.
Sisonke calls for urgent response to crisis
The Sisonke National Movement, which advocates for the rights of sex workers, has been raising the alarm since the closure of US-funded facilities. Before the closures, Sisonke was in talks with National Department of Health through the South African National AIDS Council about the provision of services to sex workers and other vulnerable groups, said the organisation’s spokesperson Yonela Sinqu.
She said that the department never answered activists when they asked what would happen should donor funds no longer be available for these facilities.
She said the plea for assistance without referral letters is made to all provinces, not only Gauteng. However, Gauteng is the only province that has approached us with the crisis of people without referrals, she said.
Department of Health spokesperson Foster Mohale has not responded to requests for comment.
Finding a path forward for South Africa’s healthcare workers
Donald McMillan
By Donald McMillan, Managing Director at Allmed Healthcare Professionals
06 May 2025
South Africa’s healthcare system is under serious pressure. The sudden suspension of critical US funding has resulted in the loss of around 15 000 healthcare jobs – many of them linked to HIV/AIDS programmes that served as lifelines for vulnerable communities. Combined with broader public sector budget cuts and a national hiring freeze, the situation threatens to undo decades of progress in healthcare delivery. As public hospitals struggle with fewer staff and shrinking resources, the country is at risk of losing not only jobs, but skills, infrastructure, and hope. But in the face of these challenges, there are still ways to keep services running and people employed. One of them is through Temporary Employment Services (TES), which provides a flexible staffing approach that can help stabilise the system while longer-term solutions are explored.
A healthcare system under pressure
The US aid cut has had an immediate and devastating impact. Programmes focused on HIV, tuberculosis, and reproductive health, many of which were propped up by international donor funding, have been forced to scale back or shut down entirely. Thousands of community healthcare workers, nurses, counsellors, and administrators have found themselves jobless, while patients are left facing longer wait times and reduced access to care.
At the same time, cost-cutting across the public sector has put a freeze on new hires, even in essential departments like health and the impact is already being felt. With public hospitals and clinics stretched thin, they’re unable to take on newly trained doctors and nurses. And while the private sector plays a role, it simply cannot absorb the overflow. This isn’t just a staffing issue, it’s a setback for the entire healthcare system, affecting everything from medical training to frontline care.
Young professionals left in limbo
Every year, South Africa produces thousands of highly trained doctors and healthcare workers, many of whom move into the public health system after completing their compulsory community service. These roles used to be a given but with hiring freezes and shrinking budgets, many young professionals are now finishing their training with nowhere to go. Despite their skills and frontline experience, these workers are left in limbo. This is a double blow as South Africa loses out on the return from its investment in their education, while the risk of a growing skills drain looms large. With countries like the UK, Australia, and Canada actively recruiting healthcare workers, there’s a real chance they may leave and not come back.
A flexible solution in Temporary Employment Services
In response to this crisis, temporary employment solutions have become a practical and effective solution. TES providers offer qualified healthcare professionals short- to medium-term flexible contracts, enabling them to continue working in their field while delivering essential support to overburdened healthcare facilities.
This approach offers a lifeline not just for displaced workers, but for clinics and hospitals struggling with limited resources. TES employees can be rapidly deployed where they are needed most, whether to cover staff shortages, serve remote communities, or support seasonal fluctuations in demand. Unlike permanent hires, they don’t carry long-term costs such as medical aid or pension contributions, making them a more budget-conscious option in uncertain times.
The benefits of the TES model have already been proven. During the COVID-19 pandemic, temporary staff played a key role in scaling up testing, vaccination, and treatment efforts across the sector. That same adaptability is needed now to respond to the healthcare funding crisis.
Rethinking the future of healthcare work
While temporary employment solutions cannot not solve the problem alone, it can provide an important stopgap and potentially a new way of thinking about workforce planning in the healthcare sector. Rather than relying solely on permanent positions, South Africa may need to adopt a more fluid, demand-based deployment model that allows professionals to move between roles, regions, and areas of urgent need.
Shifting to this model calls for a change in mindset. Permanent posts have traditionally been seen as the gold standard in healthcare, valued for their stability and benefits. But in a time of uncertainty, contract and locum roles – especially when managed by trusted TES providers – can offer a practical alternative, combining income, ongoing experience, and flexibility.
Retaining talent, restoring hope
Avoiding long-term damage to South Africa’s healthcare system will require urgent, coordinated action. Government departments must urgently reprioritise spending toward essential services like health and education. At the same time, private healthcare providers and staffing agencies must step up and work together to ensure that skilled professionals are not lost to the system or the country.
Despite the current turbulence, South Africa’s healthcare workers remain among the best trained and most resilient in the world and with the right support structures, including flexible employment options like TES, we can preserve our healthcare capacity and continue to serve those who need it most.
The World Health Organization warns that global health funding cuts are paving the way for a resurgence of diseases that had been brought to the brink by vaccination.
One example of prior success is Africa’s “meningitis belt”, spanning parts of sub-Saharan Africa, where vaccination campaigns had successfully eliminated meningitis A. Likewise, yellow fever and related deaths were drastically cut by improved routine immunisation and emergency vaccine stockpiles.
The WHO says that this hard-won progress is now threatened. “Funding cuts to global health have put these hard-won gains in jeopardy,” warned Tedros Adhanom Ghebreyesus, WHO Director-General.
Outbreaks on the rise
In 2023, measles cases were estimated at more than 10.3 million – a 20% year-on-year increase. In a statement marking the beginning of World Immunization Week,the WHO, UN Children’s Fund UNICEF and their partners warned that this upward trend is expected to continue into 2025.
After years of declining cases in Africa thanks to improved vaccine access, yellow fever is also making a return. The start of 2025 has already seen a rise in outbreaks across the continent, with cases also confirmed in the Americas.
The threat of vaccine misinformation
Vaccination efforts are increasingly under pressure due to a combination of misinformation, population growth, humanitarian crises, and funding cuts.
Earlier this month, a WHO review across 108 countries found that nearly half are experiencing moderate to severe disruptions to vaccination campaigns, routine immunisations, and supply chains due to falling donor support.
“The global funding crisis is severely limiting our ability to vaccinate over 15 million vulnerable children in fragile and conflict-affected countries against measles,” said Catherine Russell, Executive Director of UNICEF.
High healthcare returns on vaccination
Vaccines save around 4.2 million lives each year, protecting against 14 different diseases. Almost half of those lives are saved in Africa.
Despite this, falling investment now risks the re-emergence of diseases once thought to be under control.
Health experts emphasise that immunisation is one of the most cost-effective health interventions. Every $1 invested in vaccines brings an estimated return of $54 through better health and economic productivity.
UNICEF, WHO, and their partners are calling on parents, the public, and political leaders to support immunisation programmes and ensure long-term investment in vaccines and public health systems.
Mycobacterium tuberculosis drug susceptibility test. Photo by CDC on Unsplash
By Catherine Tomlinson
Health research in South Africa has been plunged into crisis with the abrupt termination of several large research grants from the US, with more grant terminations expected in the coming days and weeks. Professor Ntobeko Ntusi, head of the South African Medical Research Council, tells Spotlight about efforts to find alternative funding and to preserve the country’s health research capacity.
Health research in South Africa is facing an unprecedented crisis due to the termination of funding from the United States government. Though exact figures are hard to pin down, indications are that more than half of the country’s research funding has in recent years been coming from the US.
Many health research units and researchers that receive funding from the US National Institutes of Health (NIH) have in recent weeks been notified that their grants have been terminated. This funding is being slashed as part of the efforts by US President Donald Trump’s administration to reduce overall federal spending and end spending that does not align with its political priorities.
Specifically, the administration has sought to end spending supporting LGBTQ+ populations and diversity, as well as equity and inclusion. As many grants for HIV research have indicators of race, gender, and sexual orientation in their target populations and descriptions, this area of research has been particularly hard hit by the cuts. There have also been indications that certain countries, including South Africa and China, would specifically be targeted with NIH cuts.
On 7 February, President Donald Trump issued an executive order stating that the US would stop providing assistance to South Africa in part because it passed a law that allowed for the expropriation of land without compensation, and separately because the South African government took Israel to the International Court of Justice on charges of genocide in Gaza.
Prior to the NIH cuts, some local research funded through other US entities such as the US Agency for International Development (USAID), and the Centers for Disease Control and Prevention (CDC) were also terminated.
How much money is at risk?
“In many ways the South African health research landscape has been a victim of its own success, because for decades we have been the largest recipients of both [official development assistance] funding from the US for research [and] also the largest recipients of NIH funding outside of the US,” says president and CEO of the SAMRC Professor Ntobeko Ntusi.
Determining the exact amount of research funds we get from the US is challenging. This is because funding has come from several different US government entities and distributed across various health research organisations. But the bulk of US research funding in South Africa clearly came from the NIH, which is also the largest funder of global health research.
According to Ntusi, in previous years, the NIH invested, on average, US$150 million – or almost R3 billion – into health research in South Africa every year.
By comparison, the SAMRC’s current annual allocation from government is just under R2 billion, according to Ntusi. “Our baseline funding, which is what the national treasury reflects [approximately R850 million], is what flows to us from the [Department of Health],” he says, adding that they also have “huge allocations” from the Department of Science, Technology and Innovation. (Previous Spotlight reporting quoted the R850 million figure from Treasury’s budget documents, and did not take the additional funds into account.)
How is the SAMRC tracking US funding terminations
Ntusi and his colleagues have been trying to get a clearer picture of the exact extent and potential impacts of the cuts.
While some US funding given to research units in South Africa flows through the SAMRC, the bulk goes directly to research units from international research networks, larger studies, and direct grants. Keeping track of all this is not straight-forward, but Ntusi says the SAMRC has quite up to date information on all the terminations of US research awards and grants.
“I’ve been communicating almost daily with the deputy vice-chancellors for research in all the universities, and they send me almost daily updates,” says Ntusi. He says heads of research units are also keeping him informed.
According to him, of the approximately US$150 million in annual NIH funding, “about 40%…goes to investigator-led studies with South Africans either as [principal investigators] or as sub-awardees and then the other 60% [comes from] network studies that have mostly sub-awards in South Africa”.
Figures that Ntusi shared with Spotlight show that large tertiary institutions like the University of the Witwatersrand, the University of Cape Town, and the University of Stellenbosch, could in a worst case scenario lose over R200 million each, while leading research units, like the Desmond Tutu Health Foundation and the Centre for the AIDS Programme of Research in South Africa, could each lose tens of millions. The SAMRC figures indicate that while many grants have already been terminated, there are also a substantial number that have not been terminated.
Where will new money come from?
Ntusi says the SAMRC is coordinating efforts to secure new funding to address the crisis.
“We have been leading a significant fundraising effort, which…is not for the SAMRC, but for the universities who are most affected [and] also other independent research groups,” he says. “As the custodian of health research in the country, we are looking for solutions not just for the SAMRC but for the entire health research ecosystem.”
Ntusi explains that strategically it made more sense to have a coordinated fundraising approach rather than repeating what happened during COVID-19 when various groups competed against each other and approached the same funders.
“Even though the SAMRC is leading much of this effort, there’s collective input from many stakeholders around the country,” he says, noting that his team is in regular communication with the scientific community, the Department of Health, and Department of Science, Technology and Innovation.
The SAMRC is also asking the Independent Philanthropic Association of South Africa, and large international philanthropies for new funding. He says that some individuals and philanthropies have already reached out to the SAMRC to find out how they can anonymously support research endeavours affected by the cuts.
Can government provide additional funds?
Ntusi says that the SAMRC is in discussions with National Treasury about providing additional funds to support health researchers through the funding crisis.
The editors of Spotlight and GroundUp recently called on National Treasury to commit an extra R1 billion a year to the SAMRC to prevent the devastation of health research capacity in the country. They argued that much larger allocations have previously been made to bail out struggling state-owned entities.
Government has over the last decade spent R520 billion bailing out state-owned entities and other state organs.
How will funds raised by the SAMRC be allocated?
One dilemma is that it is unlikely that all the lost funding could be replaced. This means tough decisions might have to be made about which projects are supported.
Ntusi says that the SAMRC has identified four key areas in need of support.
The first is support for post-graduate students. “There’s a large number of postgraduate students…who are on these grants” and “it’s going to be catastrophic if they all lose the opportunity to complete their PhDs,” he says.
Second is supporting young researchers who may have received their first NIH grant and rely entirely on that funding for their work and income, says Ntusi. This group is “really vulnerable [to funding terminations] and we are prioritising [their] support…to ensure that we continue to support the next generation of scientific leadership coming out of this country,” he says.
A third priority is supporting large research groups that are losing multiple sources of funding. These groups need short-term help to finish ongoing projects and to stay afloat while they apply for new grants – usually needing about 9 to 12 months of support, Ntusi explains.
The fourth priority, he says, is to raise funding to ethically end clinical and interventional studies that have lost their funding, and to make sure participants are connected to appropriate healthcare. Protecting participants is an important focus of the fundraising efforts, says Ntusi, especially since many people involved in large HIV and TB studies come from underprivileged communities.
Ultimately, he says they hope to protect health research capacity in the country to enable South African health researchers to continue to play a meaningful and leading role in their respective research fields.
“If you reflect on what I consider to be one of the greatest successes of this country, it’s been this generation of high calibre scientists who lead absolutely seminal work, and we do it across the entire value chain of research,” says Ntusi. “I would like to see…South Africa [continue to] make those meaningful and leading pioneering contributions.”
African countries face a major challenge of dealing with high rates of communicable diseases, such as malaria and HIV/Aids, and rising levels of non-communicable diseases. But the continent’s health systems don’t have the resources to provide accessible and affordable healthcare to address these challenges.
Historically, aid has played a critical role in supporting African health systems. It has funded key areas, including medical research, treatment programmes, healthcare infrastructure and workforce salaries. In 2021, half of sub-Saharan Africa’s countries relied on external financing for more than one-third of their health expenditures.
As aid dwindles, a stark reality emerges: many African governments are unable to achieve universal health coverage or address rising healthcare costs.
The reduction in aid restricts healthcare services and threatens to reverse decades of health progress on the continent. A fundamental shift in healthcare strategy is necessary to address this crisis.
The well-known maxim that “prevention is better than cure” holds not just for health outcomes but also for economic efficiency. It’s much more affordable to prevent diseases than it is to treat them.
As an infectious diseases specialist, I have seen how preventable diseases can put a financial burden on health systems and households.
For instance, each year, there are global economic losses of over US$33 billion due to neglected tropical diseases. Many conditions, such as lymphatic filariasis, often require lifelong care. This places a heavy burden on families and stretches national healthcare systems to their limits.
African nations can cut healthcare costs through disease prevention. This often requires fewer specialist health workers and less expensive interventions.
To navigate financial constraints, African nations must rethink and redesign their healthcare systems.
Three key areas where cost-effective, preventive strategies can work are: improving water, sanitation, and hygiene; expanding vaccination programmes; and making non-communicable disease prevention part of community health services.
A shift in healthcare delivery
Improving water, sanitation, and hygiene infrastructure
Many diseases prevalent in Africa are transmitted through contact with contaminated water and soil. Investing in safe water, sanitation, and hygiene (WASH) infrastructure is an opportunity. This alone can prevent a host of illnesses such as parasitic worms and diarrhoeal diseases. It can also improve infection control and strengthen epidemic and pandemic disease control.
Currently, WASH coverage in Africa remains inadequate. Millions are vulnerable to preventable illnesses. According to the World Health Organization (WHO), in 2020 alone, about 510 000 deaths in Africa could have been prevented with improved water and sanitation. Of these, 377 000 deaths were caused by diarrhoeal diseases.
Unsafe WASH conditions also contribute to secondary health issues, such as under-nutrition and parasitic infections. Around 14% of acute respiratory infections and 10% of the undernutrition disease burden – such as stunting – are linked to unsafe WASH conditions.
By investing in functional WASH infrastructure, African governments can significantly reduce the incidence of these diseases. This will lead to lower healthcare costs and improved public health outcomes.
Local production of relevant vaccines
Vaccination is one of the most cost-effective health interventions available for preventing infection. Immunisation efforts save over four million lives every year across the continent.
There is an urgent need for vaccines against diseases prevalent in Africa whose current control is heavily reliant on aid. Neglected tropical diseases are among them.
Vaccines can also prevent some non-communicable diseases. A prime example is the human papillomavirus (HPV) vaccine, which can prevent up to 85% of cervical cancer cases in Africa.
HPV vaccination is also more cost-effective than treating cervical cancer. In some African countries, the cost per vaccine dose averages just under US$20. Treatment costs can reach up to US$2,500 per patient, as seen in Tanzania.
It is vital to invest in a comprehensive vaccine ecosystem. This includes strengthening local research and building innovation hubs. Regulatory bodies across the continent must also be harmonised and markets created to attract vaccine investment.
Integrating disease prevention into community healthcare services
Historically, African healthcare systems were designed to address communicable diseases, such as tuberculosis and HIV. This left them ill-equipped to handle the rising burden of non-communicable diseases, such as type 2 diabetes and cardiovascular diseases. One cost-effective approach is to integrate the prevention and management of these diseases into existing community health programmes.
Community health workers currently provide low-cost interventions for health issues such as pneumonia and malaria. They can be trained to address non-communicable diseases as well.
In some countries, community health workers are already filling the service gap. Getting them more involved in prevention strategies will strengthen primary healthcare services in Africa. This investment will ultimately reduce the long-term financial burden of treating chronic diseases.
A treatment-over-prevention approach will not be affordable
Current estimates suggest that by 2030, an additional US$371 billion per year – roughly US$58 per person – will be required to provide basic primary healthcare services across Africa.
Adding to the challenge is the rising global cost of healthcare, projected to increase by 10.4% this year alone. This marks the third consecutive year of escalating costs. For Africa, costs also come from population growth and the rising burden of non-communicable diseases.
By shifting focus from treatment to prevention, African nations can make healthcare accessible, equitable and financially sustainable despite the decline in foreign aid.
The cancellation of PEPFAR funding to South Africa could cause between 150 000 and 295 000 additional HIV infections by the end of 2028. This is unless the South African government covers some of the defunded services.
These are the preliminary findings of a new modelling study commissioned by the National Health Department to look into the impact of PEPFAR funding cuts in South Africa. It was authored by researchers at the University of Cape Town (UCT) and University of the Witwatersrand (WITS). PEPFAR is a multi-billion dollar US initiative that supports HIV-related services globally, but which has been significantly slashed by the Trump administration since February.
The research on South Africa comes at the same time that a separate modelling study was published in The Lancet which found that the discontinuation of PEPFAR could cause an additional 1-million HIV infections among children in sub-Saharan Africa by 2030. This would lead to the deaths of about 500 000 children according to the study, while over 2-million others would be left orphaned.
On 20 January, newly-elected US president Donald Trump issued an executive order which suspended virtually all US foreign development assistance for 90 days pending a review. As a result, US-backed aid programmes were brought to a standstill across the world, including in South Africa. While a waiver was published which supposedly allowed some PEPFAR-related activities to continue, this had a limited effect in practice.
Since then, some US grants have resumed, while others have been cancelled. The value of all terminated grants comes to tens of billions of dollars globally. In South Africa, numerous awards have been cancelled from PEPFAR, which had provided roughly R7.5-billion to non-profit organisations in the country in 2024. These organisations primarily used the money to hire and deploy health workers in government clinics, or to operate independent health facilities. Many of these have now been forced to close.
While there are still some active PEPFAR grants in South Africa, it’s unclear how much longer these will be retained, as many are only approved until September. The new study focusing on South Africa models what would happen if all PEPFAR funding was eliminated.
Up to 65 000 additional deaths expected by 2028
In 2024 roughly 78% of all people who had HIV in South Africa were on antiretroviral (ARV) treatment. This figure has been steadily rising over time. By 2026, it was expected to climb to 81%, according to Dr Lise Jamieson, lead author of the local modelling study.
But this trend will be reversed if the entire PEPFAR programme is cancelled and the government fails to step in. ARV coverage among people with HIV would drop to 70% by 2026, according to the study. Under the model’s more pessimistic scenario, the figure would drop even lower – to 59% by 2026.
This is partly because some people living with HIV in South Africa get their ARVs directly from PEPFAR-funded drop-in centres. If these centres close down, some patients may stop taking their ARVs. Indeed, this is precisely what happened after one centre in Pretoria stopped providing services.
The loss of PEPFAR funds could also hinder the health system’s capacity to get newly-infected people on HIV treatment. For instance, PEPFAR-funded organisations had employed nearly 2000 lay counsellors across South Africa who tested people for HIV. Without these staff, fewer people will be diagnosed and get started on treatment.
Not only will ARV coverage drop due to the cuts, but HIV prevention services will also be affected, according to the study. For instance, PEPFAR-funded drop-in sites had been providing people with pills that prevent HIV, called pre-exposure prophylaxis (PrEP). These services were targeted at groups most likely to contract and transmit HIV, like sex workers. According to the new modelling study, the full termination of PEPFAR would lead to as much as a 55% reduction in PrEP coverage for female sex workers by 2026.
Because of factors like these, the researchers estimate that the PEPFAR cuts would cause between 56 000 and 65 000 additional HIV-related deaths in South Africa by 2028. By 2045, this would increase to between 500 000 and 700 000 deaths.
Nearly 90% of USAID contracts terminated in South Africa
All of these results only hold if the South African government fails to step in, according to Jamieson. The modelling study finds that to cover all PEPFAR services from 2025 to 2028, the government would need to spend an extra R13 to 30-billion in total.
It’s unlikely that the government will cough up this amount, but according to Jamieson the National Health Department is taking steps to identify and support certain key services that were defunded by PEPFAR. She is hopeful that the results may not be as drastic as what the study suggests.
Another caveat is that the modelling study estimated what would happen if South Africa lost all of its PEPFAR funding. But at least for now, there are still some grants reaching beneficiaries in the country.
PEPFAR funds are primarily distributed by two US agencies – the US Agency for International Development (USAID) and the US Centres for Disease Control and Prevention (CDC). While both agencies paused funding after the initial suspension order in late-January, the CDC resumed its funding roughly two weeks later. This was after a US federal court ruled that the Trump administration could not freeze congressionally appropriated funds.
CDC grants only appear to be active until September (at least for South African beneficiaries), though uncertainty remains about this.
USAID has taken a much harder line – funding was suspended from late January. By late-February, the agency moved from pausing funds to issuing termination notices to most of its beneficiaries.
In South Africa, roughly 89% of all USAID funding has been cancelled. The value of all cancelled funds comes to about US$261-million (R5.2-billion). Only five other countries have faced larger cuts in absolute terms (see all country-level estimates here). Spotlight and GroundUp have confirmed that at least some of the remaining 11% of USAID funding has once again begun flowing to beneficiaries in the country.
Thus, a small amount of USAID funding is trickling into South Africa, while CDC funds have largely been retained in full. Though it’s unclear for how much longer.
Finance Minister Enoch Godongwana holding a copy of the 2025 Budget Speech. (Photo: Parliament of RSA via X)
By Charles Parry, Funeka Bango, Tamara Kredo, Wanga Zembe, Michelle Galloway, Renee Street and Caradee Wright
While the 2025 national budget boosts health spending, researchers from the South African Medical Research Council stress the need for strong accountability measures. They also raise concerns about rising VAT and omissions related to US funding cuts and climate change.
The 2025 budget speech by Finance Minister Enoch Godongwana saw a welcome boost to the health budget with an increased allocation from R277 billion in 2024/2025 to R329 billion in 2027/2028. This signals a government that is responding to the dire health needs of the public sector, that serves more than 80% of the South African population.
As researchers at the South African Medical Research Council (SAMRC), we listened with interest and share our reflections on some of the critical areas of spend relevant for health and wellbeing.
We note the increase in investment in human resources for health and allocations for early childhood development and social grants. At the same time, we also raise concern about increasing VAT, with knock-on effects for the most vulnerable in our country. There were also worrying omissions in the speech, such as addressing the impact of the United States federal-funding freeze on healthcare services nationally, and a noticeable absence of comment on government’s climate-change plans.
Health and the link with social development: Recognising the importance of early childhood development
Education and specifically early childhood development (ECD) is known to have critical impacts on children’s health and wellbeing, with longstanding effects into youth and adulthood. In South Africa, eight million children go hungry every day, and more than a third of children are reported to live in households below the food poverty line, that is below the income level to meet basic food requirements, not even covering other basic essentials such as clothes.
While the increase in the number of registered ECDs is laudable, many more ECD centres in low-income areas remain unregistered, which means they do not get support from the government in terms of subsidies and oversight.
Social grants
The increase in social grants is welcomed. However, the marginal increase of the Child Support Grant (CSG) by only R30, from R530 to R560, is too little to impact on the high levels of child hunger and malnutrition. The release of the Child Poverty Review in 2023, which highlighted the eight million children going hungry every day, including CSG recipients, proposed the immediate increase of the CSG to at least the Food Poverty Line (R796 in 2024).
Social relief of distress still too small
The Social Relief of Distress (SRD) Grant is an important source of income for low-income, working-age, unemployed adults. Its continuance in 2025 is welcomed. However, it remains too small at R370 per person per month, and the stringent means-test criteria which disrupt continuous receipt from month-to-month, makes it an unreliable, unpredictable source of income for low-income individuals.
Strengthening the healthcare workforce
The Minister stated that “R28.9 billion is added to the health budget, mainly to keep about 9 300 healthcare workers in our hospitals and clinics”. It will also be used to employ 800 post-community service doctors, and to ensure that our pharmacies do not run out of medicines. The speech highlighted the necessary commitment to strengthening the healthcare system, specifically human resources for health.
Considering the pressures on resources, primarily due to the escalating disease burden and challenges within the health workforce, the proposed budget increase from R179 billion to R194 billion – an increase of 8.2% – to maintain the current workforce and employ additional healthcare workers signifies a positive step forward that will aid in addressing staff shortages.
Despite the gains in health spending, the proposed increase in VAT raises substantial concerns to partially negate the potential benefits to the health sector. As the World Bank reports that approximately 60% of people living in South Africa live below the poverty line, increases to VAT will likely drive poverty levels higher.
A focus on other forms of taxation may be better, more evidence-based, and less likely to disproportionately affect those at the highest levels of poverty.
On the issue of alcohol taxes, often mischaracterised as “sin taxes” rather than “health taxes”, the Minister has proposed excise duties of 6.75% on most products for 2025/26. This is 2% above consumer inflation, which stands at 4.75%.
Raising alcohol prices through higher excise taxes is globally recognised as an effective way to address alcohol-related harms. National Treasury is to be commended for adjusting alcohol excise tax rates above CPI in the 2025/26 Budget. This is a move in the right direction, but it does not address the current anomalies in tax rates across different products. This failure to address shortcomings in the excise tax regime is expected, given the release of a discussion document on alcohol excise taxes in December 2024 with a February 2025 response date. The earliest we can expect substantial changes in excise tax rates is in February 2026.
From a public-health perspective, it makes sense to link alcohol excise taxes to the absolute alcohol content of the product to standardise across products. Ethanol is ethanol. The current differential in excise tax rates on different alcohol products is indefensible. Specifically, it makes no sense to tax wine and beer so much less than spirits in terms of absolute alcohol content. Wine, especially bag-in-box wine, is the cheapest product on the market in South Africa, and its affordability increases consumption, leading to more societal harm.
Beer is the most consumed product in the country and is increasingly sold in larger, non-resealable containers. A 2015 SAMRC study in Gauteng found the highest level of heavy episodic drinking with beer products, largely due to their affordability, especially in larger, non-resealable containers. Heavy episodic drinking is a major public-health concern in South Africa, with 43.0% of current drinkers engaging in heavy episodic drinking at least monthly, 50.9% of male and 30.3% of female drinkers. Increasing the excise tax on beer is a powerful tool that the state can use to reduce the level of such behaviour.
Additionally, it makes sense to have lower taxes on alcohol products with lower alcohol content, as this could shift consumption to less harmful products. The current excise tax regimen does not account for this within a single product type like beer or wine, as all products are taxed at the same rate regardless of their alcohol content.
During the COVID-19 pandemic, we saw the benefits of decreased access to alcohol: fewer injuries, fewer unnatural deaths, and communities less disrupted by patrons visiting liquor outlets. While no one advocates for total liquor sales bans, increasing excise taxes on wine and beer would decrease alcohol consumption and reduce harms on drinkers, on others around them, and on society more broadly.
Acute risk to lives with knock on effects due to US federal funding cuts
We believe the South African government has a responsibility to step into the gap left by the sudden US federal funding freeze on HIV and TB services. The US President’s Emergency Plan for AIDS Relief (PEPFAR) funds 17% of HIV and TB services in South Africa and covers salaries for thousands of health workers, including the vital services of community health workers.
The implications for people living with HIV and TB and affected by the externally funded services will be devastating. It will also have ripple effects on the health system as we see inevitable increases in demand for health services to address advancing illness, effects on families caring for ill relatives or losing income.
This area needs to be addressed and clear communication from the National Department of Health is urgently awaited. The US funding cuts clearly impact on essential research funding available to institutions like the SAMRC and no indication has been given in the budget of any plans to augment or replace such funding.
National Health Insurance for South Africa’s public sector
The Minister addressed budget allocations for NHI implementation, specifically, the mid-term indirect and direct conditional grants for NHI were R8.5 billion and R1.4 billion respectively. Although these amounts in themselves are minor compared to other health-budget allocations, allocations for infrastructure (R37.4 billion over the mid-term economic framework period) and additionally allocations for digital patient health information systems, chronic medicine dispensing and distribution systems, and medicine stock surveillance systems are vital for healthcare efficiency and improved outcomes.
Least said not soonest mended: climate change – ‘no comment’?
From a climate-crisis perspective, although the budget speech did not explicitly mention climate change or its related health challenges, there seems to be positive steps being taken to address these issues. Initiatives such as clean energy projects and efforts to improve water management have the potential to benefit all sectors of society, while helping to mitigate the health risks associated with climate change.
Promising spend on health, but who will measure the impact?
Ultimately, increasing health spend is a promising step to increase access to quality health services for South Africa’s population. However, this is not enough, government must seize the opportunity to translate the budget increase into improved health outcomes. The effectiveness of the additional funds must be maximised through efficiency, transparency, and sound governance. The government can reinforce the integrity of public-health services by aligning these increases with robust accountability measures.
Government-academic partnerships represent an opportunity to share knowledge, technical skills and resources to support evidence-informed decision-making for national health decision-making and strengthen monitoring and evaluation mechanisms. There are many examples of this working well, and we trust that the SAMRC, along with the network of higher education institutions are well placed to provide the necessary support.
*Parry, Bango, Kredo, Zembe, Galloway, Street and Wright are researchers with the SAMRC.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
