A strong healthcare system is fundamental to economic development. It supports productivity, reduces long-term healthcare costs, and contributes to a healthier, more resilient population. The World Bank Annual Report 2023 underscores that countries with robust health systems are more likely to sustain economic growth and withstand external shocks. In Zambia, where domestic health financing remains limited, donor support—particularly from the United States—has played a central role in delivering essential services. However, with recent cuts in U.S. global health funding, and the republican president on record indicating that “we are on our own”, Zambia faces uncertainty in sustaining its healthcare system. This article examines the potential implications of these funding cuts on Zambia’s health sector.

U.S. Aid and Zambia’s Healthcare System

According to USAID funding trend data, U.S. health aid to Zambia has typically ranged between $300–500 million annually over the last decade. In 2024 alone, Zambia received approximately $423.86 million in total U.S. foreign assistance. Of this, over $330 million—nearly 78%—was directed toward health-related programmes. The majority supported HIV/AIDS services, while the remainder was allocated to maternal and child health, basic healthcare, and emergency health response. According to the USAID Global Health Programs, this assistance has enabled the expansion of antiretroviral therapy (ART), strengthening of public health infrastructure, and delivery of essential services in rural and underserved communities.

Despite government efforts to mobilise more domestic resources for health, Zambia’s health system remains heavily donor-dependent. The Zambia National Health Strategic Plan (2022–2026) estimates that around 40% of total health sector financing is externally sourced. This dependence makes the system vulnerable to shifts in donor policy, such as the recently announced 83% cut to global health funding by the U.S. government.

Disruptions to HIV/AIDS Treatment and Prevention

Zambia’s progress in addressing HIV/AIDS has largely been supported by external funding, particularly through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This support has significantly expanded access to antiretroviral therapy (ART), with UNAIDS estimating that by 2023, nearly 90% of Zambians living with HIV were on ART. However, with U.S. global health funding now being scaled back, the continuity of ART supply, testing, and adherence support services faces serious risk. Interruptions in treatment could lead to increased drug resistance, poor health outcomes, and potential spikes in new infections.

These risks are further compounded by findings from the 2024 Zambia Demographic and Health Survey (ZDHS), which highlights a concerning rise in new HIV infections among adolescents, particularly among girls aged 15–19. The report links this trend to limited access to youth-friendly sexual and reproductive health services and a lack of comprehensive HIV prevention education. With U.S. support historically funding prevention and community-based outreach services, especially among vulnerable populations, further reductions could leave critical prevention gaps unaddressed—potentially triggering a resurgence of the epidemic among youth.

Risks to Maternal and Child Health Services

In addition to HIV/AIDS, U.S. assistance has also played an important role in supporting Zambia’s maternal and child health services. Programmes have included immunisation drives, prenatal and postnatal care, nutrition interventions, and emergency obstetric support. These initiatives have contributed to gradual improvements in maternal and child health indicators over the past decade.

Cuts to these programmes could lead to decreased access to skilled care during childbirth, lower immunisation coverage, and reduced availability of essential maternal and neonatal supplies, particularly in rural areas. As these services are often delivered through donor-supported health posts and outreach initiatives, any funding shortfall could disproportionately impact women and children in the most underserved communities.

Conclusion
The reduction in U.S. foreign aid, particularly for health, presents a challenge to Zambia’s health sector. Key areas such as HIV/AIDS treatment, maternal and child health services, and health workforce capacity are likely to face disruptions if alternative financing is not secured. These developments also reveal the structural vulnerabilities of donor-dependent health financing and the urgent need for a sustainable transition strategy. sources, these cuts could reverse years of progress in disease control and healthcare accessibility. In next week’s piece, we will explore potential strategies for diversifying Zambia’s health sector.

About the Authors:

Elijah Mumba is a development economist specializing in public finance and policy analysis. He is a Senior Researcher at the Centre for Trade Policy and Development, where he also coordinates the Zambia Tax Platform and Civil Society Debt Alliance. He holds a master’s degree in development economics from the University of Cape Town as a Mandela Rhodes Scholar.

Natalie Kaunda is a development economist with expertise in public policy, advocacy, and economic research. She serves as the Head of Advocacy and Campaigns at the Centre for Trade Policy and Development. She holds a bachelor’s degree in development studies from the University of Zambia and a master’s degree in economics and finance, with additional studies in sustainable development at the University of Cambridge.