IMPACT OF TRUMP’S POLICIES ON AFRICAN HEALTH OUTCOMES

Donald Trump officially took office earlier this week. There are so many reactions from different people at different levels, but as emaSwati in Africa, this could mean a major shift in the way we have always related with the United States. For the next few weeks we can look into what this means for us, but today what interests me the most is looking into health initiatives. Eswatini has been battling with a sickly health system for years now. We have survived mostly because of the aid we received from donors like the USA. The Trump administration’s approach to global health initiatives has undergone significant scrutiny, particularly regarding its impact on African countries, where health outcomes are often interlinked with US support. Central to this discourse is the President’s Emergency Plan for AIDS Relief (PEPFAR), a programme established in 2003 aimed at combating HIV/AIDS in resource-limited countries. While PEPFAR has received bipartisan support since its inception, the Trump presidency marked a period of both continuity and change, with profound implications for health outcomes across the African continent.

PEPFAR has been heralded as one of the most successful public health programmes in history, providing life-saving antiretroviral treatment to millions of people living with HIV/AIDS in Africa. As of 2020, the programme had supported more than 17 million people with treatment, significantly reducing mortality rates and new infections. Its impact extends beyond HIV care, promoting broader health systems strengthening in African nations through training healthcare workers and improving laboratory infrastructure. I have had the pleasure of being part of such initiatives and I understand its importance to the ordinary liSwati.However, during Trump’s presidency previously, several changes to PEPFAR and broader US health policies raised concerns about the programme’s future. Notable was the administration’s proposal to cut foreign aid significantly, which included funding for global health initiatives. These cuts threatened the sustainability of PEPFAR and potentially jeopardised the lives of millions dependent on its resources.

Notable

While the Trump administration did not dismantle PEPFAR, it did implement policy adjustments that influenced health outcomes. One notable change was the introduction of the ‘global health security’ framework, which prioritised certain infectious diseases while de-emphasising others. Critics argued that this shift diverted attention from comprehensive healthcare needs, favouring short-term epidemic responses over long-term structural health improvements.Additionally, the ‘Mexico City Policy’, reinstated by Trump, restricted US foreign aid for health programmes that provide or promote abortion services. For many African organisations that rely on US funding, this policy created a complex dynamic where reproductive health services — crucial for tackling maternal and child health issues — were at risk. These restrictions underscored the tensions between reproductive rights and public health funding, diminishing outcomes in comprehensive sexual and reproductive health.

Trump’s disengagement with multilateral health agreements also had implications for US relations with African countries. His administration’s withdrawal from the World Health Organisation (WHO) amid the COVID-19 pandemic sparked concerns about US commitment to global health governance and partnership. Many African leaders who rely on US support for health initiatives viewed this as a diminished role in tackling shared health challenges. Moreover, advocacy groups in Africa expressed worries about the US retreat from collaborative health efforts, emphasising that a united approach is critical in addressing health crises. The Trump administration’s focus on bilateral agreements over multilateral partnerships weakens collective responses to health issues that do not respect national borders, such as pandemics and infectious diseases.

As the Trump presidency takes over again, the future of PEPFAR and US health initiatives in Africa remain uncertain. The importance of sustained funding, collaboration and comprehensive health policies is paramount if progress against diseases like HIV/AIDS is to be maintained. There is a dire need to recalibrate US  health strategies to prioritise continuity, equitable access to health services and stakeholder involvement. In conclusion, the Trump administration’s health policies will yield mixed outcomes for Africa, with significant implications for health systems, program sustainability and health service accessibility. While PEPFAR may continue to operate and adapt, the threat of funding cuts, policy shifts and disengagement from global health partnerships pose challenges that could hinder the progress made in alleviating health crises across the continent. As African nations navigate these complexities, a commitment to collaborative global health initiatives will remain essential for improving health outcomes and ensuring equity in care delivery.

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