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How US funding cuts are reshaping aid in Africa
00:23:27
Assessing a new era of aid in Africa in the months since President Trump closed USAID
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This BBC podcast is supported by ads outside the uk.
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Hi everyone, I'm Ed Butler. Welcome to Business Daily on the BBC World Service, the show that digs deep into the world of money and work. Today we're taking different perspectives on on a theme that's concerned development officials, indeed many people across Africa over the last year or more. What does it mean for the continent to have lost some $8 billion in US aid funding practically overnight?
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The United States is not a global charity.
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What impact have those US Aid cuts had on the world's poorest continent?
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Hundreds of thousands of lives were going to be lost in a matter of months.
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The effect of U.S. aid cuts. That's our double take here on Business Daily on the BBC. A quick reminder. When Donald Trump re entered the White House in January last year, one of his earliest executive orders was to cut most US Aid funding to Africa and other poorer parts of the world. In a truth social post at the time, he called the levels of aid totally unexplainable. Close it down. He cried. More than 80% of reviewed grants were terminated, affecting about 20% of all aid reaching the African continent. And since then, many aid experts have warned of dire consequences. Dr. Atul Gawande is a public health expert, a Biden White House appointee who helped to run usaid. He believes that the cuts brought about the loss of hundreds of thousands of lives.
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Already we're in the midst of public man made death now, and yet it can be so hard to see because it doesn't happen like in a war where the bomb drops and then you see the bodies in the field. We now know it's not just malnutrition. We see loss of control of hiv, loss of control of tb. All of the technical assistance we gave to many governments and communities that enabled the increases in vaccination rates, enabled the, the delivery of better childbirth. Those have gone away. So we're seeing early deaths like the malnutrition cases. And then we see the wave. That's more to come.
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Dr. Atul Gawande well, more on all of these arguments shortly. But let's get first to my guests today. Joining me from Lagos in Nigeria is Amy Jadassemi. She is the CEO of Ladol, a special economic zone around the port in that city. She's also part of the UN Global Compact on the Sustainable Development Goals. Amy, you have feet in both camps, right? Development, business.
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My feet are firmly planted on the private sector business side. And those two things are not actually on opposite sides. We believe that we can best drive development, particularly sustainable development, through our business practices, and that sustainable development and industrialization will lead to the best outcome for communities.
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Also joining us from Darussalam is the Reverend Dr. Peter Bujari, an expert in public health who's worked on projects on controlling the spread of HIV, AIDS and TB across Tanzania and East Africa. Hi. Dr. Bujari, US aid money has been central to your work, I guess, in recent years.
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Yes. In Tanzania we received about US$450 million a year. And this is a significant contribution of the funding in the health sector and agriculture sector and many other. And so the cut has severe consequences.
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Okay, well, we're going to hear more about those effects from you in just a moment. For me, what we're discussing today has long been a source of fascination. A lot of my work has focused on this. It really gets to the heart of what aid money does, of course, and how Africa often works. I've visited many parts of the continent many times over the last 20 years, and I have seen what aid money can do. Hi, can I come in? So that was me Just a couple of months ago, stepping in the door of a new maternity clinic in Sierra Leone in West Africa. Who's it?
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We have no name for him yet.
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No name yet.
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Very, very handsome.
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And that's me meeting the clinic's latest arrival, a beautiful two day old baby boy. This facility, which is in a village in a remote hilltop area in the east of the cliff country, has only recently been built and its staff received their wages thanks exclusively to international donor money. The midwife Judith Siya Lemin says that the clinic demonstrates the dramatic difference that aid money can make in one of Africa's poorer countries.
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In the past, women are dying in labour during childbirths.
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They will die on the road.
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60 of any 1,000 were dying during childbirth.
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60 out of every thousand were dying?
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Yes. Of every 1,000 childbirths, the mothers or the children.
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That's tough.
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Yes, very, very tough by then. Now it's much better.
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Well, that's one example in Sierra Leone, US aid money of course not involved in that case. I should add, Amy, you can hear examples like this again and again across
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the continent when you talk about the individuals who work for these agencies on the ground who are for the large part professionals who add a lot of value. I have a lot of support and time for them. On the other hand though, I don't think you can any aid organization or any NGO say that they have been responsible for lifting a country out of poverty or creating a great number of jobs on the ground. I think in very specific acute situations aid makes sense. I think as a long term palliative that in some ways alleviates governments from their responsibilities to their people. I think aid can become very damaging.
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Right. So there's a difference between emergency aid and sort of development aid. That's basically what you're saying, Dr. Bujari. I mean you've worked in the prevention of HIV AIDS. That's only happening, right, as a result of the input the finance of many major global aid programs. You were saying this already. USAID was a big part. Describe in detail what you have seen since those aid cuts came in last year.
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I am managing an organization that was supporting young people who are on treatment to transition from youth clinic into adult clinic. And we're also supporting children who are on treatment already these programs have been closed. In addition to laying off 20 staff who were working in three offices in the areas that I mentioned under the USAID funded AFE Young program. So that means that I lost staff. But also the young people who we were supporting to transition into adult clinic are no longer being supported, they're likely to get lost in the system. And same as the children who are supporting to understand why they are taking medication, but also supporting their parents to better help the children.
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Okay, so, I mean, just to be clear, Dr. Gawande said earlier, didn't he, that he thought hundreds of thousands of lives will be lost in the first year. Would you say specifically that you think lives have been lost as a result of these cuts to your program?
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Yes, yes. I'm not sure how many. We currently undertaking some surveys to document that, but certainly some lives have been lost. It's only the question of being able to document who and where. But the numbers doesn't matter here. What matters is the life of somebody who has been supported by this funding for the last 20 years and only now have to succumb to death.
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Dr. Bijari, I think the work you do is tremendous and I think it's really important. But saying that we have depended on foreign aid for 20 years to save lives is a very worrying statement. To the extent that USAID goes into developing a business or enabling the development of factories that can manufacture AIDS drugs in various countries in Africa, and then after 20 years, that investment has paid off, the drugs are being manufactured locally, and therefore there is no more dependence on international aid, this would be an aid success story. And to be honest, I think a lot of people in Africa, as devastating as some of the impacts of this reduction in aid can be, feel that this reduction in aid from America is a wake up call.
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Dr. Bajari, what do you say to that?
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I kind of disagree in a way that the cut was so abrupt in a period of, say, next week you're off. So there cannot be a sustainability in such an abrupt cut. It could have been a better transition if it was given a year or two for the programs to readjust.
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Okay, well, listen, I think that the abrupt question is a good one, and I want to come back to that in a second. The biggest donor, of course, and the biggest cuts by far have come from the U.S. that's not to say there hasn't also been an erosion of European aid budgets in recent years from the uk, Germany, France and other EU nations. This is mad. Matthew Bartlett, he was appointed to the State Department by President Trump during the first presidential term of Mr. Trump. He told us why he thought the president had been so open to closing down the agency last year.
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The United States is not a global charity. USAID is not a charity. You know, it should be. Is this in the interest of the United states taxpayer because we are $38 trillion in debt. There's always been a skepticism around foreign aid in the Republican Party in terms of efficacy and rationale of creating a culture of dependency to the notion of taking money away from poor people in the US and giving it to wealthy elites and other governments around the world. I think you then had the Biden years, which you saw an explosion of money of millions and billions of dollars across the board. And that's what led to Elon Musk who eventually fed USAID into the wood chipper.
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That's Elon Musk, of course, who led the cuts program, the Department of Government Efficiency last year. So former USA coordinator Matthew Bartlett there he, despite his connections with the Trump White House, says he thought that the speed and severity of the cuts had been too fast. Amy Jeddasimi, what's your take on this? The ripping off the band aid, so to speak?
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I think the effects on the ground, depending on where you are, in some cases has been abrupt, in some cases has been less abrupt. I still think that's missing the point though. Even if it took two years to ramp down the aid, the aid is not going towards developing systems on the ground that would enable the organizations on the ground to continue to operate and deliver the service without the aid. The dependency has been on two sides. The money goes into American organizations, it pays for American medicines, it pays a lot of American personnel. And then the dependency on the African side might be because the assumption is that these organizations are coming into a zero sum game. So nothing on the ground in Africa, no capabilities in Africa. So we're going to parachute in everything as opposed to assuming that there are people and facilities and systems in Africa that just need a little bit of help to be built up so that they can stand on their own.
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Fully agree in a sense that the aid building local sustainability was one of the challenge. And so there is a directive funding, but there's no mechanism to build local sustainability and local sustainability in financing itself so that when the aid ends, the system are built and organizations are strong enough with possible mechanism to finance themselves.
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You're listening to Business daily on the BBC World Service.
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My name's Ed Butler, and today we're looking at the true cost to Africa of last year's massive cuts to U.S. and other aid spending. Many billions of dollars were summarily axed from Africa's various economies overnight. I'm with Dr. Amy Jadassemi in Nigeria and Dr. Peter Bujari in Tanzania looking at this. Let's talk about the impact of these cuts across the continent as a whole then. A recent study published in the Lancet Medical Journal projected that the global aid cuts could lead to at least 9.4 million additional deaths by 2030. It says about 2.5 million of those deaths are likely to be children under the age of five. I mean, this is pretty bleak stuff. Amy, I appreciate that your argument is sustained decades long aid has not proved efficient. But the suddenness of those loss, that loss of life, it does sort of bring you up short, doesn't it?
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Those studies are, for the most part assuming Africa's capability to respond to these cuts is at zero, which is just not the case. So similarly, during COVID it was assumed that African countries would be devastated because we had no ability to respond. We had no systems on the ground, so they applied the worst possible outcome. So I think that it will be devastating in the short term, but I think in the medium term, in a year or two, I genuinely think most countries, most governments will respond and adapt.
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Okay, Peter Bajari, I mean, in Tanzania, did the speed of the budget cuts force the government to step up and perhaps do more of what it should have been doing already?
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As a public health specialist and also in the health sector, the government's adjustment and stepping up isn't meeting what is required. In Tanzania, for instance, we had health practitioners, doctors and rebalance technicians and nurses being financed by the aid. And after the aid, they had to be withdrawn. And many of those has not been absorbed within the government system. So there was a shortage already, there's now a double shortage. And this means the hiv, TB and maternal health programs are already suffering.
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Amy Jadassemi, you are basically arguing, I think, that aid money has effectively distorted African economies over decades. Is that your opinion? And if so, how is that working?
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I think without doubt that's what's happened. The aid industry creates a status quo that enables inequalities and inequities and government failures to continue for decades. Whereas if you have a situation where the government has no choice but to step in, government will step in. Of course they will. And in some ways, you could say that three decades, four decades of international aid have artificially created a status quo that delays the ability of many African countries to develop for themselves these solutions which will be sustainable and which will benefit their people much more than the trickle of aid that has been coming in historically.
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The challenge here has probably been that the aid does not necessarily have to do what is the top priority. So sometimes the aid comes with predetermined areas of focus. But admittedly, I think, and I have seen that the coming of the aid has done much more than we have seen, including, for instance, Tanzania being able to reduce its maternal mortality rate in the last 10 years. So I think there are results that we have seen that comes from aid. But I think there are also areas where our own leaders and government have not taken responsibility. And as I mentioned, on the health sector allocation, it's still low, even though they committed. And so we may blame the aid, but I think we also need to say that the aid did cover what was important that our own government had not been able to cover.
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Because a lot of Africans do complain about poor governance their country.
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I don't think governance issues can any longer be hung around the neck of African governments as if we are exceptionally poor at governing ourselves. Governance is, of course, a necessary component of delivering poverty alleviation and delivering good health care. But if you look at how that is applied at the local level, we don't have to rely on a particular minister minister to do his job correctly. We just have to have a strong civil society. We have to have strong local systems in place, strong regulatory systems, strong laws. And then the people have to be empowered to make sure that they get what they are entitled to. And in a quiet way, that is happening certainly in Nigeria. And cuts to aid actually empower the local people and drive the local people to demand that the services that they are supposed to be getting are actually delivered to them by. By the government.
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Dr. Bajari?
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I think we have a challenge on the governance systems of our country. In Tanzania last year, you know, people are demanding their right and then they are shoot to death. So I think there are challenges on the governance of our own government. Sometimes health is not a priority, for instance. Sometimes the community health system that she mentioned. I think I do agree with that. They are not financed by the government. And so who empowers the people? Governments in Africa, they do not finance civil society organizations in any way. Europe and America, they do that. So where does the civil society organizations get resources? Probably from the private sector. And that isn't really the way from what I see happening on the ground.
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Okay, Peter, let's just go to the broad big picture now. Whatever we think of these aid cuts, we are simply, are we not at a point, point where they have become inevitable? We have had decades and decades, tens of billions and billions of dollars pumped into Africa. It has not seen the growth levels in Africa that were perhaps forecast by the people giving that aid in previous decades. No U.S. or European administration right now is going to reverse them it would seem. I mean the politics of high income nations suggests that this money is not going to be coming back at the levels that we saw before. Africa is one way or another just going to have to adjust, isn't it?
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Yes, it's going to have to adjust. I think there was a problem the way the aid is structured in itself to allow local priorities to be scaled up. But also we know, and I know from Tanzania that the government did allocate some money to begin to come in and address the shortages. However, the money has not been released on the private sector and government and non government organizations. We already exploring ways to raise resources within our own to be able to do the minimum. But as I said, it was an abrupt in a way that you do not know what to do. I had to lay off stuff and many organizations had to lay off staff because the the funding is cut in a month or two and there's nothing you can do. You cannot raise money in a month or two, not even a year. Sometime you need time to make those adjustments. I do think we have begun talking to our government, thinking about local solutions, thinking about what can we do by ourselves to maximize the impact of little resources that we have.
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Amy Jadassemi we referred to the Lancet report. One way or another, we're talking about potentially hundreds of thousands, maybe millions of lives lost in the short term. Are you basically saying that may just be a price that has to be paid for a transition that you think is inevitable and necessary.
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So I think the numbers from the Lancet are an exaggeration based on faulty assumptions. However, there will be lives lost. One life lost is too many. But this wake up call was always going to come. What matters now is what we do and There are many things we could do different to the Western solutions that have basically been imposed upon us by these aid agencies. For example, women don't have to come to hospitals to give birth. The majority of births in Africa take place at home. So how can we make it safer to give birth at home? Instead of forcing women to come to clinics to get injections, let's empower them. So let's have models that suit the lifestyles of the people that we're treating and let's have systems that are developed based on how our communities are currently set up, what people can currently afford. And the good thing is there are many, many solutions in the west that we can pick and choose from and apply in a way that suits our environments.
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Do you think access to affordable credit is more important than aid then for African economies? I mean, affordable credit has been the long complaint, hasn't it?
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So for a company like Ladol, 100%, yes. We're a growing company, we do a lot of international business, we run a huge port, we have like an industrial town. Talking in terms of credit makes sense. What the average Nigerian needs, I don't want to speak to all Africans is reliable systems. They need community level systems. They need to know that when they go to school their children will be safe and students can go to university and the universities will teach them where they can then leave and get good jobs at the level we're talking, which is that kind of governmental systems and NGOs, it's about putting in place infrastructure for people to do that in a sustainable way.
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Okay. Dr. Peter Bijari, Tanzanian public health expert, My thanks to you and of course My thanks to Dr. Amy Jadasimi of the business hub Ladol in Lagos in Nigeria. Thanks to you all for listening as well. That's it for this double take edition of Business Daily from me, Ed Butler and the rest of the team take care of.
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