Business Daily (BBC World Service)

Episode: What happens when the aid money runs out?

Date: November 21, 2025
Host: Sam Fenwick

Overview

This episode of Business Daily explores the global ramifications of declining foreign aid, with a sharp focus on the health sector. As the world’s biggest donors, including the United States and major European nations, make steep cuts to development and humanitarian budgets, the podcast investigates how these changes reverberate through vulnerable communities—especially in health programs—and the journey toward self-sufficiency for countries heavily reliant on external funding. Interviews with field leaders, policymakers, and health fund executives contextualize both the dangers and possible paths forward.

Key Discussion Points & Insights

1. The Human Impact of Lost Aid – Zambia’s Fishing Villages ([01:18]–[05:06])

• Fidus Tempa (Action Aid, Zambia) details a program addressing gender-based violence and economic exploitation in Zambian fishing communities.
  • Many women, unable to afford fish at market prices, were coerced into exchanging sex for fish ([02:43]).
  • With USAID funding, Action Aid partnered with local ministries to create safer trading practices and empower women ([03:54]).
  • The sudden cancellation of USAID support under a new U.S. administration immediately derailed progress, leaving women “shattered” ([04:46]).
• Notable Quote:

  "You are in a hopeless situation and there comes a project that gives you hope and light, gives you knowledge. ... Then you're beginning to appreciate how you can live differently and how you can empower yourself. So definitely that shattered their hope."
  — Fidus Tempa ([04:46])

2. The Scale and Suddenness of U.S. Aid Cuts ([05:06]–[06:53])

• Historically, the U.S. funded nearly 30% of global aid and 43% of humanitarian needs ([05:06]).

• Matthew Bartlett (former U.S. appointee to the State Department, PEPFAR) rationalizes the cuts from a U.S. fiscal perspective but admits the lack of transition is “dramatic and arguably been deadly” ([06:26]).

• Bartlett highlights that even where countries are “in good shape,” abrupt withdrawal without transition plans causes major societal risks.

• Notable Quote:

  “The United States is not a global charity. USAID is not a charity. ... We are $38 trillion in debt... It's been dramatic and arguably been deadly. And when there is no transition plan, these cracks become massive fissures in health and society.”
  — Matthew Bartlett ([05:41], [06:26])

3. Aid Retrenchment is Global ([06:53]–[07:55])

• Aid cuts are not limited to the U.S.; the UK, Germany, France, and Japan have all reduced funding, some by as much as 40% ([06:53]).
• This “tightening” makes running global health and poverty-reduction programs exceedingly challenging, as donor governments prioritize domestic spending while health programs seek urgent, ongoing funding.

4. The Global Fund’s Plea at the Summit ([07:58]–[10:58])

• The spotlight moves to Johannesburg, where global leaders decide on the Global Fund’s $18 billion replenishment to fight HIV, tuberculosis, malaria, and future pandemics.

• Peter Sands (Executive Director, Global Fund) argues that international health investment is security for all, not charity, as infectious disease knows no borders ([08:57]).

• He acknowledges that there is political inwardness, as governments face economic strain and voter skepticism about foreign aid.

• Notable Quote:

  “The world is totally interdependent when it comes to the threat of infectious diseases... It is through strengthening the health systems in the very poorest countries... that we make all of us, wherever we live, safer.”
  — Peter Sands ([08:57])

5. Can Countries Replace Aid with Investment?—The Zambian Case ([11:54]–[15:36])

• Zambia is attempting to fill the aid gap with domestic spending increases and investments, especially in critical minerals (like copper).

• Chipoka Malenga (Zambia’s Minister of Commerce) champions a shift from the “begging bowl” to attracting value-adding investment. Policy reforms now mean more copper is refined domestically, increasing revenue—but the transition is slow ([13:10], [14:06]).

• Projected timeline for self-sustained health funding: over 10 years ([14:37]).

• Malenga stresses the heartbreak of donor withdrawal and the newfound realization of the country’s vulnerability to global priorities.

• Notable Quote:

  "The west cut the aid from us, knowing clearly that lives will be lost. It is very heartbreaking. We never, as a government or as a continent, invested and believed in ourselves."
  — Chipoka Malenga ([14:55])

6. The Risks of Abrupt Transition to Self-Reliance ([15:36]–[17:33])

• Peter Sands supports the move toward national health system financing, yet warns abrupt shifts cost lives—and not every country starts at the same place ([15:46]).

• He points to successes (e.g., South Africa funding 3/4 of its HIV/AIDS budget) versus nations at war (Sudan, Yemen), which cannot make such transitions ([15:46]).

• Economic Returns: Ethiopia’s health sector investment led to a 16-year rise in life expectancy and a 20-fold increase in GDP over two decades ([17:00]).

• Notable Quote:

  "If you do it too abruptly, you derail progress. Lives will be lost, people will be left behind. And also countries are in very different starting points."
  — Peter Sands ([15:46])

7. Governance and Corruption—Persistent Obstacles ([17:33]–[18:08])

• Sands acknowledges that corruption and mismanagement impede aid efficacy and economic growth globally ([17:44]).
• Good governance is vital for translating health investments into long-term national budgets.

8. The (Unfinished) Success of Global Health Aid ([18:08]–[19:13])

• Sands will urge world leaders that despite enormous recent gains—increasing life expectancy, reducing disease—the work is not complete: diseases like HIV, TB, and malaria can resurge if programs are halted prematurely.

• Investment in health brings social, economic, and stability gains, benefiting both recipient and donor countries ([18:18]).

• Notable Quote:

  “The last two decades have seen in most countries increases in life expectancy of between sort of 15 and 19 years. But the job isn't finished. ... There is no kind of middle ground. You can't just sort of say, oh, we've got so far. Can we just stop here? Because these diseases will fight back.”
  — Peter Sands ([18:18])

Memorable Quotes

• “That shattered their hope.” – Fidus Tempa on aid program shutdown ([04:46])
• “USAID is not a charity... It's been dramatic and arguably deadly.” – Matthew Bartlett ([05:41], [06:26])
• “The world is totally interdependent... we make all of us, wherever we live, safer.” – Peter Sands ([08:57])
• “We need to stop going to any country in the world with a begging bowl.” – Chipoka Malenga ([13:10])
• “If you do it too abruptly, you derail progress. Lives will be lost...” – Peter Sands ([15:46])

Key Timestamps

| Timestamp | Segment/Highlight | |-----------|-----------------------------------------------------| | 01:18 | Aid’s collapse in Zambian fishing communities | | 05:41 | U.S. aid cuts—Bartlett’s perspective | | 06:53 | Europe and Japan also cut global health funding | | 07:58 | The Global Fund’s replenishment request | | 08:57 | Peter Sands: Global health investment is security | | 11:54 | Shrinking aid’s impact on Zambia’s health system | | 13:10 | Chipoka Malenga on investment over aid dependency | | 15:46 | Peter Sands: The dangers of abrupt transitions | | 17:00 | Ethiopia’s economic growth through health investment| | 18:18 | Urging leaders: "The job isn't finished" |

Thematic Summary & Takeaways

• Cutting aid risks immediate harm: Sudden program cessation devastates vulnerable communities, as seen in Zambia.
• Donor nations re-prioritize amid economic pressure: Both the U.S. and EU states are refocusing on their citizens, with global health budgets slashed.
• Transition to self-reliance is essential but complex: While investment, especially in critical minerals, provides hope for Zambia, full independence is a decade or more away.
• Investment in health has massive returns: Economically and socially, health system strengthening pays dividends for developing nations.
• Leadership plea: Peter Sands implores global leaders to recognize that halting now could reverse decades of progress, with repercussions for both local populations and the world at large.

Episode presented with urgency and empathy, balancing hard financial realities with the very human costs of aid withdrawal. The tone is thoughtful, measured, and rooted in the real stories and stakes of global health.