What happens when the aid money runs out?

Summary

Business Daily (BBC World Service)

Episode: What happens when the aid money runs out?

Date: November 21, 2025
Host: Sam Fenwick

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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.

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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])

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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])

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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" |

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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.

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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.

Transcript

[Peter Sands]

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[Sam Fenwick]

Hello and welcome to Business Daily from the BBC World Service. I'm Sam Fenwick. Coming up, what happens when the aid money runs out?

[Fidus Tempa]

It shattered their hope. The human cost to all this is how it traumatized the women today, as.

[Sam Fenwick]

G20 leaders gather in Johannesburg to debate how much they're prepared to spend on global aid, we hear from the head of the world's largest multilateral health fund.

[Peter Sands]

The return on investment on investing in health is huge. What has been achieved over the last couple of decades is transformative.

[Sam Fenwick]

In the second of our two part series on tightening aid budgets, were focusing on the health sector, the new funding models being discussed and what they could mean for countries still dependent on external support.

[Chipoka Malenga]

We need to stop going to any country in the world with a begging bow. We should interact with them to bring investment in our country that provides value addition.

[Sam Fenwick]

That's all coming up on today's Business Daily. On the banks of the Zambezi river in western Zambia lie remote fishing villages where men go out to fish and the women buy what they catch to sell at the local market. Here there are rows and rows of tiny dried fish laid out on wooden tables in the sun. But for the women running these stalls, making a living can be dangerous because the fishermen don't just sell their fish for money, they demand sex in return.

[Fidus Tempa]

So for women that were not able to buy the fish at a price that they could afford, the men would take advantage and sell the fish using sex.

[Sam Fenwick]

Fidus Tempa is the country director for Action Aid in Zambia, an international development charity that works in more than 40 countries to tackle poverty and promote women's rights.

[Fidus Tempa]

Our women in Zambia, or probably Africa, are in the lowest bracket in terms of earning an income. And so you find that because of the high poverty levels, because of the high inequalities, you know, so it exacerbates gender based violence.

[Sam Fenwick]

In 2022, more than 30,000 cases of gender based violence were reported in Zambia. A year later, that figure had risen to nearly 43,000. In 2023, Action Aid applied to the US government for money to try and protect women in these remote fishing communities. The project was funded by the United States Agency for International Development, usaid. It was the world's largest agency for foreign aid, providing funding for health, education and humanitarian programmes, including in Zambia.

[Fidus Tempa]

So this particular project was to help women gain control. The project did work. We had created partnerships with the government Ministry of Health, the referral clinics. We had created partnerships with the Ministry of Home affairs through the police departments. So it also helped in terms of women to begin to understand that they do not need to use their bodies to buy fish, but they could actually use the legalized means of trading. And so because of that, the community members would actually start negotiating their businesses with most of the fishermen within that particular locality.

[Sam Fenwick]

But just as the work was starting to take hold, everything stopped overnight. In March, the Trump administration canceled 83% of USAID's programs. And in July, it formally shut down the department.

[Fidus Tempa]

It was disastrous because, look, 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.

[Sam Fenwick]

The story of one cancelled project on the banks of the Zambezi river sits inside something much bigger. Until recently, the United States was the engine of global aid. At its peak, America provided almost 30% of all international assistance and paid for 43% of the world's humanitarian needs. Matthew Bartlett is a Republican strategist and was President Trump's appointee to the State department for the U.S. global HIV AIDS program, known as PEPFAR, during Donald Trump's first term.

[Matthew Bartlett]

When it comes to foreign assistance, we should remember many things. 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? The good news is that after 20 years, there are many countries, at least when it comes to pepfar, that are in Very good shape and they are assuming more of the responsibilities of the health of their own citizens. We applaud that we, we are looking to hopefully pass the baton to many of these governments so that they can get out of an HIV AIDS crisis.

[Sam Fenwick]

Some would argue that actually cutting everything at a moment's notice is not the way to pass the bat on.

[Matthew Bartlett]

It's been dramatic and arguably been deadly. And when there is no transition plan, these cracks become massive fissures in health and society. It's been a very, very dark time in terms of global health. Not just with the shuttering of usai, but if you look at budgets around the world, I believe nine of the top European countries are cutting their budgets too when it comes to global health.

[Sam Fenwick]

Matthew Bartlett's right. It's not just the US pulling back. Across other major donor countries, Aid budgets are under pressure too. The UK has made sharp cuts from about $18 billion last year to a projected $12 billion by 2028. After diverting more money towards defence. Germany has trimmed its development budget by 8% to around $11 billion. And its emergency humanitarian funding has been almost halved. France has gone further, still cutting more than $2 billion from its 2025 development budget, nearly a 40% drop. And Japan has reduced its contribution too. In 2024, its aid spending fell by more than 10%, down to about $17 billion, one of the lowest levels in years. And for the people trying to run global health programmes, this makes life particularly difficult. They're asking governments for money. At the moment, they're cutting back.

[Chipoka Malenga]

Why support the Global Fund? 70 reasons.

[Peter Sands]

Ready, go.

[Chipoka Malenga]

One.

[Sam Fenwick]

Today in Johannesburg, the spotlight falls on one of the most important events in global health the Global Fund's eighth replenishment summit. Representatives from governments from around the world are meeting to decide whether to commit billions of dollars needed to fund life saving treatment for hiv, tuberculosis and malaria, and to strengthen health systems for future pandemics. Set against the backdrop of the G20 meeting, the fund is asking for $18 billion. It says the money will help save 23 million lives between 2027 and 2029. What happens in this meeting will determine whether that goal can be met. Peter Sands is the Executive director of the Global Fund. It's his job to persuade global leaders to part with taxpayers money. I asked him how he's going to do that.

[Peter Sands]

Well, there's a number of different arguments. One argument is a global health security argument, which is that actually the world is totally interdependent when it comes to the threat of infectious diseases and it is through strengthening the health systems in the very poorest countries in the world that we make all of us, wherever we live, safer. But secondly, there is also an argument that to enable countries to get on a path, to become stable, wealthier, to become trading partners, places where others can invest, you need a foundation of good health.

[Sam Fenwick]

But there is an attitude, isn't there, at the moment, that is, I've got to look after my own country.

[Peter Sands]

There definitely seems to have been a sort of turning inwards in many parts of the world. And it's understandable if things are tough, people want the money spent where they live.

[Sam Fenwick]

As you meet today in Johannesburg, is there a risk that wealthy nations that are meeting around you are actually underestimating how destabilizing disease resurgence could possibly be for global markets and also migration of people?

[Peter Sands]

I think it's very easy to underestimate the potential downsides of having another pandemic of the destabilizing effects of diseases running out of control on social cohesion, therefore on conflict and on migration. But there is strong support for continued investment in global health. What has been achieved over the last couple of decades is transformative, I would say. There is also a very difficult set of realities that many donors are facing in terms of fiscal constraints, competing priorities, the increases in defence spending. And so donors are wrestling with some very difficult trade offs.

[Sam Fenwick]

This is Business Daily from the BBC World Service.

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Just clean ingredients that whiten and strengthen with science ready to switch. Visit primallifeorganics.com and use code dirty mouth for 15% off. That's primalllifeorganics.com I'm Sam Fenwick. As G20 leaders meet in Johannesburg today to debate global aid, we explore what shrinking budgets mean for health programmes around the world. In Lusaka, Zambia's capital city, the impact of reduced foreign aid is already starting to show. The US has historically provided around a third of Zambia's health budget, funding HIV treatment and basic care. The Zambian government responded to aid cuts by boosting health spending by 13% and increasing funding on essential medicines by 30%. It's also trying to crack down on medicine theft. At the same time, it's looking to raise money through commercial ventures, especially in mining and critical minerals. Billions of dollars in new investment are flowing into copper projects. But it will take some time before that revenue can replace the loss in aid funding. Is this then the solution? Zambia's Minister of Commerce, Chipoka Malenga we.

[Chipoka Malenga]

Need to stop going to any country in the world with a begging ball. We should interact with them to bring investment in our country that provides value addition. Right now my country, Zambia, holds quite a substantial amount of critical minerals that the world needs. It's high time now we partnered in investment investment that will give us revenue, that will give us liquidity to buy drugs for ourselves or to invest in manufacture of drugs in the country.

[Sam Fenwick]

But to bring value to those critical minerals, you need to be able to not just mine the raw material, you need to be able to refine the material. Yeah, you have to do that in country. That takes you inviting other people to invest in your country and then often that value does not stay in country.

[Chipoka Malenga]

You're very right on that one. But I'll tell you what we are doing as a country. Not very long ago, my country was exporting copper in its raw form. In the last three years we have reformed policies and we have attracted very sound investment that is now processing copper and it's leaving the country as a finished product and our earnings are beginning to increase. So we still have a long way to cover this gap that has been created. But with time we are going to get over it.

[Sam Fenwick]

How long?

[Chipoka Malenga]

With the investment that we are bringing in and the revenue projection and everything, we can even go to a period of more than 10 years before we can say now we are sustainably guaranteed that we can do this ourselves.

[Sam Fenwick]

I suppose the NGOs would say that many people may die in that 10 year period.

[Chipoka Malenga]

I'll be very clear with you. 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. In every circumstance, situations you need a dependable, unpredictable friend. But this is a situation where we are left now. So now we have come to realize that anybody can kick us or hit us from any direction because now almost every economy wants to take care of their citizens. And how do they do it? They cut aid. And what happens to us who are dependent on aid? We have become vulnerable.

[Sam Fenwick]

Peter Sands from the Global Fund agrees with Mr. Malenga and he believes the economic benefits of funding health care will encourage low income countries to invest more themselves.

[Peter Sands]

There's no doubt that the events of the last 12 months or so have been a huge trigger to accelerating the path to having the health systems of even the poorest countries in the world be nationally led, nationally financed. It's a journey towards self reliance. So no longer dependent on external funding. I think the challenge is though, this is a journey, it's not a switch. 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. You've got countries like South Africa who already are paying for over 3/4 of their HIV AIDS budget themselves and they have the largest HIV burden in the world. But then you also have countries like Sudan or Yemen which are at war and where the notion that they're going to be building out their health systems in the middle of the war is not really realistic.

[Sam Fenwick]

Can we see the economic impact of those health improvements?

[Peter Sands]

The economic impact is actually extraordinary. I mean, if you take a country like Ethiopia, which in the last 20 years or so has seen a 16 year increase in life expectancy and dramatic reductions in infant and maternal mortality, that has led to improvements in educational attainment and expansion of the labor force and the gdp. So the gross domestic product, the economy of Ethiopia is 20 times what it was. The return on investment, on investing in health is huge.

[Sam Fenwick]

Are there still concerns that some countries are not run as well as they could be, that there is some mismanagement, Some might even refer to it as corruption.

[Peter Sands]

Many countries in the world aren't run as well as they could be. And governance issues, corruption issues do afflict many countries in the world. And these are problematic or impediments to good economic growth and therefore the creation of tax revenues and the funding of essential services like health.

[Sam Fenwick]

You're going to be meeting with world leaders. What's going to be your overriding message to them? You know, what would you like to see come out of these talks?

[Peter Sands]

The point I'll be making is this has been an extraordinarily successful project. We have seen, if you take Africa for example, 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. And the challenge with diseases as formidable as hiv, TB and malaria is 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. We want to finish the job. The opportunity is there to finish the job. And then you also have the prize in terms of social stability, economic productivity, educational attainment. That is one that will benefit not just the communities themselves, but the rest of the world.

[Sam Fenwick]

Peter stands there, head of the Global Fund, the world's largest health fund. That's all for this edition of Business Daily with me, Sam Fenwick on how shrinking aid budgets can be reconfigured to help the world's poorest. It was the second in a two part series investigating the future of global aid. To listen to the first one, search for Business Daily wherever you get your BBC podcasts.

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