USAID freeze a wakeup call for gvt to take responsibility for the health of citizens 

Mathatisi Sebusi 

THE recent suspension of the United States Agency for International Development (USAID), a critical cog in development aid efforts in poor countries, is a wakeup call for African governments – including Lesotho’s – to take responsibility for the health of their citizens, analysts say. 

President Donald Trump, who took office last month, had ordered the suspension of all foreign aid programmes run by USAID pending a review to assess whether they serve America’s national interests. 

The suspension has sent shockwaves across the world, mostly in poor countries which depend on USAID sponsored health and development aid programmes.  USAID has for years been the premier international donor agency with an annual budget far in excess of US$50 billion. 

The suspension of USAID has already put 1500 jobs in the NGO sector in Lesotho in serious jeopardy. Affected employees are at home waiting for what happens after the 90-day suspension period during which the Trump administration plans to complete its review. 

But things look ominous and only a miracle will see USAID return in anything that resembles its original format. Trump’s key advisors have been stampeding to brew cruel epithets with which to discredit the organisation despite that it has served millions of lives worldwide. Elon Musk, one of Trump’s key allies, has branded USAID a “criminal organisation”. 

To show its contempt for the organisation, the Trump administration sent workmen to dismantle the USAID signage at its head office in Washington DC after sending its staff home.  There could be no better move with which to confirm USAID’s permanent demise. 

The Trump administration had already signalled it will expel USAID’s 10 000 employees and retain it as a mere desk in the State Department (the US’s foreign ministry) with a mere 300 employees at most. 

While a federal judge has temporarily halted Mr Trump’s actions, all signals are that USAID is all but gone. 

With that grim spectre in mind, analysts have urged Prime Minister Sam Matekane’s to swiftly implement programs to mitigate the impact of the demise of USAID. 

There is no doubt that the demise of USAID, even temporarily, will significantly cause hardships for Basotho. 

National University of Lesotho (NUL) Professor Motlamelle Kapa, said the USAID suspension inevitably holds “severe consequences” for both the government and Basotho who depend on aid. 

Prof Kapa explained that employees of US-funded projects and non-governmental organizations (NGOs) would lose their livelihoods, further exacerbating Lesotho’s already high unemployment rate. 

“These job losses will prevent these former employees from contributing to the country’s economic growth and supporting their families,” said Professor Kapa. 

“Poverty and food insecurity will reach critical levels due to the lost jobs.” 

Prof Kapa further noted that the Millennium Challenge Corporation (MCC) compact had also been suspended, jeopardizing the anticipated job creation and economic growth. 

“The project was intended to address food insecurity and high unemployment, but without it, the country will be back to square one,” he added. 

The US$300 million (about M6.5 billion) MCC Compact II is a health and agriculture project that aims to improve climate resilience for local farmers in Lesotho. The Compact was expected to invest in irrigation and other agricultural initiatives. 

The Compact also aimed to enhance healthcare services for hundreds of thousands of Basotho. 

Key expected outcomes of the Compact included a significant reduction in food imports, greater self-reliance, and increased private sector participation in policymaking and job creation. Over time, the Compact was projected to directly and indirectly create more than 90,000 jobs across various sectors, boosting economic growth and reducing poverty. 

The MCC Compact II, frozen together with USAID and other US funded programmes last month, came into force on March 31, 2024. 

Prof Kapa also expressed concerns about the uncertainty created by the USAID suspension, emphasizing the need for Lesotho to quickly develop programs to minimize the impact if the withdrawal becomes permanent. 

He stressed that this was a wake-up call for the country to strive for self-reliance and build its capacity to provide for its people without relying on international aid. 

“We need to build our capacity. Leaders of this country should be ready to build the country’s capacity so that it is able to provide for its people and not be reliant on other countries; otherwise, we will be in a very difficult situation,” Prof Kapa noted. 

Former Minister of Health, Dr Molotsi Monyamane, said the withdrawal of U.S. funding would impact HIV/AIDS and TB services. 

However, he quickly emphasized that the government could address these challenges. 

Dr Monyamane pointed out that the government already bore primary responsibility for HIV treatment, funding antiretroviral (ARV) purchases for 240,152 Basotho. 

He said: “The government will continue to support related programs, even without U.S. assistance.” 

Dr Monyamane recalled a time before U.S. sponsorship when each ministry allocated 2% of its annual budget to ARV procurement and other HIV-related services. 

He suggested a return to this practice to reduce reliance on donors. 

The government currently funds 83% of ARVs, with the Global Fund covering the remaining 17%, Dr Monyamane stated. 

While acknowledging the U.S. withdrawal would be disruptive, he asserted it would not cripple the healthcare system, and services would continue uninterrupted. 

Furthermore, Dr Monyamane stressed the importance of “Lesotho achieving financial independence and establishing a health insurance system”. 

“That would meet citizens’ health needs and free the government from dependence on external aid,” Dr Monyamane said. 

The withdrawal of USAID funding will undoubtedly pose significant challenges for Lesotho, according to Dr Tlohang Letsie of the NUL Faculty of Social Sciences. 

That was because Lesotho had become heavily reliant on American assistance, to the point that even in sectors where Lesotho had the capacity for independent operation, progress remained slow, “with genuine commitment only evident in donor-funded projects requiring financial accountability”. 

Dr Letsie explained that the loss of US aid would force the government to reallocate funds from other budgeted areas to compensate for the gaps created by the withdrawal. 

However, he offered a more optimistic perspective, suggesting this situation could serve as a “wake-up call” for the nation to prioritize self-reliance. 

While acknowledging the potential for short-term hardship and disruption, Dr Letsie expressed confidence that Lesotho could eventually achieve greater independence. 

“It might be hard and painful now, but we will eventually reach the self-reliance stage the country so much needs,” he said. 

Echoing the views of at least 1500 workers employed under frozen US-funded programmes, an affected employee (name withheld) of PSI, a PEPFAR-funded organization, painted a gloomy picture pertaining to his prospects of a better life. 

He told the Lesotho Times yesterday that his contract was suspended on January 27th, following a directive issued on January 24th, and would remain suspended until March 31st.  

He said they were informed about this suspension via email. He said if there was no new directive to reinstate USAID funding by March 31st, they faced permanent termination of their employment. 

Thus, the PSI employee expressed significant financial and psychological distress due to the suspension. 

He said as the sole provider for his family, “I am experiencing the mental strain of being unable to afford basic necessities”.  

He said with his salary, he provided medication for his sick mother, a responsibility he had only managed to start fulfilling when he got his job after many years of unemployment. 

He said he feared the consequences should his contract be permanently terminated. 

He also pointed to the wider economic impact of potential job losses.  At least 1500 jobs are on ice in Lesotho after the Trump directive. 

“My reduced income also affects small businesses he supported, such as taxi drivers and street vendors. My inability to contribute to the economy represents a loss for the country. I hope for a resolution that allows employees to return to work,” he said. 

However, Minister of Health, Selibe Mochoboroane, has assured the 240,152 Basotho on ARV treatment, that they would maintain access to their medication despite the USAID freeze. 

According to Mr Mochoboroane, while USAID funding was crucial for HIV programs in Lesotho, the government already covered 83 percent of the costs for procuring ARVs, with the remaining 17 percent coming from the Global Fund. 

“This means that although Lesotho’s budget will be strained by the loss of USAID support, the country can still largely provide for its own HIV medication needs,” he said. 

But Mr Mochoboroane was concerned about the loss of support staff employed by the various affected NGOs who were involved in the anti-HIV/Aids crusade.  That support staff had been crucial in covering the staff shortages within the Ministry of Health. 

He said the ministry had been dependent on various partners, including Jhpiego, the International Centre for AIDS Care and Treatment Programs (ICAP), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).  Most of the staff in these NGOs are now sitting at home. 

“The current structure of the Ministry of Health does not include positions for counsellors,” he stressed, emphasizing the urgent need to address this challenge, as people required counselling prior to being tested for HIV. Most of these counsellors came from the affected NGOs. 

Additionally, Mr Mochoboroane expressed concern over the potential loss of jobs in the country and the adverse effects that a withdrawal of USAID could have on the recently launched Sustaining Epidemic Control through Unified Prevention (SECURE) project. 

“Approximately 1,500 health service providers are likely to lose their jobs because of the USAID freeze (if it does become permanent), and my ministry needs 27 million Maloti (M27 million) to pay the salaries of those workers,” Mr Mochoboroane said.