In late September 2025, the United States announced $160 million in “bridge funding” to support Mozambique’s HIV and tuberculosis programs for the next six months. While this seems like another installment in global health assistance, it underscores the challenges faced by African nations in building sustainable healthcare systems. Mozambique has one of the highest HIV prevalence rates in the world, with more than two million adults living with the virus. Tuberculosis, which often coexists with HIV, continues to strain the country’s healthcare system. For years, the President’s Emergency Plan for AIDS Relief (PEPFAR) has funded much of the country’s HIV response, contributing to a dramatic decline in AIDS-related deaths and new infections across sub-Saharan Africa.
However, this dependence on external funding has led to significant structural fragility. In early 2025, when the U.S. reduced aid disbursements due to a policy review, Mozambique’s clinics faced shortages of essential drugs and testing supplies. The new $160 million will only cover expenses through March 2026, leaving the country’s healthcare future uncertain. This scenario is not unique to Mozambique; many African countries, including Malawi, Kenya, and Nigeria, rely heavily on foreign donors for HIV treatment. In these nations, donor funding makes up a significant portion of the healthcare budget, and any cuts or delays can have dire consequences.
This temporary nature of external aid highlights the critical need for African countries to strengthen their own healthcare systems. Over the years, countries like Rwanda and Botswana have shown that it is possible to reduce dependency on foreign aid through strategic investments in domestic healthcare financing. Rwanda, for example, now funds over half of its health budget internally, integrating HIV care into universal primary healthcare. Botswana, once heavily reliant on donors, now uses national resources, including diamond revenues, to finance antiretroviral therapies.
Despite the economic challenges faced by many African nations, practical steps such as expanding sin taxes on tobacco and alcohol or earmarking revenues from natural resources for healthcare can help build resilience. Strengthening regional procurement mechanisms and reducing dependence on single suppliers are also crucial in lowering costs.
The recent U.S. funding decision serves as a reminder that while foreign assistance is vital, it cannot be the sole solution. African nations must accelerate efforts to build self-sustaining healthcare systems to ensure long-term health security.
