Written by: Barakat Ganiyu
The news of PEPFAR’s funding cut in January 2025 shook Nigeria’s healthcare system, leaving many wondering what’s next. Patients who had received free antiretroviral drugs for years were faced with the fear of losing access or paying out-of-pocket for these expensive medications. They were once again at risk of deteriorating health. Not only the patients were apprehensive in that situation, but also their partners who are now more exposed to contracting the infection and healthcare workers knowing they had nothing to offer them and faced a risk of layoff.
Over the next couple of weeks, many clinics were faced with empty shelves, HIV testing waned, health promotions and awareness programs declined. This cut revealed a dangerous truth – Nigeria had built its healthcare infrastructure around donor funding. With many disease programs from malaria, HIV, tuberculosis programs to childhood immunization supported by donor funding, the question – what happens when the funding disappears? – becomes unavoidable.
Nigeria has one of the world’s highest burdens of infectious diseases including malaria, tuberculosis and HIV, yet its healthcare financing is largely dependent on donor funds. Over the past two decades, billions of dollars have been channeled into Nigeria’s healthcare system to support domestic resources for disease control, thereby saving lives, raising life expectancy and in turn enhancing GDP. The Global Fund, USAID and PEPFAR have supported the nation’s healthcare system with over 10 billion dollars between 2021 and 2025 alone. A large percentage of the cost of antiretroviral regimen for over 1.6 million people, laboratory facilities, and training of healthcare workers is financed by PEPFAR but when funding ceased in January 2025, it became clear that this model of dependency is unsustainable. Global Funds’ heavy investment in detection and management of tuberculosis cases, maintenance of an optimal supply chain system as well as malaria control programs depict similar dependency patterns.
Over the course of the next few months after the cut, only pregnant and breastfeeding women had access to PreP and HIV testing services. There were concerns of an increase in the number of new HIV cases as the price of PreP – which female sex workers who rely on it for HIV prevention described as previously available to them for free – in the open market rose sharply and largely became unaffordable. A projection of significant increase in mortality was also made. Software tools used by healthcare workers to track patients, monitor adherence and maintain optimal logistics were no longer fully functional. This disruption in routine data collection, reporting, and patient tracking weakened decades of achievements in HIV program monitoring, limiting the availability of reliable data needed for planning, evaluation, and decision-making.
It is not surprising that the incident revealed the cracks in the system because how does 6% of the national budget allocated to health cater to over 200 million people. This is way below the African Union’s Abuja Declaration target of 15%. Even the release of supposed 6% of the National budget is either delayed for months or gets hitched and only crumbs eventually reach healthcare facilities and points of service. This pattern of reliance has repeated itself as governance changed over time and the government has quietly taken a back seat in infectious disease control, probably because everyone thought it was consistent and would last forever. What the funding cut ultimately exposed was not just a financial gap, but a system built on the assumption that external support would always be there.