Nigeria: What USAID’s Exit Means for Nigeria’s Healthcare System

Nigeria’s dependence on foreign aid created room for USAID — an organisation responsible for disbursing most US international aid – and left a huge gap in its absence.

Donald Trump’s re-election generated uncertainty in many parts of the world. His return to the White House, many feared, would lead to drastic shifts in global policies, especially foreign aid.

Around the world, countries recalibrated their strategies, and their citizens braced for what lay ahead. Nigeria was no exception – a country that relies on foreign aid to strengthen its healthcare system.

Aaron Sunday, leader of the Association of Positive Youths with HIV in Nigeria (APYIN), had tried to speculate what could change and how this might affect him.

Mr Sunday had grown accustomed to Mr Trump’s unpredictability and had seen some of his messages on social media. However, he could not tell if the remarks would become policy guidelines or were simply Mr Trump’s personal judgements.

Then, an executive order ushered in a 90-day freeze on foreign aid, and the United States Agency for International Development (USAID) became a target in the attempt to slash foreign assistance.

Three days later, an email landed in Mr Sunday’s inbox: the Lift Equity project, an initiative designed to improve adolescent access to HIV care in Nigeria, had been suspended. The progress they had made – engaging local authorities, advocating for policy reforms – came to an abrupt halt.

“The age of sexual debut in Nigeria is often below 18, so policies must recognise this reality to ensure effective HIV prevention and control,” Mr Sunday explained.

“We had begun building momentum, holding meetings with local authorities, parents, and health commissioners across states. Then, suddenly, everything stopped.”

Mr Sunday’s case is not isolated. PREMIUM TIMES interviewed several officials of civil society organisations and leaders of CSO networks across different states after President Trump began considering dissolving USAID. They all confirmed receiving emails suspending ongoing projects with the agency. This has left beneficiaries, many of whom rely on them for healthcare, education, and livelihoods, facing uncertain futures.

Disruptions across the health sector

The suspension of foreign assistance and the halt of USAID-funded projects sent shockwaves through developing countries.

In Nigeria, it triggered a heated debate. Some saw it as an opportunity for the government to reduce dependence on foreign aid and take greater ownership of healthcare funding. Others feared the abrupt change would cripple essential services and put vulnerable populations at risk.

Then, the effects became visible. Across national, state, and local levels, numerous non-governmental organisations saw their activities grind to a halt.

Clinics and research centres shut down. Intervention programmes were abruptly suspended. Community health workers lost their jobs, and health workers deployed by USAID to hard-to-reach areas were recalled. Humanitarian aid dwindled, leaving vulnerable groups without essential support.

For many Nigerians, this translated to more than just policy shifts – it meant empty clinics, halted treatments, and a growing sense of uncertainty about the future of their healthcare.

Reliance on foreign aid

Like many other developing countries, Nigeria relies heavily on foreign aid to address critical issues, particularly in the provision of healthcare to millions of her citizens.

The country’s dependence on foreign aid created room for USAID – an organisation responsible for disbursing most US international aid – and left a huge gap in its absence.

The US is the world’s largest international aid donor and the largest contributor of Official Development Assistance (ODA) to developing countries.

In 2023, for instance, the US disbursed close to $72 billion as aid and about $44 billion – nearly 61 per cent of this – came from USAID.

The agency is also a key implementation partner in the President’s Emergency Plan for AIDS Relief (PEPFAR), the primary source of funding for antiretroviral therapy, testing, and HIV prevention services in Nigeria.

The Chairman of the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) Bauchi chapter, Abdullahi Ibrahim, described the situation as a serious threat to HIV control efforts in Nigeria.

Healthcare services most affected

Although USAID operates extensively in developing countries and provides assistance for issues across sectors, a significant portion of its funding is dedicated to health interventions.

For instance, in 2024, the US provided $3.7 billion in humanitarian aid to sub-Saharan Africa, with Nigeria among the top recipients. About $2.7 billion, 73 per cent of the fund, was spent on health programmes.

PREMIUM TIMES gathered that due to the agency’s strong influence on the health sector, the gap created in its absence is most felt in healthcare services.

Chris Damcher, chairman of the Plateau CSO Networks, told PREMIUM TIMES that most of the intervention programmes suspended in the states focused on addressing health issues.

“The impact has been mostly on healthcare. It affected other sectors directly and indirectly, but the agency contributes significantly to healthcare,” Mr Damcher said.

Other CSO network leaders confirmed that this was obtainable in their states.

USAID services range from addressing infectious diseases to epidemics and public health emergencies. USAID provided Nigeria with vaccines during outbreaks.

In 2024, USAID donated 10,000 doses of the Mpox vaccine to Nigeria, making it the first African country to receive the vaccine – ahead of the Democratic Republic of Congo, where the disease is more endemic. This was when many African nations struggled to get the vaccine.

The agency eventually donated one million doses of vaccines to African countries.

It also played a major role in the effort to contain COVID-19 between 2020 and 2021, by supplying Nigeria with vaccines at intervals.

The agency has partnered with other health organisations, such as the WHO and the GAVI alliance, to provide vaccines for endemic diseases like measles, cholera, and tuberculosis.

Health professionals have told PREMIUM TIMES that Nigeria is unlikely to receive vaccine donations this year without USAID.

With limited access to vaccines, Nigeria risks higher infection rates, increased mortality, and greater strain on an already fragile healthcare system.

Despite waiver, HIV control efforts grounded

Despite the US waiver to exclude “lifesaving” humanitarian assistance from the aid freeze, such as funding for HIV control, the provision of this assistance in the country has dwindled.

Through interviews with multiple sources, PREMIUM TIMES gathered that many HIV clinics and research organisations in many states, including Akwa Ibom, Sokoto and Bauchi, have been shut down.

Local contractors and sub-grantee organisations for HIV programmes have suspended work, and workers deployed to ensure implementation in hard-to-reach areas have returned.

The CSO Network in Plateau said some organisations in the state have fully shut down their activities, and those still functioning might be forced to do the same if the order persists after 90 days.

This paper found that reduced clinical support affects access for people in distant and hard-to-reach communities.

According to a report by the Council of Foreign Relations, no money has been disbursed due to a lack of clarity on interpreting the waivers, and the freeze has continued to cause mass layoffs and suspensions.

The situation is likely to worsen over time, disrupting healthcare for the almost two million people in the country living with HIV/AIDs.

However, most people are still able to receive treatment and anti-retroviral drugs.

Nutrition, maternal health interventions

In Zamfara, USAID’s nutrition advocacy and caregiver empowerment programmes have been suspended. These programmes are designed to guide caregivers with an understanding of the essential micronutrients their wards need.

Musa Umar, the lead CSO for the Zamfara Network of CSO, told our reporter that the local staff assigned to execute the project in different communities were called back in January.

Health advocates said the suspension of these programmes means the support and guidance provided to parents and caregivers under the initiative are currently unavailable.

According to the United Nations Children’s Fund (UNICEF), about 250,000 children are suffering from severe acute malnutrition in Zamfara.

Humanitarian assistance for IDPs has also declined. US-funded CSOs, known for providing necessities like food to displaced families, have scaled back their services.

Mr Umar said, “In a case where there are normally five or six non-profits providing different forms of humanitarian assistance to displaced persons, you can only find one or two.”

In Ebonyi, Tuberculosis intervention projects were grounded alongside other major projects following Mr Trump’s stop work order.

Ajah Oliver, executive director of Cooperation Social Responsibility, a non-profit organisation in Ebonyi, disclosed that the state relied heavily on USAID funding. As a result, the policy ended interventions statewide.

It grounded education interventions alongside Water, Sanitation, and Hygiene (WASH) programmes.

Mr Oliver said the agency was also primarily involved in revitalising PHCs in Ebonyi through a statewide Integrated Health programme.

The programme’s major goal was to improve maternal health by ensuring better access to quality care.

Increasing domestic funding

In the wake of Mr Trump’s policy, the Nigerian government began trying to bridge the huge funding gap.

On 3 February, the Federal Executive Council (FEC) approved $1.07 billion to finance the healthcare sector reforms under the HOPE programme and N4.8 billion for HIV treatment.

A week later, the Nigerian Senate increased health sector funding in the 2025 budget by an additional N300 billion, aiming to strengthen programmes targeting tuberculosis, HIV, malaria, and polio.

However, these allocations are insufficient compared to the USAID’s interventions in the country over the last 10 years.

According to data from the US Department of State website, USAID has provided Nigeria with $6.39 billion in foreign aid in the last decade.

CSO Networks across states told PREMIUM TIMES that the country’s health system will likely experience serious setbacks without US foreign aid.

Many expressed concern that the likely implication of suspending health interventions would be an increase in the country’s disease transmission risk.

Tayo Fatinikun, Executive Director of Life Helper Initiatives, a non-profit in Sokoto, said the US policy should be a wake-up call to the government to strengthen domestic funding for key sectors.

“We can’t be dependent forever. The government, both at the state and federal level, needs to step up,” he said.

In response to the crisis, CSOs are exploring several approaches. Mr Damcher, the chairperson of the Plateau CSO network, said the CSOs are engaging with the state government to consolidate the progress made by previous interventions.

Meanwhile, some organisations are seeking alternative donors outside the US to sustain their work. Some others are waiting for the aid freeze to be lifted after 90 days.

However, US foreign policy analysts believe the policy is likely to be a termination of programmes rather than a temporary suspension.

According to Larry Garber, an adjunct professor at George Washington University, the policy on USAID mirrors proposals outlined in the Project 2025 presidential transition plan, a 900-page document considered a policy wish list for the US president.