Relief for over 15,000 South African jobs

The confirmation that the President’s Emergency Plan for AIDS Relief (Pepfar) is exempt from US President Donald Trump’s executive order to halt foreign aid to South Africa has come as a huge relief for thousands of healthcare workers whose jobs were at stake.

The decision to freeze aid cast uncertainty over many programmes, including those supported by Pepfar, a critical source of funding for South Africa’s battle against HIV/AIDS.

The programme is the largest foreign donor to South Africa’s HIV/AIDS initiatives, having contributed more than R140 billion over the past two decades.

Given that South Africa has the highest HIV/AIDS population in the world, with approximately 7.8 million people living with the disease, this funding plays a crucial role in maintaining healthcare services.

In the 2023/24 financial year, the US contributed around 17% of South Africa’s R44.4 billion HIV/AIDS budget.

However, Trump’s broader executive order against South Africa on Friday cast fresh doubts over the programme’s future in the country.

Following backlash for the decision, a waiver signed by US Secretary of State Marco Rubio for “life-saving and humanitarian” aid had allowed some Pepfar-supported activities to resume.

The US embassy has now confirmed that Pepfar remains covered under Rubio’s waiver.

“Pepfar’s implementing agencies are reviewing which activities fall under the limited waiver. It is important to note that not all Pepfar activities will resume,” a US embassy official stated.

The waiver does not extend to abortion services, family planning, gender and diversity programmes, or transgender surgeries.

According to the embassy, as of Monday evening (10 February), implementing partners in South Africa had begun receiving letters from USAID and the CDC with instructions on how to apply for the resumption of activities.

Relief for over 15,000 South African professionals

Although the initial freeze has already caused significant disruptions, the exemption is good news for over 15,300 healthcare professionals who were facing job uncertainty.

These workers include doctors, nurses, pharmacists, data capturers, and technical experts—many of whom operate in districts hardest hit by the HIV/AIDS epidemic.

Health Minister Aaron Motsoaledi had previously warned that the funding freeze had exacerbated South Africa’s already dire healthcare situation, which has been struggling under severe budget constraints.

The uncertainty surrounding Pepfar’s future further worsened these challenges, putting thousands of critical healthcare jobs at risk.

While the relief brought by the exemption is undeniable, the situation has also reignited debate over South Africa’s reliance on foreign aid for healthcare funding.

Critics argue that the country’s healthcare system should not be dependent on external funding, especially given the scale of financial mismanagement and waste within government structures.

Dr. Aslam Dasoo, spokesperson for the Universal Healthcare Access Coalition (UHAC), has been vocal in criticizing the government’s financial mismanagement.

He argues that South Africa should not have to rely on Pepfar in the first place, as the funds lost annually due to corruption and inefficiency far exceed the amount of aid provided.

According to Dasoo, the R12 billion in Pepfar funding that was temporarily frozen is a fraction of the funds wasted within South Africa’s provincial health budgets.

He pointed out that, aside from the Western Cape, most provinces have a track record of mismanaging billions in allocated healthcare funds, with some losing up to R8 billion annually due to fraud and inefficiency.

“It’s elementary; we need to change the system of financial accountability and appoint competent leadership and reporting lines.

“That way, we could save R60 billion between the eight provinces that have had qualified audits for ten or more years.”

“Our Pepfar financial support is chump change compared to what our government is allowing to be wasted or pilfered. We could support the whole of Africa with that saving,” said Dasoo.

While the exemption of Pepfar from Trump’s aid freeze is a welcome relief, it has also underscored deeper systemic issues that need to be addressed if South Africa is to achieve true financial and healthcare independence.