On January 20, President Donald Trump signed an executive order that paused foreign aid programs for 90 days pending a review of "programmatic efficiencies and consistency with United States foreign policy." Trump's America First policies operate under the notion that U.S. foreign assistance has not been aligned with the country's interests.
On March 10, Secretary of State Marco Rubio said that he had canceled 5,200 foreign aid contracts—equivalent to 83%—under the U.S. Agency for International Development (USAID). His department, which absorbed USAID, will administer the remaining 1,000 contracts. Prior to its dismantling, USAID employed more than 10,000 staff across more than 100 countries, including the United States, and the agency was credited with improving education, outbreak response, and health care in countries across the world.
USAID's withdrawal from sub-Saharan Africa is particularly damaging. There, the agency has been instrumental in strengthening health care, education, and economic development. In 2024, the agency provided $6.5 billion in humanitarian assistance (less than 0.1% of the federal budget) to the region.
Without U.S. assistance, sub-Saharan Africa needs to explore alternative strategies to sustain progress on three critical areas: infectious disease response, economic and developmental stability, and educational and institutional growth.
Infectious Disease Outbreaks
The dissolution of USAID will significantly disrupt infectious disease response and surveillance efforts in sub-Saharan Africa. In the 2023 fiscal year alone, U.S. foreign assistance invested $10.6 billion in combating HIV/AIDS and an additional $1.5 billion in addressing emerging public health threats such as Ebola, malaria, and tuberculosis, primarily in the African region.
One of the most prominent examples of USAID's role occurred during the 2014–16 Ebola outbreak in West Africa that infected more than 28,000 people worldwide and killed 11,300, primarily in Guinea, Liberia, and Sierra Leone. USAID mobilized the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), and other health agencies to help eliminate cases. Their efforts resulted in notable improvements [PDF] in data tracking, disease management and isolation, and contact tracing efforts that have helped equip countries in sub-Saharan Africa with the capacity to address [PDF] future outbreaks and enhance preparedness and curb cases sooner. In Kenya, USAID supported the establishment of eight laboratories and implemented community-based surveillance in 12 counties to enhance disease detection.
The dissolution of USAID will significantly disrupt infectious disease response and surveillance efforts in sub-Saharan Africa
More recently, in November 2024, USAID pledged $500,000 to combat Marburg virus in Tanzania by training health-care workers, enhancing laboratory testing capabilities, strengthening community health and surveillance, and improving emergency infrastructure to contain the spread. Although the outbreak is declared over, the agency's shutdown could threaten future response efforts in Tanzania and elsewhere in sub-Saharan Africa. Although the Trump administration's Department of Government Efficiency claimed that USAID's Ebola prevention efforts in Uganda had been restored, the agency informed several U.S. government-affiliated organizations that their contracts were terminated. Amid the freeze on USAID funding, Ebola cases in Uganda have risen to 14 as of March 8.
To strengthen pandemic preparedness in a post-USAID era, Africa should focus on empowering regional and local institutions, such as the Africa CDC. As a leader in regional health systems, the Africa CDC, with support from the African Union and pan-African investment, can play a central role in managing infectious disease outbreaks across the continent.
If the Africa CDC can secure its targeted annual budget of $1 billion, it can enhance existing surveillance systems, such as the Integrated Disease Surveillance and Response system, develop rapid response and disaster-preparedness protocols, and implement measures to contain outbreaks and prevent cross-border transmission. After the pause in USAID services, the Africa CDC has stepped in to support Tanzania's current Marburg outbreak response, working directly with the Tanzanian government and providing $2 million to deploy epidemiologists, laboratory personnel, and polymerase chain reaction tests to accelerate case detection.
Economic and Developmental Setbacks
Although health-related investments make up the largest portion of U.S. financial assistance to sub-Saharan Africa, USAID has also contributed to the region's economy and trade with the United States. Pursuant to the African Growth and Opportunity Act (2000) USAID established several investment hubs across the region. One of these, the East African Trade and Investment Hub, reported around 600 million exports and created more than 40,000 local jobs between 2014 and 2019, predominantly within the agricultural sector. After the establishment of Feed the Future in 2010, USAID has helped grow Africa's agricultural industry, decreasing poverty by 16% in rural areas of Uganda between 2010 and 2013.
For the region to maintain its economic growth without USAID support, countries should support local entrepreneurship and investment in agricultural, infrastructural, and technological development. As an example, the African Development Bank Group pledged 74 million euros (roughly $80 million) in 2024 to promote young and female entrepreneurs in Senegal, underscoring the critical role that small and medium enterprises play in the economy. The Boost Africa Initiative, launched in 2019, is another enterprise from the African Development Bank Group, the European Investment Bank, and third-party investors.
The initiative invests 200 million euros over a seven to eight years into 1,500 African startups. It is expected to address financing gaps in business creation, boost innovation, create new jobs, and develop an efficient entrepreneurial ecosystem in Africa. Although continued European support is uncertain, the African Development Bank Group can continue to contribute financial capital and provide networking opportunities for entrepreneurs.
Africa should also work to attract greater foreign investment from the private sector. Bloomberg Philanthropies has invested more than $500 million in improving road infrastructure across Africa since 2007, funding bridges, roads, and traffic systems to enhance transportation safety. Major tech companies including Facebook, Google, Microsoft, and Uber have launched initiatives to foster innovation in Africa that include expanding internet access, boosting tourism, and advancing renewable energy solutions across the continent.
Educational Impact
USAID investment in education in sub-Saharan Africa has been instrumental in improving primary and secondary education, enhancing English language proficiency, and preparing the region's growing youth population for the workforce. Top aid recipients Ethiopia and Somalia have received $17 million and $14 million toward basic education, respectively. Beyond literacy and graduation rates, expanding educational opportunities plays a crucial role in promoting political stability and driving future economic growth.
The USAID downsizing marks a pivotal moment in sub-Saharan Africa's history
Without USAID, efforts to improve education for young leaders in sub-Saharan Africa should continue to prevent negative consequences for economic growth and political stability. Empowering local educational institutions can help maintain access to education for African youth. The Aga Khan Development Network has established schools in several sub-Saharan African countries, including Tanzania and Uganda, that provide high-quality education, improving English proficiency, and preparing youth for the workforce.
Additionally, leveraging public-private partnerships in the education sector is essential. One example is the Vodacom e-School, a flagship initiative between Vodacom and the South African government that provides free, online education content learners from the first year of formal schooling to grade 12. Private organizations such as Aga Khan and Vodacom should continue to collaborate with government school systems facing funding gaps and infrastructure challenges, to ensure broader access to education across sub-Saharan Africa in the absence of foreign aid.
Philanthropic contributions will be crucial for advancing education, particularly higher education. With higher education attendance rates remaining low—around 12%—local organizations and NGOs such as the Mo Dewji Foundation in Tanzania have been dedicated to funding scholarships for passionate youth with promising futures as Africa's next leaders. Sustaining financial support from pan-African leaders and institutions for these educational initiatives will be essential for empowering African youth and ensuring their success.
The USAID downsizing marks a pivotal moment in sub-Saharan Africa's history. Although the agency's contributions have been instrumental in the region's development over the past few decades, African nations should now prioritize regional collaboration, investment in local institutions, and strategic partnerships with the private sector to sustain progress in health, economic development, and education. Strengthening organizations such as the Africa CDC, fostering entrepreneurship, expanding agricultural investments, and leveraging philanthropic and private-sector contributions will be essential in navigating this transition. Despite the uncertainty ahead, Africa has the opportunity to assert greater autonomy in its development, ensuring long-term resilience and sustainable growth independent of USAID.
EDITOR'S NOTE: Bloomberg Philanthropies is a supporter of Think Global Health.
