For six weeks now, Elizabeth Tembo (not real name) from Zingwangwa Township in Blantyre has not gone for viral load testing due to suspension of the services in public health facilities.
She used to go for the routine health check at Zingwangwa Health Centre.
This is the first time the mother of two is experiencing such a scenario after she got diagnosed with HIV a decade ago and was subsequently placed on antiretroviral therapy.
“The day I went for my routine viral load check, I was told I can no longer do so because the services were suspended,” she said.
The suspension is a strange phenomenon for Tembo because upon getting diagnosed, she was encouraged to go for viral load checks, a routine she has religiously adhered to.
A viral load test monitors effectiveness of treatment in people living with HIV.
Tembo said on Friday that the suspension means she will not know how her body is responding to treatment. She is worried.
Her colleague, who sought anonymity, said the situation is discouraging.
She said: “I also need to know if the treatment is working. It gives peace of mind to know.”
Nation on Sunday has established that viral load testing is only continuing for suspected treatment failures.
The suspension took effect in February 2025, a week after US President Donald Trump issued an executive order on January 25 2025 freezing international aid.
About 55 percent of Malawi’s health funding comes from donors.
United States Agency for International Development (USAid) —an independent federal government agency responsible for administering aid, was the biggest donor in the health sector, supporting specific areas of family planning, HIV and Aids, tuberculosis, malaria, emerging pandemics and health system strengthening, among others.
An analysis published on the Centre for Global Development website— a think-tank based in Washington DC and London, states that Malawi alongside 26 other countries will struggle to cover the US funding gap in the health sector.
Health researchers Pete Baker, Katherine Klemperer, Sam Hughes, Janeen Madan Keller and Javier Guzman state that the countries remain financially exposed and constrained; hence, will not be able to fund its health sectors.
The analysis, which focused on 2022, compared the total amount of US bilateral global health funding and domestic government expenditure for individual countries.
The analysis also focused on a particular country’s World Bank income classification and level of indebtedness.
Titled 26 Countries Are Most Vulnerable to US Global Health Aid Cuts; Can Other Funders Bridge the Gap?, it says between 2022 and 2023, Malawi received $228 million (K399 billion), representing 207 percent of the government’s domestic health expenditure.
Other countries assessed are Mozambique, Zambia, Zimbabwe, Burundi, Liberia, Uganda, South Sudan, Haiti, Somalia, Afghanistan, Sierra Leone, Democratic Republic of Congo, Yemen, Madagascar and Cameroon.
The Syrian Arab Republic, Rwanda, Mali, Ethiopia, Central African Republic, Togo, Kenya, Niger, Burkina Faso and Lao People’s Democratic Republic-a landlocked country in South East Asia were also assessed.
“These 26 countries-which collectively receive $3.4 billion in United States bilateral global health assistance can be considered as highly exposed, highly fiscally constrained and are exceptionally unlikely to be able to fill the [funding] gap,” reads the analysis.
The analysis further states that the aid freeze is particularly concerning because other major global health donors, including European governments, are trimming their aid, which is resulting in low and middle-income countries facing mounting pressure.
It says affected governments are yet to implement strategies to ensure healthcare provision in critical areas such as HIV continue.
Reads the analysis: “Governments have not yet developed the know-how, capacity to manage these kinds of services or procure these products because they are often managed by donors supra-nationally.”
In the proposed 2025/26 fiscal plan, government intends to allocate K741.05 billion to the health sector, up from K729.47 billion in the previous financial year.
The proposed allocation represents 9.2 percent of the national budget pegged at K8 trillion. This proposed allocation, however, falls short of the Abuja Declaration on Health.
The Abuja Declaration, adopted by the African Union in April 2001, stipulates that African countries who are signatories to the pact, should allocate 15 percent of the total budget to health sector to improve healthcare access.
Malawi’s proposed fiscal plan, on the other hand, did not explicitly
mention interventions on how the Malawi Government will fill the funding gap in the absence of US aid.
Among others, the proposed healthcare allocation will go towards contribution to the health sector joint fund, Malawi Emergency Project to protect essential health services, construction of Mponela Community Hospital, construction of 55 health posts and completion of the Cancer Centre.
Malawi-Liverpool Wellcome Trust Clinical Research Programme senior research associate (health economics) Dr. Jobiba Chinkhumba said in an interview on Wednesday the aid freeze will have severe consequences.
A lecturer at Kamuzu University of Health Sciences’ School of Global and Public Health, said to mitigate the adverse effects, government will need to re-prioritise and reallocate budgets to sustain essential services.
He said: “This will be a significant challenge for the country given the high burden of communicable, non-communicable diseases and competing demands for limited health sector resources.
“It is also crucial to ensure that every dollar in the health sector is used efficiently as the cost of wastage will be substantial”.
In the medium term, Chinkhumba said government will have to explore domestic funding options for the health sector.
“Efforts are already underway to expand the health financing sources with several reforms in progress. It is essential to accelerate the implementation of these reforms while carefully evaluating them to ensure sustainability and equitable contributions,” he said.
Ministry of Health spokesperson Adrian Chikumbe had not responded to our questionnaire as we went to press yesterday.
