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U.S. Funding Cuts Negatively Impact TB Care and Prevention Across Africa

30 April 2025

According to a rapid survey conducted by the International Union Against Tuberculosis and Lung Disease (The Union), 65% of National TB Programmes in Africa (11 out of 17 respondents) declared that the US Government funding stoppage has already negatively affected TB care and prevention.

The National TB Programmes (NTPs) reported the effects of the funding cuts to include:

  • Disruption in financial support for TB case detection and consequently reduced capacity for active case finding and diagnostic expansion
  • Decreased availability of essential TB diagnostic tools, affecting laboratory operations and delaying patient diagnosis
  • Layoffs of key TB service personnel, especially contract-based workers funded through external support
  • Reduced financial resources for patient outreach and adherence monitoring, thus impacting treatment success rates

Of the 17 NTPs to respond, ten (59%) expected further disruption of TB services within the next three months. The anticipated consequences include: reduced diagnostic capacity, limited procurement of medical supplies and weakened supervision of treatment adherence programmes.

The survey responses were from NTPs in: Benin, Burkina Faso, Djibouti, Eswatini, Ethiopia, Guinea, Guinea-Bissau, Kenya, Madagascar, Namibia, Niger, Nigeria, Sierra Leone, Somalia, South Africa, Togo, Zimbabwe.

Despite funding termination, all the countries indicated that they could still currently procure TB treatment medications and diagnostic consumables, at least in the short term.

However, The Union also learned that:

  • Patient access to diagnosis and treatment has already been affected in four (24%) countries, particularly in settings where laboratory operations depend on US-funded initiatives
  • Six countries (35%) have experienced disruptions in monitoring, evaluation, reporting and supervision
  • In 11 countries (65%), TB-related training activities for established staff through refresher courses have been affected and courses for new staff have been suspended
  • Eleven countries (65%) noted that implementing partners, including international non-governmental organisations have reduced their operational scope, resulting in downsizing of staff working in TB programs, ending of TB outreach and advocacy activities and reduced financial support for decentralised TB service delivery.

Dr Kobto Ghislain Koura, Director of TB at The Union, said: “This crisis is a reminder that Africa cannot rely indefinitely on external aid to fight TB. It is time for governments to strengthen domestic funding and focus resources on evidence-based strategies that deliver the greatest impact.

“Sustainable TB control demands national commitment, smart prioritisation, and regional collaboration to protect the progress we’ve made.”

The paper has been published in The International Journal of Tuberculosis and Lung Disease.

In many countries the World Health Organization (WHO) plays a vital role in technical assistance and program oversight for NTPs. Nine (53%) countries reported that WHO’s country-level support to TB programs has been affected, with the most common disruptions including:

  • Suspension of consultant recruitments responsible for capacity building and monitoring
  • Reduction in technical support for NTP evaluation and policy implementation
  • Delays in procurement processes for essential TB-related resources

Dr Cassandra Kelly-Cirino, Executive Director of The Union, also expressed her concerns: “The implications of these funding cuts will be felt by us all, but the people and communities we serve will be those who suffer most. We urge the US Government to reconsider these orders and return to its position as a compassionate global health leader.

“This incredibly difficult funding and geopolitical landscape means that we have to be more strategic and prioritise our efforts on interventions that will have the most impact on reducing TB incidence rates.

“The only solution to the problem of TB is to end it, soon, not to plan for long-term and expensive ‘control’ programmes. When it is ‘ended’ the cost of keeping it ‘ended’ will be very small. We have achieved this goal in some countries. We need to achieve it everywhere, soon!”

 

Source: The Union

SEE ALSO:

Uganda is one of the highest-burden countries for both TB and TB/HIV, with approximately 91 000 new cases each year. Most of the country’s TB funding actually came through PEPFAR, as well as USAID and the CDC. With the Executive Orders related to USAID and the funding freeze, “we see a lot happening in terms of the staff going back home, putting tools down”. There is also a lot happening “especially around the community targeted TB programming,” which is a real threat to TB care, prevention, early detection and contact tracing – much of which is carried out by health volunteers. The funding changes have had an impact on TB referrals and transport of samples (the latter of which has long been supported by the CDC). Treatment support for patients has been cut off as well.


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