“I felt
shattered,” Makura told the Guardian, after finding herself out of a job and
struggling to feed her family and keep them in school. For the past three years
she had been earning US$500 (£400) a month. “My job was my only source of
income. I still do not know what to do,” she says.
Her dismissal
came shortly after US President Donald Trump’s executive order pausing foreign
assistance, pending a 90-day period, to developing nations. She is one of those
who worked for organisations that relied on the US president’s emergency plan
for Aids relief (Pepfar) and USAid.
In Zimbabwe,
USAid provided funding of up to US$360m to support health and agricultural
programmes. Makura is one of the thousands of Zimbabwean healthcare workers who
worked for non-governmental organisations and civil society groups supporting
HIV and Aids-related services, who received those funds.
She was
responsible for collecting blood samples, measuring viral load, tuberculosis
(TB) screening, TB prophylactic treatment advocacy, viral load collection and
anti-retroviral therapy (ART) resupplying. About 1,2 million people taking ART
were supported by USAid along with services such as counselling and testing.
Clinics such as
the Population Solutions for Health (PSH) and New Start centres providing
counselling, free testing, voluntary male circumcision, ART and pre-exposure
prophylaxis, known as PrEP, across the country were closed down on January 28.
In a Press
release dated January 29, the US embassy in Harare encouraged the Zimbabwean
government to “take seriously its responsibility for the health of its people”.
Trump’s
administration gave a reprieve to some of the services on HIV and Aids after a
public outcry, but in Zimbabwe, healthcare workers say they are yet to receive
communication on what is exempted from the executive order.
Population
Solutions for Health clinics, such as this one, providing free testing,
voluntary male circumcision, ART and PrEP, relied on USAid.
Gumisayi Bonzo,
a director at Trans Smart Trust, an organisation offering HIV and Aids services
to transgender and intersex people, says they have been forced to stop
implementing programmes.
“All nine
transgender staff who were referring transgender people for clinical services
at PSH clinics lost their jobs,” Bonzo said, adding that they were also
struggling with paying the rent on their offices in Harare.
Hazel Zemura,
director of All Women Advocacy, an organisation representing sex workers in
Zimbabwe, says it is a blow to her community that clinics offering HIV and Aids
services have been forced to close.
“These are safe
spaces where HIV key-affected populations go for ART refill, STI screening and
treatment, viral load testing, cervical cancer screening, PrEP and
post-exposure prophylaxis (PEP),” she says, adding that they had also stopped
providing services to sex workers under USAid funded programmes.
Calvin
Fambirai, executive director at the Zimbabwe Association of Doctors for Human
Rights, said because the health sector in Zimbabwe was donor-dependent, any
gains made over the years in areas such as HIV and Aids were likely to be
eroded.
“There is a
need to strengthen domestic financing for health to ensure that shocks such as
the withdrawal of US support are mitigated,” he said.
In 2023,
Zimbabwe reached 95-95-95, the UN Aids target where 95% of people living with
HIV know their status, 95% of those are on ART and 95% of those on ART have
achieved viral suppression.
Activists
attribute this milestone to donor-funded interventions, while Zimbabwe’s health
sector is under-resourced. Annual funding falls short of the 2001 Abuja
declaration, which calls for at least 15% of the budget to be allocated to the
health sector.
Martha
Tholanah, an Aids activist, said it was a wake-up call for Zimbabwe to put more
domestic resources towards health.
“The way it has
been done in such an abrupt manner is disruptive, unfair and cruel,” she said,
adding that the most vulnerable people were exposed to even greater risks.
“Our government
needs to act. We need to see action, as words alone will not be enough to
reassure citizens.”
While Trump’s
administration is reviewing foreign assistance during the 90 days, Makura’s
future is uncertain.
“My days are
dark with uncertainty. I will transfer my children to cheaper schools. I should
give notice of vacation to my landlord and maybe find a little room where I can
squeeze in with my three children?” she saic.
“I am confused
because of poor communication. Perhaps starting a job hunt is the only sensible
action while I wait in vain.” Newsday
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