For over two decades, Tanzania has heavily relied on international funding to support its healthcare services, particularly in the fight against HIV and AIDS. One of the major partners has been the President's Emergency Plan for AIDS Relief (PEPFAR), which has contributed significantly to the provision of medical treatment, prevention, laboratory services, community programs, and data systems, as well as the empowerment of healthcare workers. This collaboration has enabled millions of people to access life-saving services.
However, changes in US funding have raised concerns about Tanzania's ability to sustain these services if external funding decreases or shifts focus. The question is not whether this aid has been beneficial – it has been crucial. The big question now is how much of this investment has built lasting national capacity, and how much continues to rely on external funding to function. This vulnerability was exposed in 2025 when some US funding was suspended or disrupted.
According to UNAIDS, the suspension of US funding led to a significant slowdown in some HIV prevention programs that had relied entirely on PEPFAR funding. Affected services included programs targeting young girls and women in vulnerable environments, orphaned and vulnerable children, and voluntary male circumcision. Other services, including PrEP for certain high-risk groups, were also impacted. The effects did not stop at prevention; UNAIDS also reported concerns about potential disruptions to treatment, with patients hoarding ARV drugs in fear of shortages.
The challenges Tanzania faces are not unique. A 2026 analysis by the Centre for Epidemiological Modelling and Analysis at the University of Nairobi found that Kenya's external health funding decreased from KES 126 billion to KES 54 billion in the 2025/26 financial year, following the withdrawal of US aid and a decline in government funding. The analysis estimated that Kenyan counties would need approximately KES 47.8 billion annually to fund over 41,000 workers supported by PEPFAR.
Uganda and Zambia are also facing similar challenges. UNAIDS reported that the reduction in US funding affected the distribution of HIV products, community programs, PrEP, HIV testing, and the capacity of some ARV service delivery points. In Zambia, a 2026 analysis found that the suspension of US funding led to a decline in some HIV services after activities were halted in January 2025.
The Tanzanian government has begun taking steps to mitigate these effects. UNAIDS reported that the government is working to integrate some healthcare workers into the government payroll, strengthening the electronic Care and Treatment Centre system, ensuring the supply of health products through the Medical Stores Department (MSD), and exploring the use of postal services for laboratory sample transportation.
Another step is to increase domestic revenue for health. According to the World Bank, Tanzania has introduced seven new revenue measures expected to collect up to TSH 586 billion, with 70% allocated to the HIV Fund and 30% to the Universal Health Insurance Fund for vulnerable populations. However, the World Bank has warned that actual collections may fall short of projections.
Key points
- Tanzania faces significant challenges in sustaining its health system as external funding decreases or shifts focus.
- The country is taking steps to mitigate these effects, including integrating healthcare workers into the government payroll and increasing domestic revenue.
- The sustainability of Tanzania's health system will depend on its ability to build lasting national capacity and reduce reliance on external funding.
