Tanzania is grappling with the challenge of sustaining essential healthcare services following changes in US funding for HIV programs. For over two decades, the US has been a significant partner in Tanzania's fight against HIV through the President's Emergency Plan for AIDS Relief (PEPFAR). The program has supported testing, treatment, prevention, laboratory systems, disease surveillance, and health system strengthening. With the shift in US funding, concerns have emerged about the sustainability of these programs.
The impact of the changes in US funding began to manifest in 2025 when the US government suspended or reviewed a significant portion of its international aid. In Tanzania, reports from UNAIDS indicated that some HIV prevention services heavily reliant on PEPFAR funding faced challenges. Affected services included programs targeting young girls and women, services for children in vulnerable environments, and voluntary medical male circumcision. Some Pre-Exposure Prophylaxis (PrEP) services, which reduce the risk of HIV transmission, also encountered difficulties.
The challenges extended beyond treatment to include concerns about the availability of antiretroviral drugs, transportation of laboratory samples, and continuity of care. However, Tanzania had an antiretroviral drug reserve expected to meet needs for several months. The bigger challenge lay beyond drugs, as the uncertainty of long-term funding raised questions about how other services enabling treatment would be financed. Programs supported by the US have also contributed to building laboratory capacity, data systems, disease surveillance, technical expertise, community services, and the health workforce.
The experiences of other East African countries, such as Uganda and Kenya, provide insight into the potential challenges Tanzania may face during the transition from external funding to domestic resource reliance. In Uganda, changes in US aid affected the transportation of HIV commodities from district centers to lower-level health facilities. Some community services and those operated by non-governmental organizations were suspended. UNAIDS also reported concerns about reduced capacity in some facilities providing antiretroviral therapy.
In Kenya, similar challenges were reported in some areas, including reduced prescription refill periods, patients missing clinic appointments, and disruptions in some surveillance services. These changes also raised concerns about confidentiality and stigma after some HIV services were rapidly integrated into primary health care services. An analysis by the Center for Global Development showed that a significant portion of resources allocated through PEPFAR in some African countries was affected by the suspension of funding agreements.
Tanzania's situation is critical because its HIV service delivery system is interdependent at many levels. A patient may receive medication at a health facility, but treatment success also depends on laboratory tests, viral load monitoring, accurate data, healthcare professionals, community-based patient monitoring, and a reliable supply chain of medicines and medical supplies. Therefore, the challenge is not only ensuring the availability of drugs but also sustaining the entire system that enables these services to function.
Despite these challenges, Tanzania has not started from scratch. The government has taken steps to mitigate the impact of funding changes, including efforts to integrate some health workers into the government payroll, strengthening electronic HIV medical information systems, and ensuring the continued supply of medicines and health products through the Medical Stores Department (MSD). There have also been efforts to explore alternative methods for transporting laboratory samples to ensure uninterrupted testing.
Key points
- The shift in US funding for HIV programs poses significant challenges to Tanzania's healthcare system, particularly in sustaining essential services such as treatment, laboratory services, and community outreach.
- The experiences of Uganda and Kenya demonstrate the potential risks of transitioning from external funding to domestic resource reliance, including disruptions in HIV services and impacts on treatment outcomes.
- Tanzania must increase domestic investment, strengthen government systems, and adopt sustainable financing models to ensure the long-term viability of its healthcare services.
