Millions of Africans depend on health services that could be disrupted when foreign donors withdraw funding or governments fail to protect patients from unethical medical research.
Development Diaries reports that Zimbabwe is seeking new ways to protect its HIV response after the withdrawal of US-funded programmes affected about 6,000 health and community health workers.
Around the same time, authorities in Guinea-Bissau halted a foreign-funded hepatitis B vaccine trial that would have withheld the vaccine from thousands of newborns, following ethical concerns.
In Zimbabwe, the affected workers include doctors, nurses, pharmacists, laboratory scientists, support staff and community health workers, with the government saying it is stepping up domestic resource mobilisation and strategic partnerships as it works towards ending AIDS as a public health threat by 2030.
Across the continent, the funding squeeze is wider, as Amref Health Africa cited a 23.1 percent decline in official development assistance in 2025 and warned that reduced external support is exposing weaknesses in health systems that depend on international funding for HIV treatment, immunisation, maternal and newborn care, nutrition, and frontline staffing.
The consequences are particularly visible in countries where donor-funded programmes carry much of the cost of delivering essential services because when foreign funding stops, workers lose their jobs and communities lose access to the people who provide care, testing, treatment information and referrals.
Guinea-Bissau presents a different picture of health sovereignty. On 19 October, the Judicial Police raided the offices of the Bandim Health Project and seized hepatitis B vaccines intended for a proposed clinical trial.
The project was expected to receive $1.6 million from the United States Centres for Disease Control and Prevention (CDC) to study the effects of giving the vaccine at birth.
The proposed study involved 14,000 newborns, with only some scheduled to receive the vaccine at birth. Project leader Christine Stabell Benn confirmed that police had sealed the refrigerator containing the vaccines.
The trial has since been halted, with the Africa Centres for Disease Control and Prevention (Africa CDC) saying it could only proceed if redesigned to address ethical concerns. The objections centred on the decision to withhold a vaccine that protects newborns against hepatitis B, a potentially life-threatening infection.
While Zimbabwe’s challenge is the dependence on external funding to sustain essential services, Guinea-Bissau demonstrates the importance of national institutions having the authority and capacity to scrutinise research involving their citizens.
Article 16 of the African Charter on Human and Peoples’ Rights recognises the right to the best attainable state of physical and mental health, while the Abuja Declaration of 2001 committed African Union member states to allocating at least 15 percent of their annual budgets to health, a target Zimbabwe has not met.
Similarly, Article 7 of the International Covenant on Civil and Political Rights prohibits medical or scientific experimentation without free consent, just as the Declaration of Helsinki sets ethical standards for medical research involving human participants, including protections for vulnerable populations.
The consequences of weak health systems are often felt first by people with the fewest alternatives, and these include women, who make up a large proportion of people living with HIV in southern Africa and much of the community health workforce.
Losing these workers can therefore affect both access to healthcare and household incomes, just as adolescent girls who depend on community outreach for HIV prevention, testing and contraception may find those services harder to reach when outreach workers are laid off.
In Zimbabwe, health worker unions and treatment advocacy groups should demand that the 2027 health budget include a specific allocation for community health worker salaries, with the number of positions to be funded made public.
Across Africa, citizens can request access to national registers of externally funded clinical trials and ask whether the studies have received approval from the relevant ethics committees.
Patients and community groups should equally document clinic-level disruptions, including medicine shortages and reduced outreach visits, and submit their findings to health authorities.
As for Zimbabwe’s Ministry of Health and Child Care, it should publish a transition plan within 90 days explaining how many of the 6,000 affected positions can be absorbed into the public health system in 2027 and the cost of doing so.
Africa CDC, on its part, should develop a continental standard for externally funded research involving African children, including safeguards against research designs that would be unacceptable in the funder’s own country, and maintain a public register of trial approvals and refusals.
Foreign partnerships can support African health systems, too, but governments must retain the capacity to protect essential services and determine the conditions under which research is conducted.
When a funding decision can remove thousands of health workers from their jobs, or a research grant can determine whether newborns receive a life-saving vaccine, African institutions must have the resources and authority to put public health first.
Photo source: MSF
