In late January, the US suspended billions of dollars worth of international aid, including South Africa’s HIV-related programs. The South African government may have been able to respond by invoking an emergency funding mechanism, but it has not yet done so. Meanwhile, activists, health researchers, and even technical advisors to the government are increasingly irritated by the government’s lack of transparency on this issue.
To fund several health services repaid by the US, the National Department of Health was able to bypass budgets and secure emergency funds from government bonds. But this hasn’t happened yet.
This emergency funding mechanism falls under Section 16 of the Financial Management Act. The Minister of Finance allows funds to be allocated in exceptional cases “without serious bias against the public interest, it cannot be deferred to future parliamentary fund diversion.”
It has long been proposed by civil society as a way to save the vital HIV-related services that the health sector has been reimbursed by the United States. Section 16 allocations may be funded by national emergency reserves or borrowings. Emergency reserves are partially present to address unexpected funding gaps like the health department has faced over the past two and a half months.
In late January, US President Donald Trump signed an executive order that would globally suspend virtually all of the US international development funds. Since then, the US has moved to terminate thousands of aid contracts. This includes grants worth billions of rands that sponsored important HIV-related services in South Africa.
US Aid Cuts | Millions of South Africa will be infected with #HIV and hundreds of thousands more will die in the next decade, written by @Francoisventer3.
https://t.co/j5i8s97w2b pic.twitter.com/jipzxcihkk
– Spotlight (@SpotLightNSP) March 4, 2025
Spotlight and Groundup sent questions to the National Health Bureau about why they had not secured emergency funds from the State Treasury since the crisis began in January. In response, spokesman Foster Mohale said that government bonds “indicate that they may prefer Section 16 funding motivation.”
It is unclear why the health department should inform the health department that the application will be considered favorably for it to be applied.
In some confusion, Mohale also said that the Health Department had sent a letter to the National Treasury, including “(a) a solid proposal regarding Section 16 application.”
We asked the National Treasury Media Office about this. He confirmed the existence of this proposal, saying he received it on April 15th.
Questions to the health department were sent on April 14th.
Therefore, it appears that in “a solid proposal on Section 16 Application,” the Health Department apparently submitted their letters to the National Treasury, the day after they asked about why they didn’t.
Perhaps even more oddly, Mohale insisted that “the treasury is not formally responding to the proposal.” However, the Health Department apparently had just sent the proposal to the Ministry of Finance when it made the claim. (National Treasury said it received it on April 15th. The National Treasury media office said it responded the following day on April 16th.
Confusion and counterclaim
Despite these strange media engagements, government and civil society sources say this is not the first time the national Treasury Department and the Health Department have communicated about emergency funds. Instead, discussions on this are ongoing.
The Health Department appears to have submitted obviously important information to the National Treasury Department as part of its funding request, but has not provided a detailed plan on how emergency funds will be used. This is required before issuing the Section 16 assignment.
“As we understand, the Treasury was waiting for full motivation from the Ministry of Health regarding special emergency allocations,” said Fatima Hassan of the Health Justice Initiative. “As of April 14th, no information has been submitted.”
Since only a portion of the US funding gap can be funded through section 16 allocations, the health department may need to provide very specific details about which services they want to fund and how they will do this.
Civil society groups are concerned that the Health Department does little to gather information that would allow such assessments.
At first, there appears to have been some confusion about how the evaluation should be carried out in the first place. On February 25th, an article was published in IOL citing Health Minister Dr. Aaron Mossoaredi, who said the Department of Health had hired Deloitte to carry out the investigation. However, in response to questions from the Spotlight and Ground Up, Mohare denied that Deloitte was hired.
“The company provided assistance, but it would have been too long to procure the free offering,” he said. It remains unclear what kind of analysis the Ministry of Health has conducted. The US began halting global aid services in late January, but the Health Bureau took until early March just to meet with the reimbursed organizations.
According to Hassan, the meeting did not include all the organizations that were refunded. Hassan said many of the invited people will only be notified for a few hours before the meeting begins. Note, participants had to physically attend the meeting at Centurion.
As we understand it, this is the only conference the department still holds in a repaid organization, and at first glance it seems to have followed a wave of international media attention.
Did the department do anything?
Spotlight and Groundup were able to identify only a few small cases in which the Health Department responded to US funding cuts. These instances primarily involve doing what the unit head can do to adapt to the situation and protect staff.
For example, in the Department of Health’s procurement department, several staff members received funding from the United States Agency for International Development (USAID). After USAID deducted the funds, the unit made arrangements to keep these staff in the short term.
Procurement Director Khadija Jamaloodien told Spotlight and Groundup: To maintain staff more permanently, she said posts need to be created and promoted.
Similarly, the Department of Health’s Central Chronic Drug Distribution and Distribution (CCMDD) program had two USAID-funded staff. Maggie Munsamy, head of CCMDD, said independent donors provided funds to maintain these staff.
Beyond this, it appears that little has been done to address the closure of major US funding services. One technical advisor from the Health Department told Spotlight and Groundup:
“They did nothing to replace the (US-funded) infrastructure. …We don’t have any communication from the Department of Health yet. …When I speak to the Department of Health and ask what we can do, there is a decisive silence.”
Emergency holidays council
The same concerns are reflected by several civil society groups. Hassan said since February 5, the coalition of organizations has sent two letters to the government asking for information on what it is doing to deal with US funding cuts. Signatories for these letters include the Health Justice Initiative, The Treatment Action Campaign, Cancer Alliance, and Sweat.
These letters, like the presidency, are addressed to the Ministers of Health, Finance and International Relations. So far, they have not received a single response, she says.
Asked about this, Mohale stated: “The department meets all roles affected by the Pepfer suspension, and these meetings provided actions taken to address the background of the issue and challenges.
In response, Hassan said, “Several groups have been requesting information back to February. It is hardly satisfying to respond by saying that one of these groups may be involved in one or two meetings.”
Must read | Abruptly cutting grants from the world’s largest health research funders threatens to unravel the medical research environment in SA. Will the government turn this crisis into an opportunity to renew? @marcuslowxhttps://t.co/ib8w48aydq
– Spotlight (@spotlightnsp) April 3, 2025
Hassan’s coalition appears to be the only person to be ignored by the government on the issue.
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On April 4, another group of prominent health researchers and activists wrote to the chairman of the Portfolio Health Committee. Its leading signature was Zackie Achmat, co-founder of TAC. The letter urged the committee to seek funding for the program we previously supported. It also requested a meeting with the Portfolio Committee.
In response, the group met in silence.
On April 10, Spotlight and Groundup sent questions to the committee about why they didn’t respond to the letter. Shortly afterwards, the committee sent an email to ACHMAT saying that Congress had been on a break and that “the date will be given when the committee meets again.”
In response, Achmat told Spotlight and Groundup:
If the South African government continues to continue plaster civil society officials and delays its response to the crisis, the outcome could be disastrous. Recently available data suggests that USAID has thus far reduced 89% of grants to South African organizations. This is equivalent to billions of rands. And it’s not clear how many of the remaining 11% are still active. Since this data was published, at least one of the retention list grants has been cancelled.
As a result, USAID-funded drop-in centres providing HIV treatment and preventive services have been shut down. And thousands of USAID-backed medical staff working in government clinics and community settings have lost their jobs. Recent modeling studies estimate that if the South African government fails to intervene, US funding cuts could result in up to 65,000 HIV-related deaths by the end of 2028.
If the government does not secure emergency funds to cover repaid services, additional money will need to be allocated until the budget adjustment period in September or October.
In the meantime, certain clinics will continue to operate without critical US-funded health workers, including data capturers and HIV testing staff. Thousands of orphaned children with HIV will continue to be left without a USAID-funded counselor. US-funded clinical trials testing new HIV and TB treatments and vaccines will be undermined. USAID-funded services for rape survivors are not available.
Published by Spotlight and Groundup.
