Community health worker Prossy Muyingo
Prossy Muyingo is concerned. Uganda announced an Ebola outbreak on Jan. 30, following the death of a nurse in Kampala.
Muyingo is an award-winning community health worker who lives in Uganda’s Mityana district, about 28 miles from Kampala. CHWs are generally from the same communities they serve, and they help to plug the gap where nurses and doctors are in short supply.
Uganda has overcome Ebola in the past. “We made sure that the information we had on the ground moved faster than the virus,” Muyingo explains, reflecting on the work she and her fellow CHWs did in previous outbreaks. However, the new outbreak comes amidst a period of uncertainty and desperation in the global health community as a wave of orders from the new U.S. president and secretary of state abruptly halted most aid. While preparations were made for a foreign aid review by the new administration, the sudden cessation of aid while the review was ongoing caught many off guard.
The State Department’s new spokesperson stated that the 90-day cutoff of foreign aid was deemed necessary because they lacked trust in aid workers to provide information otherwise — even though continued funding typically relies on regular reporting.
The aftermath has been chaotic. HIV clinics in South Africa closed; one clinic, unable to continue supplying antiretroviral medicines to its patients, provided details of a suicide crisis hotline. Tons of food aid destined for Mozambique remained in storage. Classrooms shut down.
In Uganda, Muyingo’s patients receive essential medicines, such as antiretroviral drugs for HIV, for free thanks to health aid. The aid freeze means they will likely have to pay out of pocket — in addition to missing out on reminders and health information crucial to the work of a CHW.
“My patients are stranded. What will happen to them?” Muyingo ponders. She estimates that perhaps 2% of her patients will be able to afford the necessary medicines. Understanding the high cost of these medicines, especially as one of her children has sickle cell disease, adds to her concern.
“My family will be greatly affected,” Muyingo shares. While her compensation as a community health worker is modest, it helps provide essentials like flour for her family. Going without pay for 90 days will present a challenge. However, her side business as a hairstylist working from home — a skill passed down from her mother — will provide some relief.
Community health workers are already feeling the impact of uncertainty, service interruptions, and loss of work, notes Madeleine Ballard, CEO of the Community Health Impact Coalition, a nonprofit that supports CHWs worldwide. “They are witnessing suffering and experiencing it themselves,” Ballard states. “It’s always most devastating when those who care for others are not cared for themselves.”
What Is ‘Lifesaving Assistance’?
Marco Rubio, the new U.S. secretary of state, has allowed for “core life-saving medicine, medical services, food, shelter and subsistence assistance, as well as supplies and reasonable administrative costs necessary to deliver such assistance.” However, aid organizations report a lack of clear guidance on what this entails. From tuberculosis medication to food aid, distinguishing between emergency aid (which is permitted but still unclear) and longer-term support that also saves lives.
For example, Olivia Ngou, executive director of Impact Santé Afrique, which operates in Cameroon to enhance local political advocacy and community engagement around malaria, has not received confirmation that malaria aid falls under the exception for lifesaving assistance. Advocates in the U.S. are currently seeking clarification.
Delays are crucial for ongoing malaria treatment and testing carried out by CHWs in remote areas. It also impacts the months-long preparation for the rainy season, when malaria risk escalates. “Preparations for that have come to a halt,” Ngou reveals. “Missing even just one week or one month could result in the loss of many children.” She emphasizes the importance of the 48-hour window for testing and treatment following a mosquito bite to prevent severe malaria.
The process for requesting waivers during the near-total aid freeze has been confusing. Some organizations report a lack of clarity on where to submit these requests.
Examples provided have also been puzzling. The initial example cited by the State Department spokesperson of unjustified aid being cut due to the freeze was condoms and other contraception in Gaza. However, there has been no recent spending on contraception in Gaza, according to AFP. (The State Department did not respond immediately to a request for comment.)
On a broader scale, the notion that contraception is unacceptable aid is incomprehensible to those who have witnessed the impact of AIDS, as Muyingo has with her mother, who taught her hairstyling. Muyingo has seen the positive effects of neutral, science-supported information on contraception: “Family planning has enabled many students to complete their studies,” among other benefits. Some individuals do not use condoms simply because they cannot afford them, Muyingo explains.
The Heritage Foundation, the conservative think tank behind the contentious Project 2025 policy agenda, has labeled HIV as a lifestyle disease. As Health Policy Watch points out, the Heritage Foundation’s belief that “education and abstinence could end the AIDS epidemic” has proven unsuccessful in both the U.S. and Africa.
What Makes America ‘Safer, Stronger, And More Prosperous’?
A phrase that is being reiterated frequently is “safer, stronger, and more prosperous.” This is the State Department’s mantra for justifiable aid. “Our test is simple,” the department’s spokesperson tweeted.
However, many types of aid that appear to enhance the country’s safety, strength, and prosperity have been halted. These include pandemic preparedness and aid that stabilizes vulnerable regions, as Ballard remarks. “This isn’t charity, this is smart economics.”
One of the most compelling pieces of evidence for the cost-effectiveness of aid comes from malaria. GiveWell, an organization that evaluates impactful charitable projects, states that there is “exceptionally strong” evidence of the benefits of seasonal malaria chemoprevention (costing about $7 per child) and mosquito nets (around $5 each).
While malaria still claims about 600,000 lives annually — which is 600,000 too many — it is no longer the death sentence it once was for millions worldwide. In the first 15 years of the 21st century, the mortality rate for malaria in children was halved. “That was rapid, amazing progress,” Ngou marvels, acknowledging U.S. leadership for this achievement.
Scientists have also surmounted the challenges of creating vaccines for parasitic diseases, and vaccination against malaria is now routine in several African countries, starting in Cameroon. However, vaccination programs have been halted due to the aid stoppage, sometimes before children complete the full four-dose course of the malaria vaccine.
Overall, progress on malaria has been remarkable but fragile, according to malaria experts. The disease is opportunistic, resurging and spreading to new populations (including in the U.S.) when vigilance and prevention efforts are disrupted.
Malaria No More estimates that a 90-day U.S. aid freeze could prevent the delivery of 15.6 million doses of medicine, 3.7 million treatments for pregnant women, trainings for 64,700 health workers, and 9 million insecticide-treated mosquito nets.
The numbers are even more alarming. Malaria No More’s analysis, considering all U.S. malaria program funding contributions, suggests that every day the 90-day aid freeze persists, over 1,000 additional individuals will succumb to malaria. These are preventable deaths, primarily affecting children.
A significant portion of U.S. malaria aid is channeled through the U.S. President’s Initiative on Malaria, a bipartisan program operating in Africa and Southeast Asia. PMI has saved the lives of over 11 million people. Ngou emphasizes that it particularly targets the most vulnerable and those in greatest need: pregnant women and children under 5.
African nations have been ramping up their efforts against malaria, Ngou highlights. In 2024, health ministers from 11 African countries signed the
