The recent decision by the Trump administration to cut funding to the President’s Emergency Plan for AIDS Relief (PEPFAR) has once again exposed Africa’s overreliance on foreign aid to sustain critical health services. For Nigeria, which has the second-highest number of people living with HIV globally, this move is not just an inconvenience; it is a potential death sentence for thousands who depend on antiretroviral therapy (ART) to stay alive. But rather than simply lamenting the loss of funding, this should serve as a wake-up call—Nigeria and the rest of Africa must take ownership of their healthcare research and funding.
HIV/AIDS treatment in Nigeria is heavily subsidised by foreign donors, with PEPFAR alone contributing hundreds of millions of dollars annually to ensure that ART drugs are available. These drugs have become so effective that individuals with suppressed viral loads can no longer transmit the virus. However, with funding cuts, the availability of these drugs becomes uncertain. If Nigeria does not rise to the occasion, the consequences will be dire:
A Surge in Infections – With nearly 200,000 new HIV infections recorded annually, a decline in treatment access could lead to an exponential increase.
Increased AIDS-Related Deaths – Without ART, HIV progresses to AIDS, which is fatal.
A Healthcare System on the Brink – Nigeria’s healthcare infrastructure is already fragile; additional strain could be catastrophic.
And let’s not forget that funding for other diseases such as tuberculosis and malaria—already major health burdens—is also at risk.
Beyond the issue of dependency lies another uncomfortable reality: foreign health funding in Nigeria is not always used for its intended purpose. There have been whispers—and outright accusations—of individuals and institutions diverting these international funds for personal gain.
While patients suffer shortages of ART drugs, some actors within the system milk donor funding under the guise of implementation costs, inflated research budgets, and misappropriated grants. If Nigeria had robust and transparent healthcare financing, foreign aid would be supplementary, not the lifeline it has become.
The saying “The best time to plant a tree was 20 years ago; the second-best time is now” applies perfectly here. The time for Africa to invest in its healthcare system was yesterday; the urgency today cannot be overstated. Here’s how Nigeria—and Africa at large—can take charge:
Ring-Fenced Health Taxes: Introduce and strictly enforce a tax that is specifically dedicated to health research and service delivery, ensuring that funds do not disappear into bureaucratic black holes.
Local Production of ART Drugs: Instead of depending on expensive foreign imports, Nigeria should invest in pharmaceutical manufacturing to produce ART and other essential medicines locally.
Accountability Mechanisms: Every kobo allocated to health funding should be trackable, with independent audits and whistleblower protections.
Public-Private Partnerships: The government should incentivise private investments in healthcare infrastructure and research, reducing reliance on unpredictable foreign donations.
Technology-Driven Healthcare: Invest in telemedicine and digital records to reduce corruption and inefficiency in drug distribution and healthcare delivery.
Africa must redefine its relationship with foreign aid. While assistance from international partners is valuable, it should not be the cornerstone of our survival. Nigeria has the human and material resources to build a self-sustaining health sector; what is lacking is the political will and prioritisation. Until we take charge, we remain at the mercy of donors—some of whom may wake up tomorrow and decide that we are no longer worth the investment. And when that happens, what next?
