DAR ES SALAAM: Tanzania is facing a growing challenge to the sustainability of critical health programmes as changes in United States foreign assistance expose the risks of relying heavily on external financing for HIV prevention, treatment, laboratory services and community-based healthcare.
For more than two decades, U.S.-supported programmes, particularly through the President’s Emergency Plan for AIDS Relief (PEPFAR), have played an important role in Tanzania’s HIV response, supporting testing, treatment, prevention, laboratory systems, surveillance and health-system strengthening.
The scale of that support has made the question of what happens when American financing is reduced more than a funding issue. It has become a test of whether Tanzania can maintain essential services when an important international financial partner steps back.
The impact was already being felt after the U.S. government moved to freeze or review much of its foreign assistance in 2025. In Tanzania, UNAIDS reported that HIV-prevention interventions heavily dependent on PEPFAR funding were disrupted, including programmes targeting adolescent girls and young women, services for vulnerable children and voluntary medical male circumcision.
Some PrEP services were also affected, while concerns emerged over the availability of antiretroviral medicines, transportation of laboratory samples and continuity of treatment.
At the time, UNAIDS reported that Tanzania had existing antiretroviral stocks expected to cover several months, but warned that uncertainty over longer-term financing could create difficulties if alternative funding was not secured.
U.S.-supported health programmes have also contributed to laboratory capacity, data systems, surveillance, technical assistance, community outreach and healthcare personnel. This means that replacing American financing requires more than finding money to purchase medicines. Tanzania must also determine how to finance the wider infrastructure that allows HIV and other health programmes to function.
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In Uganda, disruptions to U.S. assistance affected the movement of HIV commodities from district facilities to lower-level health centres, while some community and NGO-supported services were suspended. UNAIDS also reported concerns over reduced capacity at some ART facilities, disruptions to PrEP and HIV testing and uncertainty surrounding health workers whose salaries had previously been supported by U.S. programmes.
Research from Uganda subsequently documented interruptions in several HIV services, including prevention activities, viral-load testing and community outreach, while the loss of donor-supported workers and data personnel affected the operation of some facilities and HIV data systems.
Kenya has faced similar pressures. Research examining the impact of the funding disruption found reports of ART rationing, shorter medication-refill periods, missed clinic visits and interruptions in monitoring in one county. The changes also raised concerns about confidentiality and stigma as some HIV services were integrated more rapidly into general primary healthcare.
An analysis by the Center for Global Development found that a significant share of planned PEPFAR-related resources in several African countries was affected by the termination of U.S.-funded awards. South Africa retained less than 25 percent of planned resources in the remaining active USAID PEPFAR awards examined, while Tanzania, Uganda, Zimbabwe, Malawi and the Democratic Republic of Congo were among countries where between 25 and 50 percent of planned resources were associated with terminated awards.
The comparative experience suggests that the biggest danger is not necessarily an immediate collapse of HIV treatment. Instead, the pressure can appear gradually through reduced prevention, fewer community services, weaker laboratory monitoring, shortages of trained personnel and declining support for vulnerable populations.
U.S. government records show that PEPFAR-supported activities have continued to receive funding in Tanzania during 2026, including programmes involving the Ministry of Health and organisations implementing HIV services in regions such as Pwani, Kigoma, Mara and Shinyanga.
This continued support means Tanzania is not starting from zero. However, it also demonstrates how deeply international financing has been incorporated into the country’s health-service delivery structure.
Tanzania has already been exploring ways to reduce the impact of the funding changes. Measures reported by UNAIDS include efforts to absorb some health workers into government structures, strengthen electronic HIV treatment databases, maintain the distribution of medical commodities through the Medical Stores Department and find alternative arrangements for transporting laboratory samples.
The challenge is whether these measures can be expanded quickly enough and financed sufficiently to prevent gaps in services.
The issue is particularly important because HIV programmes depend on an interconnected system. A patient may receive antiretroviral medicine from a health facility, but the effectiveness of treatment also depends on laboratory testing, viral-load monitoring, reliable data, trained healthcare workers, community follow-up and a functioning supply chain.
The African comparison therefore offers Tanzania a warning about the consequences of an abrupt financing transition. Uganda has experienced disruptions in community and facility-based services, Kenya has reported pressure on treatment and monitoring, while South Africa has confronted substantial reductions in portions of its planned U.S.-supported programme resources.
For Tanzania, the question is increasingly whether domestic financing and other international partners can fill the space created by changing U.S. support without weakening the country’s progress against HIV and other major health challenges.
The country may be able to maintain essential treatment services in the short term, but sustaining the broader health programmes that support those services will require greater domestic investment, stronger government systems and predictable alternative financing.
The American funding shift has therefore exposed a wider vulnerability facing Tanzania and other aid-dependent health systems: when external financing changes suddenly, the real test is not simply whether a country can replace the money, but whether it can take over the entire system that the money helped sustain.
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