Foreign aid cuts put HIV, TB, malaria gains at risk, Ex-minister warns

Former Minister of Health and Nigeria’s Ambassador-designate to Canada, Prof. Isaac Adewole, on Tuesday warned that recent cuts in foreign development assistance could undermine decades of progress in the fight against HIV/AIDS, tuberculosis, malaria and other public health challenges unless Nigeria and other developing countries significantly increase domestic investment in healthcare.

Adewole gave the warning at the 25th anniversary celebration and public health symposium of APIN Public Health Initiatives in Abuja, where stakeholders reflected on 25 years of public health interventions and discussed strategies for sustaining gains amid a rapidly changing global funding landscape.

Speaking on the theme of sustaining health gains amid global uncertainty: evidence-based pathways to future impact, the former minister said the world had recorded remarkable progress over the past three decades in reducing child mortality, maternal deaths and infectious diseases, but warned that those achievements could be reversed if countries fail to strengthen their health systems and financing mechanisms.

According to him, global under-five mortality fell significantly between 1990 and 2021 due to improved immunisation coverage, better management of pneumonia, diarrhoea and malaria, enhanced nutrition and improved maternal healthcare services.

He also highlighted major gains against HIV/AIDS through free and subsidised antiretroviral therapy, decentralised HIV care, prevention of mother-to-child transmission services and expanded community-based interventions.

Adewole further pointed to progress in tuberculosis control through the scale-up of Directly Observed Treatment Short-course, deployment of rapid molecular diagnostic technologies such as GeneXpert and better integration of TB and HIV services.

Similarly, he noted that malaria control efforts, including the mass distribution of insecticide-treated nets, wider use of artemisinin-based combination therapies, rapid diagnostic testing and the introduction of malaria vaccines, had helped reduce disease burden across many countries.

He also cited advances in the prevention of vaccine-preventable diseases, noting that polio cases had fallen by more than 99 per cent globally since 1988, while countries, including Nigeria, had expanded access to vaccines against hepatitis B, rotavirus, meningitis and human papillomavirus.

Adewole disclosed that Nigeria had vaccinated nearly 17 million girls against cervical cancer through the HPV vaccine programme.

However, he stressed that emerging threats such as climate change, pandemics, antimicrobial resistance, economic instability and declining donor support now pose significant risks to those gains.

“Pandemics, climate change, food insecurity, conflict, economic shocks, misinformation and declining development assistance are major sources of uncertainty that must be factored into our health programmes,” he said.

The former minister noted that while much attention has focused on recent reductions in United States foreign assistance, many European countries have also cut development aid.

“People used to say it is Trump, it is Trump. But the UK, Germany, the Netherlands, Sweden and many others have also reduced overseas development assistance. It is not just the United States,” he said.

According to him, overseas development assistance has declined sharply in recent years, making domestic resource mobilisation an urgent priority for countries seeking to sustain public health programmes.

“The issue of local funding has become critical, and countries must now use their own resources in order to address this,” Adewole added.

He warned that crises often disrupt routine health services, weaken supply chains, divert resources from healthcare and erode public trust in institutions, making health systems more vulnerable.

“We need to do more than ever before to ensure that these gains are sustained,” he said.

Speaking on behalf of the Coordinating Minister of Health and Social Welfare, Muhammad Pate, the Director-General of the National Agency for the Control of AIDS, Dr. Temitope Ilori, described APIN as one of Nigeria’s most successful indigenous public health organisations.

She recalled that APIN was established 25 years ago when the country’s HIV epidemic was characterised by widespread stigma, limited treatment options and weak healthcare infrastructure.

“Today, APIN stands tall as one of our premier indigenous non-governmental public health organisations, partnering with the Federal Government of Nigeria to improve healthcare and change lives,” Ilori said.

According to the NACA boss, APIN has expanded its footprint to 30 states and currently supports treatment services for nearly one-fifth of Nigerians living with HIV.

“APIN currently manages treatment services for nearly 20 per cent of Nigerians living with HIV and has contributed immensely to the decline in HIV prevalence across the country,” she said.

Ilori said the organisation has played a pivotal role in strengthening laboratory networks, supporting strategic health information systems, conducting major community health surveys and building public health infrastructure nationwide.

“APIN has strengthened laboratory networks, supported strategic data systems, conducted major public health surveys and helped build a robust public health infrastructure across Nigeria,” he said.

She noted that APIN’s work aligns closely with the Federal Government’s Health Sector Renewal Investment Initiative and has supported efforts to expand HIV services to primary healthcare centres, strengthen prevention of mother-to-child transmission programmes and improve health workforce capacity.

Despite the achievements recorded over the years, Ilori said significant challenges remain.

These, she noted, include persistent HIV infections among key populations, the growing threat of drug-resistant tuberculosis, rising non-communicable diseases and heavy dependence on foreign donors for health financing.

“We must not become complacent even as we celebrate our successes,” she said.

“The need for more sustainable domestic health financing to reduce our over-dependence on international donors remains critical.”

In his remarks, the Chief Executive Officer of APIN, Prof. Prosper Okonkwo, said the organisation remains optimistic despite growing uncertainties in the global health funding environment.

“As we look to the future, we do so with great enthusiasm and expectation, even as the global health funding landscape continues to shift in ways that few of us would have predicted a few years ago,” Okonkwo said.

He said APIN had spent years building the capacity needed to navigate changing realities in international development financing and would continue to adapt to emerging challenges.