In January, U.S. President Donald Trump froze foreign aid immediately upon his inauguration for 90 days. This will particularly harm Africa. ChosunBiz examines the impact of budget cuts and potential solutions in Malawi, a major recipient of international aid, and explores its prospects for self-sustainability, diagnosing Africa's future.
"Malawi has made progress in various ways compared to the past. However, this does not necessarily mean success. The moment we take our foot off the pedal, Malawi could revert back to the past in an instant."
Samson Mondolo, the Minister of Health of Malawi, emphasized this while assessing the country's healthcare system. Mondolo, who has been in office since April 2023 and is a specialist in anesthesiology, has dedicated many years to the medical field at Queen Elizabeth Central Hospital, Malawi's primary public hospital. He is recognized for leading medical responses on the front lines during national disasters such as the COVID-19 pandemic and Cyclone Freddy.
Minister Mondolo identified 'financial independence' and 'health system integration' as the current top priorities of the Malawi Ministry of Health. Following the U.S. dismantlement of the United States Agency for International Development (USAID) to freeze Official Development Assistance (ODA) earlier this year, and a partial suspension of funds for the President's Emergency Plan for AIDS Relief (PEPFAR), which has been operational since 2003, the Ministry of Health has focused on maximizing budget utilization.
In particular, the Ministry has comprehensively reorganized the healthcare workforce, which was previously managed separately by disease. Instead of assigning personnel by institutional sectors such as ▲HIV infection, ▲maternal care, and ▲family planning, the system has been revamped so that one healthcare worker can provide various core services. Health services that are 'directly related to life', such as securing the continuity of HIV treatment, preventing maternal mortality, and preventing adolescent pregnancies, have been set as priorities around which a 'medical service package' is structured for budget reallocation.
However, the focus is not solely on workforce reduction. The government is taking steps to expand necessary personnel, striving to secure professional personnel that had previously relied on support from external sources such as volunteers. The Ministry has recently hired 2,100 nurses and clinical staff to provide primary care in local communities and is currently in the process of hiring an additional 2,700. Notably, in a rare move for Africa, community health workers are being officially hired as government employees, ensuring regular training and job security.
International organizations and NGOs are also restructuring their support strategies in line with these changes. The United Nations Population Fund (UNFPA) has been operating a Maternal Health Trust Fund since 2008, providing essential health services for mothers, newborns, and adolescents in 44 countries including Malawi. Since 2021, it has prioritized areas such as ▲climate crisis response, ▲expanding health rights for adolescents, and ▲building a sustainable national financial system to efficiently operate healthcare infrastructure within restricted budgets.
The deployment of around 20 midwives and skilled healthcare professionals to the flooded areas of southern Malawi during Cyclone Freddy in 2023, along with the use of helicopters for emergency deliveries, is regarded as a successful outcome of the flexible management of this fund.
In addition, UNFPA is running a joint financial program called 'Compact' to support Malawi's financial independence beyond short-term assistance. This program allows UNFPA to contribute additional funding proportional to the percentage of health budget secured by the Malawi government, which has, in fact, exceeded its target for health budget execution annually since 2023.
Richard DeLayte, acting director of the UNFPA Malawi office, positively assessed the government's reform efforts but expressed concern about the sudden cut in aid. According to DeLayte's view, the shock of aid suspension ultimately affects the most vulnerable segments of society—women and children. However, since aid-receiving countries cannot permanently rely on external assistance, he argues that the current moment must be transformed from a 'crisis' to an 'opportunity.'
"External aid will inevitably come to an end at some point. The important thing is the self-sustainability of the country after aid. What aid-receiving countries must do now is a structural transformation beyond simple responses. While the impact of budget cuts from USAID is unavoidable, turning this moment into an opportunity depends on the country's reform will."