In January, U.S. President Donald Trump froze overseas aid for 90 days immediately upon taking office. This is particularly detrimental for Africa. ChosunBiz examines the impact of budget cuts and solutions in Malawi, a major recipient of international aid, and further assesses Africa's potential for self-sustainability, diagnosing the future of the continent.
On the 21st, I visited the Bwaila Fistula Center in Lilongwe, Malawi. This center, which is officially part of Bwaila Hospital and is known for treating women's diseases, has been operating for about 13 years and is run in collaboration with the Malawi government, the Freedom from Fistula Foundation (FfFF), the United Nations Population Fund (UNFPA), and several non-governmental organizations (NGOs). About 50 women from various parts of Malawi come to this facility each month for fistula surgeries.
Upon entering the facility, more than 20 women were seated in chairs and corridors waiting for their treatment, consisting of pregnant women, mothers, and elderly women across various age groups. Inside the center, there was a ward with 45 beds and a dedicated operating room, where women undergoing treatment were talking with nurses and midwives while having hoses attached to their abdomens. Notably, a significant portion of the staff at this facility have previously received fistula treatment at the same or similar facilities. For instance, among the 15 facility management staff, 7 have experience with fistula surgeries, providing an advantage as patients can receive care in a more comfortable environment.
A fistula is a term describing the formation of a long tunnel-like hole in the skin related to the anus. Among them, obstetric fistulas occur during childbirth, creating abnormal passages between the vagina and the urinary or gastrointestinal tract, commonly afflicting women in developing countries who experience obstructed labor. In sub-Saharan Africa, the incidence of obstetric fistulas is about 10 cases per 1,000 births, and maternal and infant mortality rates are also high in areas where these fistulas occur. According to United Nations Population Fund (UNFPA) estimates, currently over 20,000 women in Malawi are believed to be experiencing obstetric fistulas.
The Bwaila Fistula Center is not only for medical staff and patients. The center provides various support, including the supply of medical supplies such as sanitary napkins, psychological counseling, and women's empowerment programs. Women who have completed recovery can prepare for social reintegration through training in sewing and renewable energy usage. Lilian James, a 36-year-old tailor who learned sewing skills at the center after her recovery in 2022, said, "I faced mental trauma after being ostracized by my community due to the condition and, to make matters worse, struggling for livelihood." She added, "After receiving sewing training at the center, I envisioned starting a business, and now I can afford to pay for my daughter's education alone."
Numerous projects led by NGOs are underway in Malawi to supplement the poor local health infrastructure. According to the Malawi Ministry of Finance, the government has allocated at least 9% of its overall budget for health-related expenditures annually since 2019, and 12% the previous year, but this is insufficient to meet local medical needs. The Malawi NGO Regulatory Authority (NGORA) estimates that as of 2025, there are about 250 NGOs operating in Malawi, most of which are engaged in health-related projects.
Another representative NGO-led initiative includes the European Union (EU)-United Nations (UN) partnership, the Spotlight Initiative, and programs supported by TEENS, UNFPA, and Safe Space Mentorship. In Malawi, where women typically have their first sexual experience at an average age of 16.8 (compared to 18.5 for men), these programs focus on educating and providing counseling for women aged 10-24 on issues such as child marriage, teenage pregnancy, school dropouts, and gender-based violence. So far, more than 50,000 mentees have completed the program, qualifying them to become mentors afterward.
Dorine Mwachitamtolo, 19, who became pregnant at 17 and dropped out of school, recalled, "I learned about self-determination and life planning at the Safe Space after my pregnancy," adding, "I decided to resume my studies, using this experience as a turning point."
However, following the disbandment of USAID, NGOs that conduct projects with international funds have not been able to escape backlash, leading to heightened tension in the industry. This is because Western countries, mindful of the U.S. actions, are also cutting related budgets. For example, Keir Starmer, the British Prime Minister, recently announced in Parliament that to increase defense spending, the international aid budget for 2027 would be reduced from 0.5% of GDP to 0.3%. Additionally, the EU has pledged to increase defense spending, implicitly suggesting cuts to support budgets.
A survey conducted by NGORA among NGOs in Malawi found that 25% of the 151 responding NGOs reported that 'budget cuts negatively impacted their operations.'
Margaret Moyo, director of the Bwaila Fistula Center, expressed concern about the deteriorating local situation due to the shrinkage of NGO activities. Moyo emphasized, "Given the nature of the work, it is common for various NGOs to collaborate on a single project. The absence of one NGO can lead to project halts and ultimately worsen local conditions."