Zimbabwe is facing growing pressure to finance essential healthcare services after the United States ended its bilateral health funding, raising con...
HARARE — Zimbabwe is facing growing pressure to finance essential healthcare services after the United States ended its bilateral health funding, raising concerns over the future of HIV, malaria and tuberculosis programmes.
The funding withdrawal comes as malaria cases and deaths have risen sharply, while health organisations warn that disruptions to prevention, surveillance, medicines and community-based programmes could reverse gains made against major diseases.
By mid-April 2026, Zimbabwe had recorded 65,399 malaria cases and 174 deaths, according to the Ministry of Health and Child Care’s National Malaria Control Programme surveillance data cited by Save the Children. The figures compared with 36,421 cases and 85 deaths during the same period in 2025.
The increase has raised particular concern because Zimbabwe had recorded major improvements in malaria control in previous years. Between 2023 and 2024, malaria cases fell by 76.6%, equivalent to about 487,000 fewer infections.
Malaria gains under pressure
Save the Children said cuts to foreign aid contributed to the premature ending of the second phase of the Zimbabwe Assistance Program in Malaria (ZAPIM II), a USAID-funded programme supporting Zimbabwe’s National Malaria Control Programme.
The programme’s second phase was scheduled to run from 2021 to 2026 but was discontinued following changes to US foreign assistance.
Save the Children said the disruption had contributed to shortages of insecticide-treated mosquito nets, delays in vector-control operations and weaker disease surveillance.
Heavy rainfall and changing weather patterns have also created conditions favourable for malaria transmission.
Jemitius Gangata, 27, died from malaria in March in Mahombokombe village in Mashonaland West.
His widow, 25-year-old Miriam Chasi, said nurses told the family malaria medicines were in short supply when they sought treatment for her husband.
“Nurses claimed that there were so many malaria patients who wanted the treatment drugs, which were said to be in short supply. We couldn’t do anything to save my husband’s life and we lost him,” Chasi said.
Save the Children has warned that the reversal of malaria-control gains could have consequences beyond Zimbabwe, given the movement of people and the shared malaria burden across southern Africa.
Neighbouring countries including Botswana, Mozambique, South Africa and Zambia could also be affected by increased transmission.
The Global Fund remains another major source of funding for Zimbabwe’s health programmes, although international health financing is facing wider pressures.
US funding withdrawal
The United States formally moved to end its health funding to Zimbabwe after negotiations over a proposed bilateral health agreement collapsed.
The proposed memorandum of understanding was valued at about US$367 million over five years and was intended to support HIV/AIDS, tuberculosis, malaria, maternal and child health and disease-outbreak preparedness.
Zimbabwe withdrew from the negotiations in February after raising concerns over provisions requiring the sharing of sensitive health and biological data.
Government spokesperson Nick Mangwana described the proposed arrangement as an unequal exchange, arguing that Zimbabwe would be required to share biological resources and data without guarantees that it would receive access to medical innovations resulting from the information.
US Ambassador to Zimbabwe Pamela Tremont subsequently confirmed that Washington would wind down its health assistance.
In September, the US confirmed that funding for Zimbabwe’s health programmes would end at the close of the month following the failure of the negotiations.
The decision represents a major change for a country that has depended on US assistance for essential health programmes for years.
HIV treatment faces uncertainty
One of the biggest concerns is the future of Zimbabwe’s HIV response.
PEPFAR, the US President’s Emergency Plan for AIDS Relief, has supported Zimbabwe’s HIV response since 2006. The programme and other development partners have helped expand access to antiretroviral treatment and laboratory services.
Zimbabwe has about 1.3 million people living with HIV, with more than 1.2 million receiving treatment through programmes supported by the US and other partners, according to figures cited by the US government.
Health advocates have warned that the loss of American support could affect HIV testing, viral-load monitoring, treatment adherence, community outreach and other services.
Researchers have also projected that Zimbabwe could record more than 75,000 additional HIV infections within a year under a scenario in which PEPFAR support is completely withdrawn and no replacement funding is provided.
That figure is a projection rather than a confirmed prediction of future infections and depends on whether alternative funding and services become available.
The National AIDS Council has meanwhile called for greater domestic financing of the HIV response.
NAC representative Amon Mpofu told Parliament that the AIDS Levy, which has supported the national response since its introduction in 2000, was no longer sufficient to meet all requirements.
“The AIDS Levy, while it has been resilient over the years, remains inadequate given the demands of the response, particularly at this moment. We therefore need an expanded base of domestic financing to sustain the gains we have made and meet emerging needs,” Mpofu said.
The AIDS Levy is funded through a 3% tax on individual income and a 3% tax on profits of employers and trusts.
Government promises more domestic funding
The Zimbabwean Government has said it will increase domestic financing to protect the health system from the effects of declining donor support.
In July, the Ministry of Health and Child Care launched the National Health Strategy 2026–2030, which aims to build what the Government described as a resilient, sustainable and people-centred health system.
Health Minister Dr Douglas Mombeshora said the Government intended to increase domestic health funding to at least 15% of total government expenditure while reducing out-of-pocket payments.
Zimbabwe has also announced investments in health infrastructure and family planning.
The United Nations Population Fund has reported that Zimbabwe committed more than US$250 million towards upgrading hospitals nationwide, with 30% allocated to maternal and child health infrastructure.
The country also committed US$2.25 million annually for family planning commodities in 2026 and 2027.
However, health advocates question whether these measures can replace the recurrent funding previously provided through US-supported programmes.
The Ministry of Health has also faced questions over how it plans to finance services affected by the US withdrawal.
Patients report medicine shortages
Concerns about medicine availability extend beyond malaria and HIV.
Denford Macheza, 49, from Dzivarasekwa Extension in Harare, told Health Policy Watch that he had been bedridden with drug-resistant tuberculosis for more than a month.
He said he was instructed to return to hospital on two occasions because his medication was unavailable before eventually receiving the drugs on his third visit.
“I was told on two occasions to come back for my pills as they were not yet available, and when I went back to the hospital for the third time, I obtained them. But now I suffer from a drug-resistant TB strain and I just hope I will be fine,” Macheza said.
A Harare resident, Jack Munondo, also told Health Policy Watch that he blamed the death of his pregnant wife and their unborn child on a shortage of medicines at a local clinic.
According to Munondo, his wife required labour induction but the medicine was unavailable.
Such individual accounts highlight concerns about medicine availability, although they do not by themselves establish that the US funding withdrawal caused each reported shortage or death.
People living with HIV fear rising costs
Zimbabwe has made significant progress in its HIV response and has reached the UNAIDS 95-95-95 targets among adults, according to the information supplied in the report.
However, people living with HIV have expressed concerns about whether services that were previously provided through donor support will remain free or affordable.
Tinotenda Mapuranga, who was born with HIV, said he was concerned that patients could face increased costs for viral-load testing.
“Now, with the US having cut down health support, we are going to have poor adherence to treatment. Imagine now, people are going to be paying huge amounts of money to get tested for viral load whilst with the US funding, we were getting those for free,” Mapuranga told Health Policy Watch.
Kensington Marufu, a 36-year-old lawyer who was also born with HIV, said he remained hopeful that Zimbabwe could combine domestic resources with support from other partners.
“The priority must be to ensure that people living with HIV continue to access their ARVs and essential services without interruption,” Marufu said.
Health workers warn of pressure
Health workers have also raised concerns about the impact of reduced funding on services.
Warren George, a nurse working in rural Masvingo, said the withdrawal of US support would make it more difficult to conduct community outreach and monitor patients.
He said community health workers had previously helped track people living with HIV and encouraged them to remain on treatment.
“We will have challenges with people defaulting on HIV/AIDS treatment because of zero monitoring owing to lack of resources,” George said.
George also said shortages existed even when donor funding was available, suggesting that the health system already faced significant resource constraints.
Former Health Minister Dr Henry Madzorera, who served from 2008 to 2013, said Zimbabwe should focus on improving the management of resources already available to the country.
He argued that stronger accountability and political commitment could help Zimbabwe finance its healthcare system and work towards universal health coverage.
Civil society representatives have also called for increased domestic investment and better management of public resources.
Vivid Gwede, a former programme manager for Zimbabwe Alliance, said the Government needed to prioritise health spending and address resource leakages.
Calls for urgent funding plan
Rashweat Mukundu, a researcher at International Media Support, said he had not seen detailed proposals explaining how the Government would close the funding gap created by the withdrawal of US assistance.
Health GAP’s Asia Russell has called for an emergency donor conference focused on Zimbabwe’s health financing gap.
She also urged the US and Zimbabwe to resume negotiations and called on the US Congress to protect appropriated global health funding for Zimbabwe.
For Zimbabwe, the immediate challenge is maintaining uninterrupted access to essential medicines and services while building a more sustainable domestic financing model.
The Government has said it will increase domestic health spending and mobilise additional resources. However, the scale of the funding gap and the country’s dependence on external support mean the transition is likely to remain a major test for the health sector.
The malaria figures already show the potential consequences of weakened prevention and surveillance systems, while HIV and tuberculosis programmes face their own financing pressures.
With US health funding now being wound down, the ability of Zimbabwe and its remaining development partners to maintain treatment, prevention and community health services will be closely watched in the months ahead.
