A community-led monitoring report has exposed a 'system-wide slide' in basic health services at South African clinics following US Pepfar funding disruptions in early 2025. Surveys of 326 facilities showed staff shortages, longer waits and disrupted ARV supplies affecting HIV care. Activists urge urgent government action to address the gaps.
The Treatment Action Campaign's Ritshidze project, which has monitored primary healthcare since 2018, released a report based on data from April to June 2025. It surveyed 326 public health facilities across 16 districts in the Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo and Mpumalanga. Among these, 48% reported reduced capacity due to Pepfar disruptions.
The cuts stemmed from a January 2025 executive order by US President Donald Trump, imposing a 90-day freeze on foreign aid, with Pepfar funding—worth $440 million for South Africa's October 2024 to September 2025 fiscal year—permanently axed by late February. This represented 17% of the country's R44.4 billion HIV programme budget, distributed via USAID and the Centers for Disease Control and Prevention.
Key findings included 85% of facilities lacking sufficient staff, with 21% attributing gaps to withdrawn Pepfar partners. Among users, 62% noted too few staff, and 19% said shortages worsened post-cuts. Waiting times increased, linked by 68% to staffing issues and 54% to filing problems; 22% reported longer delays after the cuts.
Filing systems collapsed in districts like King Cetshwayo in KwaZulu-Natal and Buffalo City in the Eastern Cape, with up to 80% of sites in disarray. 'For years, Pepfar implementing partners have worked directly on clinic filing systems,' said TAC general secretary Anele Yawa. 'Now, with those posts gone, data capture is falling to whoever is available.'
HIV services suffered: 9% fewer people received three-month ARV supplies compared to January 2025, while 8% more got one-month supplies. Other issues included 35% facing longer ARV collection times, an 8% drop in external pick-up points, and only 47% of non-ART users offered HIV tests.
Despite a February 2025 health department circular allowing six-month ART dispensation, no facilities implemented it during the survey period. Ritshidze recommends longer supplies and community-based pick-up points, noting Treasury's R753.5 million allocation falls short of the R3.3 billion funding gap.
In October 2025, the US approved a $115 million Pepfar Bridge Plan through March 2026 to sustain services. Yawa warned: 'Until government and donors accept and address the breadth of what was lost, the response will remain weakened.' Public health specialist Lynne Wilkinson emphasized community monitoring's role in providing real-time alerts.