Accra Reset report finds African healthcare under strain from US aid cuts

Ghana-led initiative argues African nations must lead health reform

A report published Monday by the Accra Reset, a global health initiative led by Ghanaian President John Dramani Mahama, warned that healthcare in Africa and the wider Global South is “under growing strain” following the withdrawal of US aid programs and the Trump administration’s cuts to the US Agency for International Development. The report, titled “A Sovereign Future For Health,” argues that countries in the region should take greater control of their own health systems rather than depending on aid from Western governments and international institutions.

The Accra Reset’s central claim is that aid dependency is unsustainable, and it points to recent disruptions as evidence. The Trump administration’s decision to dissolve USAID pushed Nigeria to absorb the 28,000 health workers previously employed by the agency at a cost of $200 million, the report said. External financing for health in Africa contracted by close to 70% between 2021 and 2025, leaving historically aid-dependent countries to adapt quickly. Africa produces less than 1% of its vaccines while carrying about 25% of the global disease burden, the report said, citing figures that Mahama and Accra Reset have previously highlighted.

The withdrawal of the US President’s Emergency Plan for AIDS Relief from South Africa, which had provided more than $400 million annually and is credited with saving 26 million lives globally since 2003, contributed to the closure of HIV clinics across the country and left 1.4 million people living with HIV facing uncertainty about their treatment, the report said. Research presented at the 26th International AIDS Conference in Brazil earlier this year found that the funding cuts caused “severe and devastating” disruption to HIV programs globally.

At the World Health Assembly in May, Mahama said Ghana had lost $78 million following the closure of USAID programs that had supported maternal healthcare, malaria treatment, nutrition services, and HIV/AIDS interventions.

Mahama framed the cuts as a clear example that donor dependency is not sustainable. “The past few years have shaken global health cooperation to its foundations,” he wrote in the report. “The Covid-19 pandemic exposed the risks created by concentrated production and unequal access to essential health products; rising debt and fiscal pressures have constrained national health budgets; and declining development assistance is placing programs and services under growing strain. These shocks have brought new urgency to reform debates that have continued for years with limited progress. It was in this context that we launched the Accra Reset and its Sovereign Health Agenda – to give renewed political force to the reform agenda and place the agency of countries of the Global South at its centre.”

The Accra Reset’s call for reform is paired with an argument that Western donors should evolve rather than retreat. “The Accra Reset is not an argument for traditional donors to do less on global health. It is an argument for doing it differently and doing it better,” said Naveen Rao, senior vice-president of the health initiative at the Rockefeller Foundation. “As countries take greater ownership of their health futures, donor countries should step up to support that transition – following the lead of countries that set their own priorities, and work alongside them to determine where outside support is most valuable.”

The Rockefeller Foundation released its own polling alongside the report. A survey of more than 2,000 US adults found that 75% of Americans, including 52% of those who primarily support President Donald Trump, agreed that the US should restore disease-prevention aid to contain the Ebola virus. Sixty-five percent said they supported international cooperation even if it meant compromising some national interests, and 64% said Americans had a shared responsibility to others, including people in other countries whom they did not know.

The Guardian reported that it had contacted the US Department of Health and Human Services for comment.