During his first term in office, John Mahama, who returned as Ghana’s president for a second stint this January, floated the idea of “trade not aid”. That was in 2016. Speaking to the United Nations General Assembly, Mahama said: “Africa does not need your sympathy or development assistance.” Instead, he said, it wanted a “fair chance to trade with the rest of the world” and to increase trade and investment within the African continent.
Nearly a decade later, when it comes to aid at least, the world has taken Mahama at his word. Donald Trump, who has himself adopted the “trade not aid” mantra, has declared spending on aid pointless, even anti-American. In February Elon Musk, during his brief time as Washington’s efficiency tsar, immolated the US Agency for International Development and with it a good deal of its roughly $43bn budget.
The sweeping cuts are not limited to the US. Overseas assistance budgets have been slashed around the world. Even before USAID was ended by Musk, the UK had scrapped the Department for International Development, folding it into the Foreign Office. It also dropped its pledge to keep overseas assistance to 0.7 per cent of gross national income, reducing it to 0.3 per cent.
Other European countries from France to the Netherlands have followed suit. Budgets of global health organisations such as the Global Fund to Fight Aids, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, are under pressure. The UN is also facing financial strain and is relocating staff from agencies such as Unicef and UN Population Fund to cheaper locations, including Nairobi and Panama.
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“Around a fifth of the total aid budget is gone and we have to accept that,” said one senior UN official, who said the situation was only likely to get worse. “Aid budgets are going — and organisations need to adapt.”
While aid agencies and health experts have mostly decried the cuts, there has been surprisingly little protest from Africa itself. Many leaders and ordinary citizens were suspicious of aid in the first place, with some even seeing USAID as a front for the CIA.
More generally, critics have complained that too much money was spent on bureaucracy, including high salaries for foreign consultants. Overseas assistance also created unintended consequences, they said, by hollowing out local expertise and giving governments an excuse to ignore their responsibilities for providing services such as healthcare and education.
Uhuru Kenyatta, former president of Kenya, summed up the mood when he said: “People are crying, saying Trump is not giving us any more money. Instead of crying, we should ask ourselves, ‘What are we going to do to support ourselves’?”
Several African governments, from South Africa to Nigeria, have talked about shouldering more of the burden. Rwanda has been rolling out primary healthcare backed by a sophisticated electronic patient record system that, according to Peter Piot, former executive director of UNAids, is superior to those of many European countries.
Cuts in aid have hit local healthcare centres across the continent such as this one in Migosi, Kenya © Michel Lunanga/Getty ImagesA pharmacist at a hospital in Kenya. The withdrawal of aid has led to the closure of programmes such as those focusing on HIV, malaria and child nutrition © Michel Lunanga/Getty Images
Muhammad Ali Pate, Nigeria’s health minister, has pressed his country’s treasury for a bigger health budget. He has said that his country has an opportunity to move decisively into the gap vacated by retreating aid agencies. Local provision can be achieved much more cheaply than that carried out by foreign experts on expat packages, he says.
Still, few doubt the very real damage to public health that will result from the abrupt withdrawal of aid and the almost overnight closure of programmes such as those focusing on HIV, malaria and child nutrition. Even if core services remain, health workers worry that prevention and other health-promotion strategies, including education, will suffer, storing up future problems.
Serah Malaba, co-chief executive at Tico, which works with adolescent girls and young women, said that, even in relatively wealthy South Africa, progress against HIV was threatened. She highlighted programmes that provide care to vulnerable communities in mobile clinics which, she said, were now parked idly outside hospitals.
“There is no money, there is no driver, there are no healthcare workers to manage those mobile clinics,” Malaba said. “We work through an ecosystem of partnerships. But we are almost totally crippled because that ecosystem has gone.”
A paper in the Lancet found that, if US cuts were not reversed, an additional 14mn people, a third of them children, would die worldwide in the five years to 2030.
Dion Morton, co-lead of the Global Surgery Unit, which helps improve standards of surgery in 120 countries and is funded by the UK’s National Institute for Health and Care Research, said: “Cutting our funding would not only deprive thousands of people of life-saving care, it would seriously damage the UK’s reputation on the international stage.”
Robert Rosenbaum, a former USAID employee, said the abrupt cuts will have a high human cost. He led a programme, initially called the Lifeboat Project, in which a small team trawled through USAID data to find the projects most vital for vulnerable women and children.
Their list included a community healthworker programme in Nigeria, a nutrition project in Mozambique and primary healthcare in war-torn Sudan — all of which had been cut.
“We didn’t have the luxury of thinking about what the ideal world would look like,” Rosenbaum said. “We saw incredibly important programmes falter overnight and real human suffering as a result.”
If Mahama’s statement about aid is beginning to come to pass, what about his plea for fairer and more integrated trade? Far from making it easier for African economies to trade with the outside world, a US-led era of protectionism is set to make it harder.
People are crying, saying Trump is not giving us any more money. Instead of crying, we should ask ourselves, ‘What are we going to do to support ourselves?’
Uhuru Kenyatta, former president of Kenya
South Africa faces 30 per cent tariffs on most goods exported to the US. Tiny Lesotho, which has become the “denim capital” of Africa based on tariff-free access to the US, at one stage faced a 50 per cent tariff, though this was later reduced to a still substantial 15 per cent. Farmers in Europe, the US and Japan continue to be subsidised, hardly the level playing field Mahama was calling for.
African governments have continued to talk loudly about adding value to products from cocoa beans to the cobalt and coltan used in global electronics. But, in practice, progress has been modest at best with only a few countries, such as Morocco, making real strides in building a competitive manufacturing base.
Since Mahama’s UN speech, 48 out of 54 countries have ratified the African Continental Free Trade Area. But again, practical difficulties in trading caused by fragmented infrastructure — physical, regulatory and financial — have hampered any meaningful increase in intercontinental trade.
Samuel Maimbo, who this year ran unsuccessfully for the presidency of the African Development Bank, lamented that his home country of Zambia could not export much beef to neighbouring Angola. Instead, Angola imported beef from Brazil, thousands of miles away.
Paul Collier, professor of economics at Oxford university’s Blavatnik school of government, argues that above all Africa needs investment and sustained development. What aid remains should be directed at the very poorest countries and modified to include more risk capital for job-creating businesses, he says. National development banks — if properly run — can play an important role, he adds.
Stefan Dercon, former chief economist of the now-defunct DFID, says that what most African economies need is the type of sustained growth that pulled billions of people out of poverty in Asia. “Aid clearly does save lives and do good things,” he says. “But at the end of the day, it does not bring development.”