Urgent Action Required: Western Cape Government Addresses Funding Shortfall for HIV/AIDS Services

The National Department of Health’s response or back-up plan to the 90-day suspension of certain foreign aid by the United States is said to be pivotal in ensuring that HIV/AIDS services and treatments can continue without disruption.

The Western Cape Government (WCG) has since welcomed the department's swift action, which includes a series of measures to minimize the impact of the funding pause. Among these measures are a 6-month antiretroviral treatment (ART) dispensation and a 28-day late collection allowance for clients refilling ARTs.

These efforts will help alleviate the pressure on both patients and clinics. Additionally, the WCG will introduce automatic chronic dispensing unit script renewals for ART, further reducing the need for facility visits.

The suspension of this foreign aid will further add pressure to an already overburdened healthcare system.

“While the provincial government will work with the national government to implement rollout strategies for both HIV/AIDS and TB, clarity will be needed on how these measures will be sustainably funded,” the Western Cape Government said in a statement.

The WCG said while the stop-gap measures will provide temporary relief they need to address the long-term financial strain that the suspension of foreign aid could impose on the healthcare system should foreign aid from both the United States Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) not be reinstated.

While a waiver has been issued for certain life-saving services, there is still uncertainty regarding the full scope of affected programmes.

Given these challenges, the WCG has called on the national government to provide a coordinated funded strategy in the face of the uncertain future of funding from these critical programmes.

Last week, both Provincial MEC’s of Health and Wellness, and Finance, Mireille Wenger and Deidré Baartman, wrote to their national counterparts requesting a coordinated strategy with other provinces to safeguard service delivery and to fiscally mitigate the substantive risks that have emerged after the suspension was announced by the United States.

In the Western Cape, USAID and PEPFAR funding supports both non-profit- and non-government organisations as well as provincial government programmes to address the burden of HIV/AIDS and TB.

The Western Cape Department of Health and Wellness (WCDoHW) uses this funding for technical services and health systems strengthening which includes data analysis and research, testing, mobile X-ray services and community-based support staff.

The purchase of antiretroviral treatment (ART) and clinical staff are mainly funded through the province’s own budget. Essential healthcare services, including ART provision, will therefore continue but it has meant adjustments in how and where patients access services and will increase pressure at already overburdened clinics.

“It is our mission to build a healthier Western Cape where residents can thrive, and a healthy workforce is able to fully participate in a thriving provincial economy. Although the WCG has endeavoured to reduce our reliance on foreign aid, the funds received from USAID and PEPFAR have been vital in the fight against the HIV/AIDS epidemic and TB, which often present together. Without urgent action as a sector, we could face losing some of the gains made in our fight,” Wenger said.

Unpacking the financial implications of this suspension of funding, Baartman added: “The USAID and PEPFAR funding freeze has cross-cutting implications for the Western Cape Government’s fiscus, particularly in healthcare, social development, and economic growth initiatives.

“The financial risks include a funding shortfall for health services in the 2025/26 financial year and a potential loss in funding for child services over the next three years.”

“The sudden withdrawal of financial support means that difficult decisions lie ahead for departments at a time where the Western Cape’s financial resilience has been stretched to its limits. We urge the national government to provide a unified strategy for provinces as they navigate this financial uncertainty.”

Premier Alan Winde concluded: “The Western Cape Government works hard to develop and grow relations with key international partners, such as the USA, towards the apex priority of helping businesses create jobs and helping our residents get those jobs.

“Our partnerships have also proven crucial to supporting programmes which have been hugely beneficial to the most vulnerable in our province. The USA has been an important partner to the Western Cape, and we look forward to engaging with Washington to find common ground and certainty on this important matter.”