HARARE – In March, 27-year-old Jemitius Gangata succumbed to malaria in Mahombokombe village in Zimbabwe’s Mashonaland West Province, becoming part of the country’s growing malaria statistics. 

By mid-April, the country had recorded over 65,000 malaria cases and 174 deaths, almost double the numbers from the same period last year, when 36,000 cases and 85 deaths were recorded, according to Save the Children, a non-governmental organisation. 

Gangata’s widow, 25-year-old Miriam Chasi, said nurses delayed giving her husband malaria treatment because they said there was a shortage.

“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,” said the mother of two.

Save the Children warned earlier this year that US aid cuts have led to “premature ending of the second phase of the country’s largest malaria programme – Zimbabwe Assistance Program in Malaria – which had been on track towards eliminating the deadly disease”.

Zimbabwe had achieved some of the largest declines in malaria incidence and mortality in the world, reducing cases by 76.6% from 2023 to 2024.

Save the Children, one of the four partners implementing the malaria programme, said the closure of the programme has led to “shortages of insecticide‑treated mosquito nets, delays in vector control operations, and weakened disease surveillance, with heavy rainfall and fluctuating weather patterns further promoting the spread of the disease”.

Megan Rabbitt of Malaria No More said that US funding for malaria in 2025 amounted to almost $20 million.

This money funded essential drugs, commodities and laboratory systems, and the jobs of approximately 8,300 health workers are in jeopardy, “reducing national capacity for case management, disease surveillance, and outreach”, said Rabbitt.

A resurgence of malaria in Zimbabwe also threatens its neighbours, Botswana, Mozambique, South Africa, and Zambia. 

Meanwhile, the Global Fund’s grant for the country has been lower for the past two grant cycles as it, too, is facing financial challenges. 

Gaping hole in the budget

Zimbabwe’s health budget faces gaping holes after the United States announced it would end all bilateral health funding to the country by the end of September – one month before malaria season begins. 

“US government contributions comprise 54% of national healthcare spending, supporting a range of clinical care, laboratory systems, health workforce, commodities, and community-based programs,” according to Health GAP, the global access project. 

The US President’s Emergency Plan for AIDS Relief (PEPFAR) has spent over $1.7 billion in Zimbabwe since 2006.

“Of the 1.3 million Zimbabweans living with HIV, more than 1.2 million are now on life-saving HIV treatment thanks to PEPFAR and support from other donors,” according to a 2023 statement by PEPFAR, which has been substantially reduced since Trump assumed office and is being replaced by the bilateral MOUs.

Researchers project that there could be over 75,000 new HIV infections in Zimbabwe within a year “as a consequence of full PEPFAR withdrawal and no additional government or international support”.

When the National AIDS Council (NAC) addressed the Zimbabwean Parliament last month, it appealed for more domestic financing for the HIV response, warning that the declining donor funding placed pressure on the AIDS Levy and threatened the sustainability of prevention and treatment programs.

The country’s AIDS Levy, introduced in 2000, entails a 3% income tax for individuals and a 3% tax on profits of employers and trusts. NAC administers the funds, and 50% goes to antiretroviral medication.

However, NAC’s Amon Mpofu told MPs: “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.”

Breakdown in talks

The US announcement follows the Zimbabwean government’s decision not to pursue a bilateral memorandum of understanding (MOU) with the US under its “America First” Global Health Strategy. The MOU was worth $367 million over five years.

A leaked letter from Albert Chimbindi, Zimbabwe’s Secretary for Foreign Affairs, describes the MOU as “clearly lopsided”, adding that it “blatantly compromises and undermines the sovereignty and independence of Zimbabwe”.

US Ambassador to Zimbabwe Pamela Tremont confirmed the US withdrawal in February.

“From that time, civil society advocated behind the scenes to try to restart MOU talks – on terms that were fair for Zimbabweans,” according to Health GAP’s Asia Russell. 

But the talks did not resume, with Russell blaming hard-headedness on both sides. 

“Ambassador Tremont insisted talks would only restart if Zimbabwe’s government reached out to them. Because President [Emmerson] Mnangagwa had already issued a formal communique severing talks, easy paths to compromise were unrealistic,” she said.

“The US and Zimbabwe dug into their respective positions; in Zimbabwe, political leaders falsely claimed the national government would cover gaps in essential healthcare services left by a sweeping US health program shutdown.

“Tremont repeated her claim that she would be willing to restart talks if Zimbabwe’s government reached out to the Embassy. She must have known that without a détente she refused to pursue, there was no chance Zimbabwe’s government opposition to the MOU would dissolve.”

Government fails to outline plan

However, it is unclear how Zimbabwe plans to tackle the shortage, as Health Ministry officials failed to answer questions from Health Policy Watch on how it plans to tackle its obligations amid US health aid cuts.

In July, the health ministry launched an ambitious National Health Strategy 2026-2030 aimed at “building a resilient, sustainable and people-centred health system”. At its launch, Health Minister Dr Douglas Mombeshora said his government would “increase domestic funding for health to at least 15% of total government expenditure and reduce out-of-pocket payments”.

At an event hosted by the UN Population Fund (UNFPA) on the sidelines of last month’s UN General Assembly Summit, UNFPA revealed that Zimbabwe has committed over $250 million to upgrading hospitals countrywide, with 30% of this dedicated to maternal and child health infrastructure. Zimbabwe has also committed $2.25 million annually for family planning commodities in 2026 and 2027, according to UNFPA.

However, these measures are not enough to cover the shortfall.

Back in March, the Zimbabwe National Network of People Living with HIV (ZNNP+) met with Health Minister Mombeshora to express the fear of their members at the looming cuts.

According to a ZNNP+ media release, Mombeshora told them that the country “has  ARV stocks of between six and 30 months, with further shipments expected throughout the year; the government has ringfenced health-related taxes to cover the expected funding gaps, and [it is] putting in place long-term measures including the identification of further revenue sources to fund HIV, TB and malaria programmes.”

ZNNP+ responded: “While we take note of the assurances, there is need for a clear Some civil society activists have also questioned whether the Zimbabwean regime, mired in decades-long corruption, will foot the national health bill on its own – particularly as the country’s PEPFAR grant covered over 40% of the country’s HIV bill.

Other civil society groups are also sceptical about the government’s ability to deal with the crisis.

“The government of Zimbabwe needs to step forward and prioritise funding the health sector more than before to avoid a crisis,” said Vivid Gwede, former programme manager for Zimbabwe Alliance, a collaborative philanthropic initiative that pools donor funds to provide grants, technical support, and capacity building for civil society groups.

“That means plugging resource leakages and cutting unnecessary expenditure. As usual, preventive health measures need to be stronger to reduce treatment burdens. Anything short of that will spell a public health crisis,” added Gwede.

Tuberculosis surges amid drug shortages

Tuberculosis has already started to resurge amid the US health aid cut, which started 18 months ago when Donald Trump became US president.

Denford Macheza, a 49-year-old resident in Harare’s Dzivarasekwa Extension, has been bed-ridden with drug-resistant TB for over a month, and blames his condition on a shortage of drugs at his local hospital.

“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 told Health Policy Watch.

Pregnant women have also not been spared. Harare resident Jack Munondo blames the death of his pregnant wife on a shortage of drugs at their local clinic.

Her labour needed to be induced, but there were no drugs at their local clinic.

“The baby died before birth because my wife couldn’t get the drug to induce her to exert pressure to push the baby out and the nurses just looked on helplessly, shouting at each other,” Munondo told HPW.

Uncertainty for people living with HIV

Zimbabwe has made significant progress against HIV, including reaching the UNAIDS 95-95-95 targets among the adult population, meaning 95% of people living with HIV know their status, 95 of those diagnosed are on treatment, and 95% on treatment are virally suppressed. 

Many Zimbabweans living with HIV are fearful of what the health cuts might bring.

“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,” Tinotenda Mapuranga, who was born with HIV, told HPW.

Kensington Marufu, also born with HIV, is trying to keep a positive outlook.

“As an individual, I remain hopeful. I believe that the gap created by the withdrawal of US support can be addressed through a combination of domestic resources, existing development partners, new donors and innovative financing mechanisms,” said Marufu. 

“The priority must be to ensure that people living with HIV continue to access their ARVs and essential services without interruption. Ultimately, the success of this transition should be measured by one thing: whether the person who walks into a clinic tomorrow can still receive the treatment they need and walk home with confidence,” 36-year-old Marufu, a lawyer by profession, told HPW.

Dr Henry Madzorera, Zimbabwe’s Health Minister between 2008 and 2013,  claimed that the country “does not need more external aid”.

“We need better and more accountable management of the resources the Lord has already given us. Together, we will prosper,” said Madzorera, adding that, “with enough political will, Zimbabwe can finance her healthcare and achieve universal health coverage.”

Nurse warns of hardship ahead 

Warren George, a nurse working in rural Masvingo, said that the aid cuts will make his job harder.

“It is really a difficult situation. We can’t really say the government of Zimbabwe is in a position to become a standalone supporter in terms of finances to face the health burden that we already have,” George told HPW.

“Even with health aid available, it was not easy. Personally, I have been doing the tuberculosis program in Chivi district, and with the funding that was available, there were still shortages in medical supplies,” said George. “The US health aid has been fostering something the Ministry of Health and government here cannot do alone.”

George said that, before the Trump cuts, community outreach agents used to track people living with HIV to check that they were adhering to treatment.

“We will have challenges with people defaulting on HIV/AIDS treatment because of zero monitoring owing to lack of resources,” added George.  

For Rashweat Mukundu, a researcher at the International Media Support (IMS), much harder times may lie ahead: “I have not seen any concrete policy propositions on how the Zimbabwean government will close this gap, but I guess the responsible authorities are fully aware of the demands that come with the withdrawal of American funding, and the vulnerability that Zimbabwe finds itself in regarding health funding,” he told HPW. 

Meanwhile, Health GAP’s Russell proposed several actions to alleviate the crisis. These include an emergency donor conference focused on Zimbabwe’s funding cliff, global partners pushing the US and Zimbabwe “to come back to the negotiating table immediately” to resolve concerns, and the US Congress “earmarking appropriated global health funding for Zimbabwe, which would effectively override this decision”.  

Image Credits: UNICEF Zimbabwe, Emmanuel Museruka/ MMV.