The Nation
1 August 2025
Bradley Fortuin
In a government clinic in Zomba, nurse *Takondwa starts her shift just like she has for the past fifteen years by unlocking the medication cupboard that stores medications such as antiretroviral (ARVs) and for treating tuberculosis (TB) and prepping the consultation room. Except now, the medication cupboard is nearly empty, the queue outside is longer than usual with anxious patients, while the instructions from above about restocking are vague.
“No one officially told us what to do when the stock started running low”, she says. “we just kept coming to work, but we did not know if we should ration the medication, refer patients, or wait for more supplies. So, we decided to ration treatment while also referring to other clinics”.
*Takondwa is one of the many healthcare workers across Malawi who are facing this situation. The United States Agency for International Development’s (USAID) halt in funding, which resulted in funding cuts, has led to serious disruptions in services and medication availability. However, one of the main issues is not just about the resources but also the absence of clear, honest, and transparent communication from the government. A communication that assures the public and healthcare providers while sharing an immediate plan and a long-term sustainability of services.
In January 2025, it was reported that the US government halted USD 284.7 million (about MWK 493.7 billion) worth of foreign aid to Malawi, a large chunk of which was for HIV/Aids interventions. In February 2025, the Minister of Health, Khumbize Kandodo Chiponda, assured the public that the government has enough ARVs for people living with HIV and that the “public should not worry”, despite the disruption of medication stock flow by USAID. By March 2025, USAID reported that more than 4500 healthcare staff had terminated their contracts. A public health system panic!
Is the official story the realities on the ground?
In a recent July 2025 meeting with several government and community organisations representatives In Blantyre, Zomba and Liwonde, we spoke frankly about the state of the healthcare services, particularly on HIV and TB-related services. According to one of the Ministry of Health representatives, the government had anticipated this crisis, they already had a contingency plan in place, communicated this with clinics across several districts across the country, and were ready to step in to fill the gap. This means that the Ministry of Health would, from then on, provide essential HIV and TB treatment for all Malawians affected, including key and vulnerable populations.
But this is not what many on the ground are experiencing. Community organisations supported by USAID’s US President’s Emergency Plan for AIDS Relief (PEPFAR) shared disturbing reports about ART and TB medication stockouts, healthcare providers, including peer outreach workers, losing their jobs, some community organisations that were safe spaces for key and vulnerable groups shutting down and no clear guidance from the government. The gap in service delivery is growing and with this comes risks, especially for people with low viral loads. One clinic staff said plainly, “We heard from the ministry on the radio like everyone else. We did not get direct communication or guidelines. We did not even know if we were part of the contingency plan.”
The cost of silent and mixed signals.
In public health, silence can be deadly. Therefore, open, transparent communication regarding access to medication is not just an act of courtesy but is part of healthcare ethics. Without this from the government, healthcare workers on the ground are left to improvise, and patients are left in the dark, thus resulting in a loss of trust in the government and the healthcare system.
“You are the ones who told us that we should take ARVs for the rest of our lives, now you are taking them away!” said a worried and angry female sex worker in Zomba. In 2014, Malawi launched the 2015-2020 National HIV Strategic Plan to help reach the UNAIDS 90-90-90 targets. One of these targets was that 90% of people diagnosed with HIV would receive ART. This involved ensuring access to and adherence to ART medication. This placed a lot of reliance on foreign aid programs such as PEPFAR to provide HIV prevention and treatment medicines to the government. Like many African countries in Southern Africa, Malawi has, for a long time, depended on foreign aid for its health system. However, when foreign donors pull back, which they eventually do, realistic plans, open communication and public transparency must be shared with everyone. There is a deep disconnect between how and what communication is disseminated.
Meanwhile, stigma and possible consequences discourage people from speaking out. One community health advocate said, “We do not want to burn bridges, but we cannot keep pretending everything is fine. It is not. People are defaulting on ART and it is not their fault.” A central issue here is transparency. If the Ministry of Health truly anticipated the USAID cut, why have public briefings, memos and communiques not been made about the future and implementation plans? If clinics were informed, why are there so many reports of mixed signals?
Transparency is not just about publishing a press release. It is about a proactive two-way communication with stakeholders, especially those most affected. It means clinics get detailed protocols on time and not vague assurances. It means community organisations are treated as partners, not afterthoughts.
The US Senate recently agreed to not proceed with USD 400 million in cuts to PEPFAR, however, there is no indication how PEPFAR funding will be administered in the absence of many USAID and Department of State staff and whether any future funding will be allocated to PEPFAR.
Back in Zomba, nurse *Takondwa finishes her shift by telling one more patient to return next week. She is not sure if the medicine will be there. But she will be back because, for now, she still believes in the work and hopes that her belief does not run short like the medicines.
This article is part of the Southern Africa Litigation Centre’s campaign highlighting how global health funding cuts affect Malawi’s health system.
*Not real name, fictional setting.
*The writer, Bradley Fortuin is a consultant at the Southern Africa Litigation Centre and a social justice activist.