The United States has formally exited the World Health Organisation (WHO), marking one of the most consequential withdrawals in a broader retreat from multilateral institutions under the (Donald) Trump administration.
As one of the WHO’s largest financial contributors, the US departure removes between 15% and 18% of the organisation’s budget, raising urgent questions about global health governance, particularly in Africa.
For African countries, which rely heavily on WHO-supported programmes, this move is more than symbolic. It threatens to disrupt health financing, technical support, and coordinated responses to cross-border diseases. While also exposing long-standing structural weaknesses in Africa’s health systems.
The ‘Business Rescue’ approach
The US departure from the WHO is not an isolated event. It is but part of a consistent strategy by the Trump administration to dismantle multilateral commitments in favour of a lean, “America First” operation. Dr Oscar van Heerden, a geopolitical analyst, framed the situation through a corporate lens. He suggested the US government is acting like a corporation in distress.
“When Donald Trump took over the presidency in the United States, the United States incorporation, if we see it as a company, was in business rescue,” Van Heerden explained. “One of the first things you do when you are busy with business rescue is you have to cut expenditure.”
This corporate restructuring logic led to the slashing of federal employees and a significant pullback on aid to developing economies. He argued that the US is simply no longer willing to fund global health initiatives when its own citizens lack access to adequate healthcare.
The financial fallout is catastrophic. Global health expert Dr Agbor Ebuta noted that the US withdrawal removes approximately 15% to 18% of the WHO’s budgetary allocations.
“You have mandatory contributions of up to $110-million off the table and voluntary contributions up to $600-million,” he stated. “That is significantly going to impact the capacity of the WHO to react to global diseases and to ensure that there is that collectivism that builds resilience across borders.”
Healthcare leader and consultant Dr Victor Ngani highlighted the specific danger to Africa. With the continent allocated over $1.6-billion of the WHO’s programme budget, the withdrawal of funding and technical human resources leaves vulnerable populations at the greatest risk.
The deficit reality
While the loss of US funding is a major blow, the panel emphasised that it merely exposes pre-existing structural weaknesses in Africa’s health sector. The continent is facing a severe deficit in human resources, infrastructure, and domestic funding.
Dr Ebuta painted a grim picture of the current reality. Africa has a shortage of over 2.3 million doctors, a number expected to rise to 4 million by 2030. Furthermore, over 90% of medications used on the continent are imported. And digital health infrastructure remains woefully inadequate.
“We need to audit our human resources, identify the gaps more clearly, and find alternative sources of funding,” he urged.
Dr Ngani echoed these concerns. He pointed out that despite the 2001 Abuja Declaration pledging 15% of national budgets to health, most nations average around 7%. He criticised African leaders for viewing healthcare as an expenditure rather than an investment.
“We have allowed our healthcare to be funded almost exclusively by external partners,” he stated. “The complacency has been on our side. We’ve been very comfortable receiving funding to sort out our issues.”
Corruption was also identified as a critical barrier. Dr Ebuta warned that without robust governance and anti-corruption tracking systems, even increased funding would fail to solve the crisis.
Bilateralism over Multilateralism
Coinciding with its exit from the WHO, the US is implementing an “America First Global Health Strategy,” signing multi-year bilateral health Memoranda of Understanding with at least 14 African nations. This shift raises concerns that the US is bypassing collective obligations to negotiate deals that heavily favor American interests.
Dr Ebuta argued that this allows the US to “itemise their interests more clearly” rather than lumping them together in a multilateral framework. By dealing directly with individual nations, the US can leverage health relationships to extract economic benefits.
“I believe the thinking behind this is basically to be more specific in terms of outcomes that are targeted,” Ebuta said. He added that the policy is designed to “milk that relationship in a way that favours making America great again.”
Dr Ngani provided a concrete example, citing the bilateral agreement signed between the US and Kenya. He pointed out that the deal focused on two primary American interests: access to data and preventing diseases from leaving Africa to reach the US.
“He’s saying it all the time that these kinds of conversations are putting the American interests first,” he observed. “If these agreements are one-sided, then there’s a chance it may not be as successful as envisioned.”
Dr Van Heerden drew parallels between this health strategy and the Trump administration’s approach to trade. He noted a refusal to engage with blocs like the European Union in favour of individual deals where the US can “optimise their return”.
Africa at a crossroads
As the era of reliable Western multilateral support fades, the experts agreed that Africa faces a definitive moment of choice: continue to seek new external saviours, or finally build internal resilience.
When asked about filling the funding gap, Dr Van Heerden suggested that a “basket of countries” might step in. But he warned against simply replacing one dominant donor with another. He emphasised that the “collective West” has long used money and power to divide African nations. And that the only path forward is unity.
“Africa needs to begin to sing off the same hymn sheet,” Van Heerden said. “If we don’t do this, then we are not going to advance as Africa. We are not going to be able to speak with one tongue.”
For Dr Ngani, the crisis is a blessing in disguise. He argued that for too long, Africa has been a “passenger” in the multilateral world. With an illusion of power while its destiny was held by outsiders.
“It would be the saddest thing if this phase passes and you are still looking up to outsiders to help us,” Ngani reflected. “Think of it like a sleeping giant. Something has to wake us up. And if this doesn’t wake us up, I don’t know what will.”
The path forward requires innovation, such as expanding health insurance coverage and leveraging digital tools for preventative care. this to reduce the burden of non-communicable diseases. The solution lies in leadership and introspection.
“It may be bitter for a short while, but if we look inwards and stop holding out our hands for arms, then there’s a real possibility that going forward, because of this one event, Africa is much stronger,” Ngani concluded.
