Article by Syriacus Buguzi in The Lancet
Volume 406, Issue 10519p2525-2526November 29, 2025
"Following a large drop in international aid, and the harms that followed, Tanzania is taking steps to decrease its reliance on external funding for health. Syriacus Buguzi reports from Dar es Salaam.
Having relied for decades on foreign aid to tackle health issues such as HIV/AIDS, tuberculosis, and malaria, Tanzania is taking a major step to fund its own health care following US President Donald Trump's policies that led to widespread aid cuts. The east African nation now aims to generate additional revenue from taxpayers, totalling US$225 million—about half of its 2024–25 health-care budget—to make up for declining donor funding for HIV and other health initiatives.
Tanzania's move epitomises a broader global trend where developing nations are seeking greater self-reliance as international priorities shift. Inspired by the “trade, not aid” model, countries including Rwanda and Ethiopia have already made strides in domestic health financing, reducing dependency on external aid and minimising vulnerability to geopolitical changes.
Donors have historically funded more than 40% of Tanzania's health expenditures, according to REPOA, a policy research organisation in Tanzania. The USA was the largest funder, contributing $2·8 billion annually between 2012 and 2022, but other major donors include the UK, Canada, and Scandanavian countries as well as The Global Fund to Fight AIDS, Tuberculosis and Malaria, The World Bank, and WHO. In 2024, for example, Tanzania received $166 million in HIV/AIDS assistance from the USA. It is the seventh largest recipient of aid in Africa.
However, after Trump took office earlier this year, all foreign aid spending was frozen as part of his America First agenda, with the US Agency for International Development (USAID) dismantled and the US President's Emergency Plan for AIDS Relief (PEPFAR) transformed. Official development assistance to Tanzania plummeted from $761 million in 2013 to a projected $118 million in 2025, a severe reduction that forces the country to pursue a path of self-reliance.
For Tanzania, these changes have served as a wake-up call, prompting an overdue commitment to financial autonomy in the health sector. “The decline in development assistance is already palpable, and its impact is felt so acutely that it necessitates a huge investment in our healthcare systems now more than ever”, says Ntuli Kapologwe, a Tanzanian health systems researcher and Director General of the East, Central, and Southern Africa Health Community.
In June, in response to significant cuts in aid from the US Agency for International Development (USAID), Tanzania's then Minister of Finance, Mwigulu Nchemba, announced a raft of measures including new taxes and levies to raise additional revenue for health care. This includes increased excise duties on alcoholic beverages and electronic communication services, and new levies on fuel, minerals, imported vehicles, sports betting, land-based casinos, and train and air transportation tickets.
The Ministry of Finance said that 30% of the revenue from the taxes and levies go to the Universal Health Fund, established to help finance Tanzania's push towards universal health coverage. The other 70% of the revenue would be allocated to the AIDS Trust Fund—an initiative established by Parliament in 2001 to increase domestic funding for the country's HIV/AIDS response. According to UNAIDS, an estimated 1·7 million people in Tanzania were living with HIV in 2022. The fund “had remained largely dormant, despite showing promising results between 2016 and 2020 when there were efforts to implement initiatives”, says Elisha Osati, a researcher in infectious diseases and Chairman of the Tanzania Sickle Cell Disease Alliance who has been advocating for the revival of the AIDS fund in the wake of the aid crisis. The funds are expected to help sustain the supply of antiretroviral drugs, strengthen the wider national HIV health system, and support progress towards the UNAIDS 95-95-95 HIV goals."
Full text
