Cash-strapped African nations are looking at imposing sin taxes, restructuring debt and even trying to take a cut of diaspora remittances to replace lost aid funding and prop up their health systems.
So called sin tax, is an excise tax specifically levied on certain goods deemed harmful to society and individuals, such as alcohol, tobacco, drugs, candy, soft drinks, fast foods, coffee, sugar, gambling, vaping, cannabis and pornography.
According to the Telegraph, ten months after Donald Trump slashed America’s lavish overseas aid, former recipients are scrambling for new ways to fill the gaps, said one of the continent’s leading public health experts.
International health aid is projected to drop by two-fifths in 2025 compared with 2023, according to new World Health Organization figures.
A WHO survey has found cuts have reduced critical services such as maternal care, vaccination and disease surveillance – by up to 70 per cent in some countries.
Nations have acknowledged Mr Trump is not going to change his mind, and similar cuts from the UK and others mean global aid funding is not going to return to levels of recent years.
Prof Helen Rees, a world renowned HIV and global health researcher, said: “We are seeing just a real change in the way that people are thinking about the way we are going to finance.
“Because that is the reality and this is not going to come back to any of those levels that we have seen.”
Prof Rees, who heads the Wits RHI research institute at Johannesburg’s University of the Witwatersrand, said there was also an acknowledgement in many countries that they had become too dependent on aid.
She said: “Many African health ministers have now said we shouldn’t have done this, we shouldn’t have had this level of dependency, so that when it was withdrawn, we all suddenly reeled backwards and said oh my goodness, we hadn’t planned for this.”
African health leaders have also admitted that the previous international largesse had been inefficient and often wasted, doing too little to build up lasting health systems that could stand alone.
Dr Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention, recently estimated that 60 per cent of traditional foreign health aid to Africa was effectively wasted.
He said: “Let me also shock you: We don’t need more than 40 per cent of [the] money we were receiving before.”
As aid cuts have bitten, Kenya, Nigeria and South Africa have all allocated budget increases to health, and are trying to get the increases approved by their parliaments.
Prof Rees said countries were looking at how they could increase taxation to make up for the lost money.
Some were looking at so-called sin taxes, including targeting a boom in online gambling.
Ghana earlier this year put a 20 per cent increase on taxes for alcohol, tobacco products and sugary drinks, in part to raise money for its health service.
Crypto currency could be another target for taxation, Prof Rees said.
Another area being investigated is money sent from abroad.
She said: “If you imagine some of the big countries that have got a big diaspora, remittances are a hugely important part of the foreign exchange income.
“So is there a way that diaspora remittances can be looked at?”
Countries were also looking at pooling procurement to get better bargaining power on vaccine and drug deals, following an example set by the Pan American Health Organisation, which has had a similar scheme since the 1970s.
As countries fund themselves with more of their own money, they will have to make their own prioritisations about what healthcare they want.
Prof Rees said: “Actually some of these health products that we really need are expensive. Countries are going to have to say, if I buy that vaccine, I can’t buy that drug, or I can put money into health services.”
The financial squeeze is not confined to countries. She said global health agencies such as those run by the United Nations, or bodies such as the Global Fund and the GAVI vaccine alliance were also looking at how to cut costs, pool resources and streamline.
She said: “At every level, people are starting to say it can’t be business as usual and we have to rethink at every single level how we do our business.”
International aid will not disappear, but she said increasingly Washington was doing country-to-country deals, rather than backing big global agencies and programmes.
African nations were also going to have to be better at making the case for support, she suggested.
While there was a clear humanitarian case for health aid, she said there was also a case that it had security and stability benefits for richer countries, including a reduction in migration.
She said: “There’s also a very real case about stabilising poor countries.
“Investment in development and investment in health is a stabiliser for countries. If countries can’t afford to do it adequately themselves, you are going to get destabilisation of economies and therefore of political stability.
“Are countries just going to close borders, or do you say that investment actually builds stability and therefore the need for immigration diminishes? Development aid and stability are incredibly important.”
The WHO this week launched new advice for countries dealing with the aid cuts.
Dr Tedros Adhanom Ghebreyesus, the director general, said: “Sudden and unplanned cuts to aid have hit many countries hard, costing lives and jeopardising hard-won health gains.
According to the African Energy Chamber’s 2025 report, African oil and gas firms face growing “off-field risks,” including regulatory uncertainty, security vulnerabilities, and tighter financial conditions—factors that complicate efforts to raise capital or pursue stock listings.
