What USAID’s Dismantling Looks Like on the Ground in Africa
Locals in Malawi and Kenya who worked with the agency face stalled development, cancelled programming, and shortages of lifesaving supplies: ‘I think we will forget America is even there.’
JOHN IS OLD ENOUGH TO REMEMBER the dark days when AIDS ravaged his country and his family. Living in Malawi, he has seen up close the difference made by the lifesaving work of PEPFAR, which is administered in large part through the U.S. Agency for International Development. For him, the American government has been a steady, sustaining presence for many years through a multiplicity of programs under the umbrella of USAID. He had believed it was a relationship of mutual benefit to Malawi and America.
Now, in the wake of the Trump administration’s dismantling of USAID, he wonders what will happen to his country. He worries the deadly past might revisit. “We are so scared we might see people dying like that again,” he told me on the phone this week.
John’s work brings him into contact with many USAID employees and projects in Malawi.1 In particular, he knows that USAID brings badly needed development and services to rural areas, which in Malawi, as in many other African countries, are chronically underserved by their governments. Wealth, power, and influence tend to be concentrated in cities.
Specifically, he describes to me the importance of USAID educational programming for rural children. The agency has built rural schools with science labs and libraries, both rare in those settings. John thinks support for rural girls’ education is especially vital in a country where many families don’t prioritize educating their daughters. He says USAID programming has ensured girls don’t miss school during their periods because they lack feminine products, a common problem for girls in Africa.
“USAID had focused on the girl child,” John says. “They focused on so many problems facing girls in the rural areas.”
But then, the cuts came. “The students in the villages may not know what is happening, but they are affected.” Over the last few weeks, John has witnessed the sheer chaos of USAID’s dismantling in one of the world’s most aid-dependent countries. The U.S. government provided $350 million in aid across multiple sectors last year, equivalent to 13 percent of Malawi’s national budget. Its permanent cessation would be not only a humanitarian catastrophe but an economic one.
John’s own employment and that of many Malawians he knows is in danger. He tells me people report to work each day not knowing if they still have a job. “Everyone looks sad because no one knows what will happen,” he says. “We may pretend we are okay, but we are not okay.”
Donald Trump and Elon Musk have repeatedly given as the rationale for gutting USAID the prevention of waste, fraud, and abuse. But John expects Malawi will see—is already seeing—more waste and corruption. He mentions two educational projects that have stopped midstream, leaving half-finished buildings standing idle, construction materials unused, and boxes of books and computer tablets unattended. He fears that without USAID administration, these supplies will vanish into the ether of the corruption that is all too common in Africa to the benefit of the politically well connected. If they haven’t already.
“Where is the cement [and other supplies]? Still there? Stolen? Who knows?” he said.
SIMILAR CONCERNS WERE RAISED by a Kenyan friend, Jane, a home health nurse employed by her county government.2 County governments manage Kenya’s public health system, which distributes antiretrovirals and other medications from PEPFAR.
Kenya is another country that receives large amounts of USAID programming, based not just on need but on its status as a stable, democratic, and economically dynamic nation and the regional base for multiple NGOs that operate on the continent. In 2024, USAID invested $359 million in Kenya.
Jane’s workdays begin by going to a government dispensary to pick up food packets and antiretroviral and tuberculosis drugs before visiting the homebound. She says her job has always been made difficult by corruption and mismanagement in the county government. Sometimes there is no food available, and she has often dipped into her own scarce funds to provide for her patients.
“When you go see a patient and they haven’t food, what do you do?” she told me via text. “We even seek help from churches.”
But she’s always had access to needed drugs—until the last few weeks. She doesn’t know with certainty as to why she can no longer reliably receive them; according to a U.N. report, Kenya should have enough antiretroviral drugs on hand to cover the need for another few months.
But Jane already sees a connection between the shortages she’s experiencing and the chaos surrounding USAID. She suspects that wealthy and well-connected people are hoarding them in anticipation of them running out.
“We will lose a lot of patients that we’re not supposed to,” she messaged me.
I ASKED JOHN ABOUT ANOTHER Trump administration talking point regarding the dismantling of USAID, one I’ve heard in my own evangelical circles: that USAID aggressively promotes an LBGTQ “agenda” through its overseas aid.
He seemed completely befuddled. “I haven’t seen anything like that,” he said. “You know, here in Malawi, most people are not comfortable with this issue, so if there is money going to that, it must be a very small amount.”
In the educational sector, which John is most familiar with, the only thing he’s seen that might be remotely related is a book that teaches children tolerance for those with HIV. He does not consider those books a problem. “They are trying to promote empathy and coexisting,” he said.
There is USAID programming aimed at supporting LGBTQ communities in Africa, but understanding the context of extreme discrimination, far worse than what you see in the United States, is essential, as it is for assessing the kind of gender-based programming John told me about. What many Americans might consider “DEI” or an “LGBTQ agenda” in Africa might be advocating and providing for the basic human rights of people who face severe marginalization, legal persecution, and/or violence, including girls, women, LGBTQ people, and the disabled. In some countries, USAID-funded clinics might be the only ones that offer any kind of medical care to LGBTQ people.
Efforts to combat and treat HIV disproportionately help women, as the spread of HIV is closely tied to gender-based violence, which almost half of African women experience, a rate almost unseen elsewhere in the world. There’s a danger that even if most USAID programming is resumed, projects like the ones John told me about aimed at girls might be labeled “DEI” and permanently shuttered. Any programming to assist LGBTQ communities seems a dead letter.
I asked John about the broader discussion over aid and dependency, which is a vigorous debate in Africa itself. Critics argue that aid disincentivizes better governance and point out the meager return in economic growth. Even when dispersed through NGOs, they say, foreign aid provides services for which governments can take credit, or at least through which they can avoid blame and accountability from their citizens.
“We agree we cannot continue to be beggars,” John says. “But the people who feel the most pain [from aid cuts] are the innocent. The politicians will find a way, but not the innocent child in the village.” Certainly a wholesale, overnight cessation does nothing but endanger those who are already vulnerable.
John is also bewildered as to why America would see an advantage to itself in ending USAID. “USAID made America to be everywhere. Now it’s like the lights are turned off,” he says. “I think we will forget America is even there. Does [Trump] not know the consequences of this?”
John is not his real name, and he has asked me not to identify where he works for fear he will lose his job.
Jane is not her real name, either; she, too, fears losing her job.
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