On January 20, President Donald Trump sanctioned a 90-day halt on foreign aid, a decision that affected all financial support distributed by the United States Agency for International Development (USAID). The decision has had a profound impact and generated widespread alarm worldwide, none more so than in Africa.

In 2023, USAID had allocated a total of $12.1bn to countries in sub-Saharan Africa, with the objective of improving healthcare, delivering food assistance, and promoting security. Critically, USAID distributes funds for the US President’s Emergency Plan for AIDS Relief (PEPFAR), the global fund to fight AIDS.

The 90-day funding freeze has caused considerable distress across Africa, as millions of people dependent on services supported by the US government now face a daunting and uncertain future.

On February 6, in a comprehensive briefing to Parliament, South Africa’s Health Minister Aaron Motsoaledi outlined the widespread effect of PEPFAR on the country’s HIV response. He revealed that PEPFAR contributes 17 percent of the total funding, which surpasses 7.5 billion rand ($407m), and supports various programmes for the 7.8 million South Africans living with HIV/AIDS, the highest figure in the world. He also pointed out that more than 15,000 healthcare personnel, including nurses, pharmacists, and directors, are remunerated through PEPFAR.

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South Africa’s HIV/AIDS response is certainly in a precarious state now, subject to the Trump administration’s whimsical, aggressive and vindictive political agenda. Nevertheless, the truth is that this “USAID crisis” might have been averted if the Southern African nation had assumed responsibility for its socioeconomic issues in the first place, instead of delegating them to a foreign nation that has now become hostile.

As the most advanced, diversified, and productive economy in Africa, South Africa should not have relied excessively on PEPFAR, particularly to the extent that USAID funding becomes a fundamental component of its health budget.

This dependence on USAID funding is actually a symptom of a more critical problem within the healthcare system and the government as a whole: widespread, high-level mismanagement and corruption. Each year, due to gross maladministration and unchecked corruption, South Africa loses billions of rand, funds that are essential for addressing vital service delivery needs, including those related to HIV/AIDS healthcare.

Tembisa Provincial Tertiary Hospital (TPTH), a public facility under the auspices of the Gauteng Department of Health, serves as a prominent example of the extensive deprivation caused by corrupt practices. In August 2024, the Special Investigating Unit (SIU), an independent agency of the South African government responsible for investigating malfeasance in state-owned enterprises (SOEs), reported that corruption networks had caused financial losses exceeding 3 billion rand at the institution, with evidence pointing to the involvement of senior hospital staff in these illicit operations.

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For several years now, the hospital has struggled to meet its service delivery obligations and faced substantial resource limitations, including critical shortages of specialised staff and equipment, which have, in certain instances, resulted in preventable deaths.

The overspending, wasteful expenditure, and fraud seen at TPTH is, unfortunately, representative of a widespread trend.

Last year, the Auditor General of South Africa (AGSA) found that the Gauteng provincial government – just one of the nine provincial authorities in South Africa – incurred 9.879 billion rand in irregular expenditure in the 2023-24 financial year. Moreover, irregular expenditure in 2024 reached 50.65 billion rand across 38 government departments, while 27 SOEs recorded a total of 69.35 billion rand.

When contextualised, such high figures demonstrate that the $7.5bn in yearly assistance from the US to South Africa is minor in comparison to the substantial billions that are lost as a result of fraud, mismanagement, and corruption.

By fostering a culture of clean and accountable governance, South Africa can substantially lessen or wholly eliminate its problematic dependency on assistance from the US in healthcare and beyond. A similar situation exists in Kenya, where the US has committed to providing $207m in assistance for the year 2024.

The suspension of aid from Washington has, in one instance, endangered the health of HIV-positive orphans residing at Nyumbani Children’s Home in Nairobi. Between 1999 and 2023, USAID and PEPFAR contributed more than $16m to the orphanage, allowing it to support approximately 50,000 children through its rescue centre and two outreach initiatives, Lea Toto and Nyumbani Village.

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Without the requisite funding in place, thousands of vulnerable children could fall seriously ill or die. Many more youths might be deprived of vital HIV/AIDS counselling services.

Kenya, like South Africa, has the opportunity to extricate itself from the grip of the US aid industry and to support orphanages such as Nyumbani Children’s Home through its own funding. This, however, can occur only if the Kenyan government adopts a strong position against corruption, re-evaluates government expenditure, and focuses on enhancing effective governance

According to the findings of the Ethics and Anti-Corruption Commission, corruption is costing an estimated 608 billion Kenyan shillings annually ($4.7bn) to Kenya, equivalent to 7.8 percent of its gross domestic product (GDP).

Nairobi has a responsibility to care for its most disadvantaged citizens. The children of Nyumbani Children’s Home should not have to rely on Washington for HIV/AIDS services. The primary reason these orphans are in such a challenging situation is the indifference of Kenya’s self-serving politicians towards their wellbeing and the overall welfare of the nation.

About 37.5 percent of the Kenyan population is regarded as multidimensionally poor, signifying they experience deprivation in multiple facets of life, including health, education, and living standards, as measured by the Global Multidimensional Poverty Index (MPI). However, Kenyan President William Ruto, on March 16, 2023, appointed the most bloated administration in the East African nation’s recent history.

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Ruto, a veteran politician, was also ranked second in the Organized Crime and Corruption Reporting Project’s (OCCRP) 2024 Corrupt Person of the Year award, after Syria’s former strongman Bashar al-Assad. This award, embarrassingly, honours leaders who are believed to be actively promoting global organised crime and corruption.

Meanwhile, in West Africa, Nigeria presents an even more compelling case than Kenya.

On February 14, Nigeria approved a funding allocation of $200m to mitigate an anticipated deficit in 2025, resulting from cuts in US health aid. In 2023, the US provided more than $600m in health support to Nigeria, accounting for over 21 percent of the nation’s annual health budget, primarily towards malaria prevention, HIV eradication, and vaccine distribution.

Nonetheless, many of Nigeria’s socioeconomic challenges are largely self-imposed. It must strive for greater self-sufficiency rather than relying on US assistance. The country has vast economic potential – a potential that cannot be fulfilled due to, among other things, significant corruption and waste. Nigeria loses approximately $18bn each year to financial misconduct and corrupt procurement processes. Corruption, according to a study compiled by PricewaterhouseCoopers (PwC) Nigeria in 2016, may well reach 37 percent of the country’s GDP by 2030.

The report identified three main ramifications of corruption, notably a decline in governance effectiveness, which is primarily attributed to a reduced tax base and the ineffective distribution of government resources.

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Nigeria – which experienced a wave of #EndBadGovernance protests in 2024 – certainly possesses the resources and capabilities to liberate itself from US aid permanently. To achieve this, the country must prioritise the implementation of strong, progressive, and principled governance.

From Zimbabwe to Uganda and Tanzania, gaining independence from the so-called benevolence of the West must be seen as a crucial element of Africa’s postcolonial success.

The painful and often humiliating contradiction of Western countries providing billions in aid to inefficient and sleazy African governments that preside over resource-rich countries should not remain the norm.

African nations must immediately shoulder full and unqualified responsibility for the persistent challenges faced by so many of their underprivileged communities.

The lives of everyday Africans should not be contingent upon US aid and the whims of Western politicians. Africa can and must look after its people.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.