South Africa — April 2026 — When World Health Organization declared this year’s World Health Day theme — “Together for health. Stand with science.” — it landed with particular urgency in South Africa.
Just over a year ago, the country faced a seismic shock to its healthcare system.
On 26 February 2025, nearly 90% of global projects administered by the United States Agency for International Development under the PEPFAR programme were terminated. The impact was immediate, widespread, and deeply destabilising — not just for South Africa, but across the global HIV response.
For South Africa, however, the consequences cut especially deep.
A System Under Strain
For more than two decades, PEPFAR had been a cornerstone of the country’s fight against HIV — helping drive down new infections by 67% and supporting one of the most extensive treatment programmes in the world.
By February 2025, PEPFAR funding accounted for R7.9 billion, or 17% of South Africa’s R46.8 billion HIV/AIDS response.
Its sudden withdrawal left a vacuum.
- Funding to 70% of healthcare facilities stopped
- Clinics closed or scaled back operations
- HIV prevention and gender-based violence programmes were terminated
- Research and clinical trials stalled
- More than 8,000 people lost their jobs
What had taken decades to build was, in many places, abruptly placed at risk.
Resilience in Action
Yet, amid the disruption, South Africa’s response revealed something equally powerful: resilience.
Aaron Motsoaledi reassured the nation that 74% of the HIV response was already domestically funded, with 90% of antiretroviral treatment (ART) financed by government. The National Treasury stepped in with an additional R753 million to support a national treatment awareness campaign.
At the same time, global and local partners mobilised rapidly:
- Bill & Melinda Gates Foundation and Wellcome Trust each pledged R100 million toward research — contingent on matched government funding
- UNAIDS coordinated advocacy and technical support
- Elma Foundation issued emergency bridging grants to NGOs
- Doctors Without Borders sustained critical HIV and TB services
- Global Fund maintained its 7% HIV contribution and explored emergency funding mechanisms
In a notable development, the Global Fund also supported the delivery of 37,920 doses of Lenacapavir — an innovative preventative HIV treatment — signalling a broader shift toward more accessible, patient-centred care.
The Gaps That Remain
Despite these efforts, the strain is still visible.
Healthcare workers and NGO staff are facing intense burnout, while staffing shortages continue to challenge service delivery. Vulnerable groups — including LGBTQIA+ communities and sex workers — have, in many cases, lost access to specialised, stigma-free care.
The system is holding — but it is stretched.
A Turning Point: From Dependence to Self-Sufficiency
The funding cuts have forced a critical reckoning.
South Africa is now navigating a transition from external dependence to internal resilience — shifting away from a charity-based model toward one rooted in self-sufficiency, collaboration, and strategic investment.
At the centre of this shift is the growing role of social investment.
The Role of Social Investment in Rebuilding Healthcare
1. Increasing Corporate Investment
South Africa has long demonstrated strength in corporate social investment, yet the healthcare sector remains underfunded by private players.
In 2025:
- Only 2% of the HIV response was funded by the private sector
- While corporate participation rose from 36% to 46%, overall investment levels remain insufficient
Without increased private sector involvement, the risk of rising infections and mortality looms large. Sustained corporate investment is not optional — it is essential to closing the gaps left by declining global funding.
2. Strengthening Community-Based Systems
Local organisations remain the backbone of healthcare delivery, particularly in underserved communities.
Initiatives like the Discovery Fund Community Health Programme demonstrate what is possible when local capacity is prioritised. Through partnerships, organisations such as Hlokomela have expanded their reach and developed funding models that extend beyond donor reliance.
Localisation is not just effective — it is sustainable.
3. Driving Cross-Sector Collaboration
In a fragmented funding environment, collaboration is no longer a strategy — it is a necessity.
Public-private partnerships can:
- Prevent duplication of efforts
- Maximise limited resources
- Deliver scalable, long-term impact
Calls for a “South African Solidarity Fund Against HIV”, inspired by the COVID-19 Solidarity Fund, reflect a growing recognition that coordinated action is the most effective path forward.
Rebuilding with Purpose
One year after the funding cuts, South Africa finds itself at a defining crossroads.
The shock exposed the fragility of a system reliant on foreign aid — but it also revealed the strength of collective action. Government, civil society, and private sector players have stepped forward, not just to respond, but to rethink.
The path ahead is clear, even if it is complex:
- Strategic investment
- Localised solutions
- Deep collaboration across sectors
This is no longer just about recovery.
It is about transformation.
Because building a resilient healthcare system is not simply about filling gaps — it is about ensuring those gaps never appear again.
