A pregnant woman brought her child to a health clinic in Farchana, Chad. They are seated under a mosquito net.
Claire Harbage / NPR
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tilting legend
Claire Harbage / NPR
During an unusually strong rainy period in Chad last year at the end of the summer and early fall, some parts of the country were so bad flooded that the houses began to collapse. Yewande Odia directs the United Nations Population Fund (Unfpa) Office in Chad, who is responsible for reproductive and maternal health. She remembers having been informed of a pregnant woman who missed her flooded house and shortly after, she entered work.
“Babies do not tell you what time they arrive,” explains Odia. “And it is stuck in horrible, dirty and stinking wastewater and it gives birth.”
She fled her house and managed to go to a higher and drier place where one of the 300 midwives that Odia’s office employs had a tent. The midwife had something called a “reproductive health kit”. It is filled with medicines and equipment which, according to Odia, “allows us in the middle of nowhere to give safe, clean and health delivery services”.
The result was that this woman – who a few moments earlier was at risk of potentially fatal complications if she had delivered in an impure setting – was able to give birth safely.
“It is a critical rescue work that (the midwives) do,” explains Odia.
This work, partly funded by the American Agency for International Development, is now threatened as a thousands of programs that the US State Department has declared that it cancels. The challenge faced by countries like Chad which are affected by the reductions of the USAID consists in determining whether they can continue part of this rescue work.
Midwives mean that more women and babies survive
Thousands of women die during childbirth each year in Chad. The World Health Organization and the United Nations say that the country has the Second highest maternal mortality rate in the world. This is largely due to the fragile health system of Chad and is aggravated by the many Chadais women who do not have access to a safe and sterile place to deliver. In addition to that, the country now houses hundreds of thousands of refugees, most of whom are women and children, who have fled violence in neighboring Sudan.
Midwives play an essential role in dropping pregnant women in a health center or a mobile clinic. “When they give birth at home,” explains the midwife Ernestine Nedjoumbaye, “there are more risk of infections and bleeding, and more women die in delivery.” But in a health framework, mothers and their babies generally survive.
Last year, Odia said that American funds provided prenatal care to 100,000 pregnant women in Chad and safe deliveries at 26,000.
Now the Secretary of State Marco Rubio has announcement The official cancellation of 5,200 USAID contracts worldwide, representing 83% of the agency’s programs. Which includes program that Odia had to pay about half of her midwives.
“Losing American funding is huge,” she said. “The lack of midwives to support these women, supporting these children means that women will die in delivery. This is the immediate impact.”
Odia says she is actively looking for alternative sources of funding to manage the deficit. But she expects her to make difficult choices soon. The money to pay the wages of the midwives is exhausted at the end of March.
“We will have to prioritize,” explains Odia. “Some things will have to go and certain things that we will have to do less.”
A crisis as great as a continent
The midwives program in Chad is only one of the hundreds of programs across Africa that have been affected by the deep and unprecedented cuts for foreign aid in the United States. There are HIV treatment programs that have closed, testing of tuberculosis that have stopped and food assistance for children with malnutrition that have been interrupted
Before Trump started his second term, programs based in sub-Saharan Africa received more than a quarter of the foreign aid budget in the United States, equivalent to some $ 5.7 billion in 2024 For health programs in particular.
Last week, in Kigali, Rwanda, at the International Conference of Africa of Health, this new reality of a world with only a net of assistance in the United States was an urgent subject of discussion.
“The primordial message is that we should never waste a crisis,” said Dr. Githinji Gitahi who runs Amref Health AfricaAn African NGO on the continent and the conference organizer.
Gitahi says that Africans have been talking about the need for self -sufficiency for years, but now there is a feeling of urgency to achieve it – and to rethink the way money is spent on health systems. “It is not a question of removing the lives saved by the USAID,” he says. But historically, a lot of stranger help Speed on global health (from government and philanthropic sources) has targeted specific diseases such as malaria, polio, tuberculosis and HIV. Gitahi maintains that previous funding has not considered taking care of several diseases or full sweeping health problems in a particular place.
He says that it is time to prioritize prevention and investment in primary health care and public health. There have already been workshops in Kenya, Uganda and Zambia to talk about such a change, explains Gitahi. During these meetings, government representatives discuss how to manage funding gaps by modifying projects or completely abandoning them. Part of this effort was already underway, says Gitahi, because a fundamental change at USAID has been planned for some time.
“He is therefore catastrophic, unprecedented but not unexpected,” explains Gitahi. “If there was really a transition plan, then we would not say that it is a bad thing. What is a bad thing, it is actually sudden and unforeseen nature.”
This is what left so many governments and health care providers in Africa and elsewhere. Some have called upon the USAID evisceration.
Dr Jean KaseyaDirector General of Africa CDC, agrees with Gitahi on the importance of seizing this moment.
“You have to find a way to survive,” he said. “Yes, we suffer, but it is also an opportunity for us to rethink how African countries must take the lead and the property of their health program.”
To do this, Kaseya says that these nations will have to find a way to contribute more of their own funds to support programs and staff which, until recently, mainly rely on external funding.
For example, Nigeria has already hired an additional $ 200 million in its health budget.
“This is the kind of movement we want to see in Africa,” he said. “We do not say that we cover the gap, but we attenuate the impact of the cut.”
For Ernestine Nedjoumbaye in Chad, the financing cuts are at a time when she and her midwifery colleagues still need help for the bases: birth beds, medicines, clothes – while doing and others do not know if they will have a job in a few weeks. Nedjoumbaye says he ends up with a dominant emotion.
“We are worried.”