by Deacon April Trout

I gave a friend some money today so that he could get out of the hospital. In Tanzania, they won’t discharge you until you pay the bill in full.

It wasn’t a huge amount for me – about $250 – but for most Tanzanians, that 650,000 shillings is a big chunk out of their budget, more than most of them make in a month. Many Tanzanians have basic health insurance through the National Health Insurance Fund or the Community Health Fund which would cover some of the hospital costs – not IVs and IV medicines, but at least the bed, nursing care, and doctor’s fees. Tragically, those government health insurance programs have been canceled: the government funded them with USAID health care dollars, which have now been cut. Medications for chronic conditions such as hypertension and diabetes, treatment for malaria, tuberculosis, intestinal parasites, and UTIs will be also unaffordable for many people. Eventually this will lead to increased morbidity and mortality throughout the country.

I decided to write about this because some of my LSS colleagues have been asking how Konde Diocese has been affected by the recent slashing of US global assistance funding. In the past two weeks or so I have been talking to a lot of people both within and outside the Diocese to get answers to this question. What I have found is this:

There are no projects identified as USAID-funded within the Konde Diocese. According to Daudi Msseemmaa, ELCA East Africa Desk Representative, there were only two USAID-funded projects within the ELCT, both involving health care, both in northern dioceses. But he also told me that, according to a trustworthy global news source, Tanzania’s health sector received $530 million in US government funding in 2023. This money goes to multiple programs throughout the country that provide health care services of one kind or another.

I contacted Dr. Lee, Konde Medical Director, to ask whether Itete and/or Matema Hospitals receive any USAID funding. In fact they do, indirectly. Like numerous other private hospitals in Tanzania, Itete and Matema are part of the USAID-funded PEPFAR program (the US President’s Emergency Plan for AIDS Relief), which provided testing, medications, education, and salaries for three staff members (a nurse, a lab technician, and an IT worker) for participating hospitals. This program has also lost its funding. The Tanzanian government has announced that it will continue to provide free HIV medication, but the rest of the program costs, including the staff salaries (about $750 per month per Dr. Lee) will now have to be covered by the hospitals. Dr. Lee stated that there about 1000 HIV patients at Itete Hospital and a larger number at Matema. To continue providing the HIV outreach services they have been offering for years, Itete and Matema will have to make cuts somewhere else in their budgets.

There are many NGOs located in Mbeya, including the Wildlife Conservation Society and Catholic Relief Services. I cannot say that I know what work these organizations do in this part of Tanzania, but bothof them are recipients of USAID funding. Their work may not directly affect our fellow Lutherans, but it’s a sure bet that people lost their jobs – and some of those people might be Lutheran. Or some Lutherans might have been participants in or recipients of their work. The cuts in USAID funding reach far and wide, in places where we don’t even think about them.

The recent withdraw of the United States from the World Health Organization has impacted global health efforts, including vaccine distribution and disease prevention, which not only provides childhood vaccines worldwide but also partners with other countries to identify and respond to emergencies and stop disease threats such as COVID and Ebola from spreading across borders. They also do a tremendous amount of health care research. The US contributed $1.284 billion to WHO during the 2022-2023 biennium, which made up about 15-20% of WHO’s budget. According to the Johns Hopkins Bloomberg School of Public Health, the withdrawal of the US from WHO and the resultant loss of funding “is likely to cause enormous strain on the global community. Ultimately the global community, including Americans, will suffer and have poorer health.”

Recent changes in US funding have created challenges for health care in the Konde Diocese. Other arenas outside of health care, such as clean water and farming projects, may have been affected as well; I haven’t researched these. Foreign aid decisions are complex; however, these changes highlight how interconnected our global community is—when funding shifts, lives are impacted.

Lord, have mercy. Let us pray for our Lutheran brothers and sisters in Konde. Namshukuru Mungu kwa kuwa pamoja nasi. (I thank God for being with us.)