BY LINDA MUJURU

Natasha Gwashure watches as tuberculosis ravages her 1-year-old son Anashe’s frail body. He has been ill for more than a month. Gwashure struggles to accept the diagnosis. Her only solace is that they have access to free medication.

“Without this support, the chances of defaulting on treatment because of monetary constraints would have been significantly higher,” she says.

For years, the United States Agency for International Development has stood at the front lines of Zimbabwe’s TB battle, providing critical support for detection, treatment and prevention. But this lifeline now hangs in the balance as a US executive order threatens to undermine years of progress, potentially forcing patients, like Gwashure’s son, to abandon lifesaving treatments.

TB is a particularly vicious illness. Left untreated, the mortality rate is about 50%. It spreads easily, when an infected person coughs or sneezes, or even sings or speaks.

US President Donald Trump issued an executive order on Jan. 20, his first day in office, to suspend nearly all international aid. That includes USAID programs, which administer lifesaving health and other services around the world.

The recent funding freeze leaves a huge gap in Zimbabwe, where nearly all funding for TB treatment comes from international donors. Just 4% of that funding is domestic.

In 2024, USAID allocated 7 million United States dollars for TB treatment, screening and other necessary interventions in Zimbabwe. Despite decades of medical advances, tuberculosis still rampages across the globe. TB affected 10.8 million people in 2023; 1.3 million of those were children.

In Zimbabwe, the battle against TB reveals a health care system struggling to keep up. In 2021, just a little over half of an estimated 30,000 new infections received treatment.

The human cost of scrapping USAID programs is already evident here. Hospitals that once benefited from US-backed health programs now face mounting pressure as health workers supported by these initiatives have been forced to stop working.

A local nurse, who requested anonymity for fear of retribution, says it’s strained an already overextended health care system. She says that nurses previously funded by USAID-backed organizations, who primarily cared for patients with HIV, TB and other diseases, have stopped reporting to work. And what used to be handled by a full team of nurses is now falling on just a handful.

The freeze has begun dismantling Zimbabwe’s TB care network. New Start Centre — once a cornerstone facility, providing essential CD4 count testing, TB screening, diagnosis and counseling — has already gone dark, its doors closed as funding runs dry.

Noah Taruberekera, executive director of Population Solutions for Health, which has relied on USAID support for these centers, acknowledges the dire challenges now confronting patients and health care providers. He says he is not authorized to share additional details.

The funding crisis ripples beyond TB control, casting a shadow over HIV programs — a critical concern since TB preys particularly on those with HIV. While effective antiretroviral therapy can reduce the risk of developing TB, ongoing screening and preventive measures are vital for those with HIV.

HIV co-infection affects 68% of TB cases in Zimbabwe, but the national government covers only 7% of the required TB budget. International donors contribute 60%, leaving a significant funding gap.

Despite the mounting challenges, Dr. Fungai Kavenga, deputy director of TB and prevention control in the government’s Ministry of Health and Child Care, remains hopeful.

“If donor support diminishes, I am confident that the government of Zimbabwe can still ensure a steady supply of treatment for TB patients,” he says.

But Barbara Samu, a TB patient receiving care at Beatrice Road Infectious Diseases Hospital, underscores the critical role of donor support. She received free medication because USAID supported the hospital.

“I can’t even begin to imagine where I would find the money for treatment,” she says. “I would be facing a death sentence.”

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