After consuming an overwhelming amount of information on the USAID funding freeze situation, I feel overdosed, literally. This isn’t just because of the sheer number of organizations that will soon scramble to secure new funding sources but also because of what the White House press secretary has revealed about the matter! The situation is serious.
According to the workingwithUSAID.org portal, an estimated 65 organizations in Tanzania receive USAID funding annually. These include prime and subcontractors. These organizations address a wide range of issues, spanning Agriculture and Food Security, Democracy, Human Rights and Governance, Economic Growth and Trade, Education, Energy, Environment, Gender Equality and Youth, Global Health, Water and Crisis and Conflict response. This column focuses on raising awareness about substance addiction, a Global Health problem. It’s crucial to highlight how this funding freeze could impact addiction treatment in Tanzania and the broader consequences it may have.
Context
Addiction is a chronic disease that alters brain function, often leading individuals to act in ways that harm them. At its core, addiction is deeply tied to behaviour, and it results from the interplay between an individual’s biology (genetics) and their environment (ref. World Health Organization). There are many forms of addiction, as I discussed in my recent article A Different Dangerous however, the most prevalent is substance addiction consisting of alcohol and drugs such as cannabis, heroin, cocaine, valium, meth, fentanyl and other synthetic substances. The availability of these substances in Tanzania varies, but all carry different levels of risk and harm. Among the estimated 65 organizations in Tanzania funded by USAID, several support substance addiction treatment, particularly through Medical Assisted Therapy (MAT) clinics that provide Methadone, which is essential in treating heroin addiction. Heroin is a drug that remains widely accessible in Tanzania, second only to cannabis and alcohol. However, unlike cannabis and alcohol, heroin is significantly more dangerous due to its high potential for addiction, overdose, and severe health complications.
Heroin use is often through injection primarily because it delivers a stronger, faster and more intense ‘high’ compared to other methods like snorting or smoking. Injecting the drug with needles, often shared, is a cheaper option for users with financial constraints, who are many. A heroin overdose can cause fatal respiratory failure, and its injection use has contributed to worsening public health challenges.
The Backdrop
Before 2011, when the first MAT clinic was established at Muhimbili National Hospital, the first of its kind in sub-Saharan Africa and funded by USAID funding to provide heroin addiction treatment, Tanzania was grappling with a heroin epidemic (ref. Drug Control Enforcement Authority reports). Tanzania was alleged to have been a heroin trafficking hub, with drugs moving from Afghanistan via the Indian Ocean, making heroin prominently available in Dar es Salaam, Tanga, and Zanzibar. This situation fueled rising HIV/AIDS cases and Hepatitis C infection rates among high-risk population groups such as People Who Inject Drugs (PWID), Sex Workers and Youth.
To date, Tanzania has 18 MAT clinics that integrate heroin addiction treatment with HIV care. On a daily basis, the clinics service more than 2000 individuals. The treatment duration ranges from two to six years. The full networks of MAT clinics operate under an integrated health service model delivered in public health facilities, referral hospitals and specialized addiction treatment centres across the country. In collaboration with USAID support, the Global Fund provided Tshs 6.7 billion to Tanzania for an HIV/AIDS prevention project that includes the establishment of MAT clinics in Shinyanga, Kahama, Geita, and Kilimanjaro regions (ref. Drug Control and Enforcement Agency 2023 annual report). Unfortunately, the agency’s 2024 annual report does not provide any update on the progress of the development of the clinics.
Impact
The USAID funding freeze would directly affect MAT clinic operations, and several key challenges could arise. A funding freeze could lead to service disruptions or clinic closures, leaving thousands of individuals (approximately 18,000) without access to the treatment they need. Without continued access to methadone and the support services offered through MAT clinics, individuals who rely on the treatment might face a higher risk of relapse.
This could lead to an increase in heroin use, overdose deaths and associated public health issues like the spread of HIV and Hepatitis C. While the Tanzanian government plays a role in funding these programs, it may not be able to fully absorb the financial burden left by the absence of USAID funding support. This could result in reduced coverage or delays in expanding treatment access to new regions, scaling up access to treatment for heroin addiction. Since MAT clinics often integrate heroin addiction treatment with HIV care, a funding freeze could undermine efforts to prevent and manage HIV/AIDS. This would disrupt progress made in controlling HIV transmission, particularly in populations at high risk.
Optimism
Winnie Byanyima, the Executive Director of UNAIDS, views the funding freeze as a missed opportunity. In a recent interview with CNN, she stated that USAID funding to Africa should be seen as a mutually beneficial relationship. She emphasized, “The aid connects the US to markets in Africa, and this benefits American companies and creates jobs for Americans.” This optimistic thinking could foster a renewed perspective on the value of international aid, encouraging stakeholders to recognize its potential to drive both global development and domestic economic growth. But is it too late? With the funding freeze already in motion, many are left wondering whether this decision is final or if it is a political move, a bluff by President Trump to renegotiate priorities or assert influence in global affairs. However, suppose it is a long-term policy shift. In that case, the Tanzanian government will need to collaborate with organizations with a vested interest in health to fill the funding gaps and innovate to sustain essential programs.
Meanwhile, the government should highlight the proven impact of MAT programs on public health and social stability. Develop policies to incentivize local investment in addiction treatment and strengthen awareness and advocacy on the disease of addiction.
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Read more about The Future of Healthcare: Can Tanzania Achieve What Even the U.S. Struggles With?