The unintended fallout of USAID Cuts: Erosion of trust in health systems
Lots of news has been reported in the past few days about the alarming consequences of staff layoffs at USAID and the life and death consequences for people globally from the freeze of foreign health and humanitarian aid.
In Uganda, the impact is unfolding in real-time, and it is devastating—not just financially but in the erosion of trust in healthcare itself.
US development aid has been so important to Uganda’s healthcare system that the USAID funding freeze has forced Uganda’s Ministry of Health to reassure its citizens that hospitals will remain open. The anxiety runs so deep that the government had to publicly affirm that its own health system is still functioning.
And at the same time, a nurse at one of Uganda’s top medical institutions died of Ebola after first seeking care from a traditional healer.
This is not just a tragic personal story. It is a warning sign of the unintended, cascading effects of aid cuts and how they collide with local perceptions and trust of the healthcare system and the government. When a healthcare system loses funding, it does not simply lose medicines, doctors, or facilities. It loses something more fragile and harder to restore: public trust.
When health workers stop trusting the system, what happens next?
Infodemic management, RCCE and humanitarian response expert Obol Sunday Jimmy notes that the late nurse was a trained medical professional working at the country’s leading hospital. And yet, when he fell ill, he did not trust the system he worked for.
His hesitation—his decision to turn to a traditional healer instead—raises a deeply troubling question: If healthcare workers themselves do not have confidence in the system, why should ordinary citizens?
And now, misinformation is spreading like wildfire. On WhatsApp and social media, some Ugandans claim that the Ministry of Health fabricated the Ebola outbreak as a ploy to secure emergency funds after the USAID cut. The logic is cynical but predictable: If people see their government struggling to keep the system afloat, they become skeptical of any crisis that suddenly demands resources.
This is how trust collapses—not in a single moment, but in layers. First, health workers begin to doubt the system. Then, the public watches them retreat. And finally, conspiracy theories rush in to fill the void.
Aid cuts are never just about money
In high-income countries, foreign aid is often framed as an act of generosity, a charitable contribution that can be withdrawn at will. But in reality, aid is not a bonus, but a pillar of stability that has been woven into the fabric of many national health systems.
USAID funds have supported disease surveillance, maternal health programs, HIV treatment, vaccine distribution, and health worker training. When that support disappears overnight, it is not just a budget shortfall—it is a fracture in the entire health infrastructure.
And that fracture is more than logistical. It is psychological.
When donor funding disappears, it signals instability. And instability breeds doubt. Doubt, in turn, breeds mistrust. And in healthcare, trust is everything.
The ripple effects of mistrust are long-term
Uganda has battled Ebola before, and it has built capacity over years to contain outbreaks. But what happens when an outbreak occurs in a moment of financial and institutional uncertainty?
🔸 Misinformation thrives—If people suspect the government is fabricating outbreaks for financial gain, public health measures become harder to enforce.
🔸 Vaccine hesitancy increases—Uganda has successfully rolled out vaccines for Ebola and other diseases in past outbreaks. But if citizens do not trust the motives of health authorities, even lifesaving interventions may be rejected.
🔸 Future outbreaks become deadlier—When people delay seeking care or turn to unregulated alternatives because they don’t have access to services or treatment, diseases spread faster and kill more people.
This is not just about Uganda. Other countries (see Malawi, Zambia, Africa CDC) have been forced to reassure their citizens that their national health services are still functioning and will be funded domestically.
It is a warning for any country where donor funding plays a key role in healthcare delivery. When aid is abruptly withdrawn, the damage is not just in statistics. It is in narratives, in perceptions, in how people feel about the institutions meant to protect them.
A wake-up call for the US and the global health community
The US government may frame its aid freeze as a financial decision, but it is, in reality, a decision about human lives.
Health systems do not exist in isolation. They are ecosystems of trust, and trust does not recover overnight.
If the US wants to be a global health leader, it must recognize that cutting off funding does not just save American taxpayers money—it destabilizes the very systems meant to prevent the next pandemic.
And when the next global health crisis emerges, the cost of mistrust will not be paid by Uganda alone. It will be paid by all of us, including Americans.