Aid cuts are unravelling malaria progress - but we can reverse it

Folake Oni is Project Director at Acasus, a development consultancy that partners with governments to deliver bold health and education reforms that improve lives at scale.

Northern Nigeria’s Sokoto State once received tens of thousands of malaria tests and treatments each month. Today, deliveries have fallen dramatically, and warehouses are understocked. Health worker training has become irregular, and outbreak data is often not acted upon.

This is not because malaria has gone away, but because funding has subsided and the means to fight the disease are vanishing. Unfortunately, the situation in Sokoto is not isolated, and the consequences of donor retrenchment are being laid bare across Africa.

While malaria remains the third most deadly communicable disease for young children, steady progress has been made over recent decades as a direct result of sustained international investment.

In countries where the Global Fund invests, malaria deaths dropped by 29% between 2002 and 2023.

But global health leaders have long warned of the devastating consequences we might face if malaria funding is cut.

That warning is no longer theoretical, and we are watching the system falter in real time. Malaria progress is unwinding because delivery systems were never built to last.

Systemic shocks 

For years, substantial donor investment helped to drive major gains against malaria. But because much of that support was delivered through isolated donor-run programmes, rather than being integrated into national systems, it was left vulnerable to systemic shocks.

We are now seeing the unintended consequences play out in places such as Sokoto where the wider system lacked the embedded capacity to cope with the immediate withdrawal of donor funds.

This is also happening in Democratic Republic of Congo, with the challenges compounded by DRC’s greater donor dependence, fragmented partner landscape, and tougher delivery terrain.

Together, Nigeria and DRC account for roughly 40% of global malaria cases, meaning that any decline in delivery capacity reverberates far beyond their borders.

A slowdown in these two countries risks straining health systems already at their limits and jeopardising the collective ambition to end malaria for good.

Further donor retrenchment risks reversing hard-won gains and costing countless lives. Yet even amid the strain, positive corrective steps are already underway.

There are solutions

With the donor landscape changing, there is an opportunity to return control of the malaria programme to governments and foster more integrated, and therefore resilient, health systems.

This will be critical in securing the next 20 years of progress and can be achieved by incorporating malaria into reform structures, protecting supply chains, strengthening supervision, and improving data use.

In Sokoto – despite the setbacks caused by sudden donor retrenchment – early signs are encouraging. The government is already working to embed malaria delivery into the state’s pre-existing reform roadmap, strengthening country-ownership in the process.

This includes integrating malaria targets into the broader health performance framework, aligning partner workplans to avoid duplication and fragmentation, strengthening supervision by leveraging existing oversight structures, and resolving supply and data bottlenecks.

A similar approach has already improved accountability and clarity in maternal, newborn and child health – and malaria can benefit from the same discipline.

This isn’t about reinventing the wheel: it’s about using the reform engine that’s already working and making malaria part of it.

These reforms mirror the Nigeria government’s move toward a Sector Wide Approach (SWAp) to health – an effort that aims to align domestic and donor funding under one coordinated government-led framework. This replaces stand-alone projects with a more unified system that strengthens routine services, improves accountability, and allows progress in one area to reinforce gains in others.

Indeed, this is not limited to Sokoto or Nigeria, and we are already seeing some instances of donors shifting their approach away from standalone programmes across Africa.

Integrated systems introduced in the wake of recent cuts are improving efficiency, increasing delivery capacity, and building more sustainable health systems. These early examples offer a blueprint for others to follow.

The next 20 years of progress will depend on whether leaders choose to patch the cracks or rebuild the foundations.

In the turbulence created by recent cuts to official development assistance, we must reconsider our approach to development, rethink how health systems are designed, and ensure our malaria response is stronger, more resilient, and equipped for the challenges ahead.

Global health leaders and funders must step up to align investments with government-led strategies, support integrated systems, and prioritise long-term capacity over short-term results.