Two significant executive orders from the new United States administration are reverberating through Lesotho’s healthcare landscape, sparking both concern and swift strategic planning.
The directives, which affect the World Health Organisation (WHO) and U.S. global health initiatives, have prompted the Ministry of Health to evaluate the potential fallout and craft response strategies.
Health Minister, Selibe Mochoboroane, highlighted that one order directly impacts Lesotho due to the U.S. withdrawal from WHO. The U.S., a major contributor with about 18 percent of WHO’s budget, has left Lesotho worried about future health funding.
“Last year, WHO funded Lesotho’s health sector with M30 million. While assurances have been made that WHO will continue to support Lesotho and other nations, the extent of future funding remains unclear,” Mochoboroane stated.
Another order has put a freeze on U.S. support via programs like PEPFAR and the CDC, which are crucial for managing HIV/AIDS and tuberculosis in the country.
“These programs fund around 1,500 healthcare workers through partner organisations, along with providing essential testing materials,” Mochoboroane noted.
In response, Prime Minister Ntsokoane Matekane, the Chairperson of the Social Cluster, and other key stakeholders launched a comprehensive review to mitigate any disruptions in healthcare services.
A primary concern was ensuring uninterrupted access to antiretroviral (ARV) medication for approximately 240,000 Basotho on treatment.
“The review revealed that the government funds 73 percent of ARV needs, with the Global Fund covering the remaining 27 percent, securing our medication supply. Additionally, we have sufficient laboratory supplies for the next five to eight months,” the minister explained.
Addressing the potential salary disruptions for healthcare workers, Mochoboroane revealed that financial assessments indicate a need for M27 million to maintain current staffing levels. A task force has been set up to devise both short-term and long-term solutions.
“The government is committed to maintaining service quality, potentially by directly employing these workers if necessary,” he added.
However, Mochoboroane also shared some relief, stating that PEPFAR has obtained a waiver, enabling staff involved in HIV/AIDS and TB programs to resume their roles in treatment, testing, counseling, and lab work.
This week, contract addendums are being finalised to ensure these workers can return to their posts without delay.
United States’ president Donald Trump’s decision to sign the executive orders affecting U.S. relations with WHO and U.S. global health programs was motivated by several factors, reflecting both his policy priorities and ideological stances.
Trump’s executive order to withdraw the U.S. from WHO cites the organisation’s alleged mishandling of the COVID-19 pandemic that arose out of Wuhan, China. He has criticised the organisation for its response to the outbreak, accusing it of being too slow and not independent from Chinese influence.
Trump has also long argued that the U.S. was disproportionately funding the WHO. The executive order specifically mentions “unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments.”
He highlighted the disparity between U.S. contributions and those of China, given their respective population sizes.
The order also claims that WHO failed to “demonstrate independence from the inappropriate political influence of WHO member states,” suggesting that the organisation was not acting in the global interest but was swayed by national politics, particularly by China.
The withdrawal also aligns with Trump’s “America First” policy, where he seeks to champion U.S. interests and reduce international commitments that he perceives as not benefiting the U.S. directly or disproportionately.
Trump issued another order for a 90-day pause on new foreign assistance obligations and disbursements, including health programs like PEPFAR, to reevaluate their alignment with U.S. interests.
This reflects his broader aim to assess and potentially realign foreign aid to prioritise American interests. The freeze is also influenced by ideological shifts, including opposition to certain types of aid that Trump’s administration views as ideologically driven or not essential (e.g., aid related to gender ideology, diversity, equity, and inclusion programs).
There is also an emphasis on “rooting out waste” and ensuring that every dollar spent abroad directly contributes to making America “safer, stronger, and more prosperous,” as stated by administration officials.
These executive orders can be seen as part of Trump’s broader strategy to retract from international commitments he views as not serving U.S. interests or as being mismanaged, realign U.S. foreign policy to focus more on domestic priorities and less on global leadership in health, which he critiqued during his campaign and first term, and challenge what he perceives as bureaucratic inefficiencies or misallocations in international aid, aiming for more direct benefits for the U.S.
This approach reflects Trump’s second-term agenda to undo many of the Joe Biden administration’s policies, assert U.S. sovereignty, and shift focus towards domestic issues, even if it means potentially reducing U.S. influence in global health governance and support systems.
Ntsoaki Motaung is an award-winning health journalist from Lesotho, specializing in community health stories with a focus on sexual and reproductive health and rights, as well as HIV. She has contributed to platforms like “Be in the KNOW,” highlighting issues such as the exclusion of people with disabilities from HIV prevention efforts in Lesotho.
In addition to her journalism, Ntsoaki serves as the Country Coordinator for the Regional Media Action Plan Support Network (REMAPSEN). She is also a 2023 CPHIA Journalism Fellow.
