By: Rebecca Furth and Mark Mwenda

In the last few weeks, US foreign assistance has come under attack by the Trump administration, with Elon Musk and his team effectively shutting down the United States Agency for International Development (USAID) and freezing foreign aid. USAID sent stop work orders to all its contractors at the end of January 2025, leading to a halt in life-saving services across the world. Community health workers have not been spared. 

Many of the life-saving services the US government supports start with community health workers meeting people in their homes or supporting patients to navigate the health system. USAID programs such as President’s Emergency Plan for AIDS Relief (PEPFAR) to tuberculosis active case finding and treatment support, ante-natal and postnatal care, and malaria prevention and treatment programs rely on community health workers. The US government’s freeze and potential withdrawal of investments in health threatens the stability and continuity of CHW programs in many countries. This article explores the devastating implications of this aid freeze. It starts with an overview of what programs we know are being affected world-wide and then takes the specific case of Kenya to look at what this freeze means for CHWs in just one country. 

The global community health impact of the USAID foreign assistance freeze

With governments often stretched thin, foreign aid helps sustain CHW initiatives that provide essential services. The sudden halt in funding threatens to bring these programs to a standstill, leaving vulnerable populations without access to critical health services. Many CHW programs depend on external aid to function effectively. Foreign aid covers a variety of inputs including CHW salaries, stipends or incentives; medications and test kits; equipment and supplies; digital devices, data entry systems, forms and job aids; and training among others. The aggregate number of community health workers that have been supported through USAID-funded programs is not known, but what is known suggests that it is significant. The President’s Malaria Initiative alone supported an estimated 115,000 community health workers.  Many of the 15,000 community health workers in South Africa were initially trained as lay workers through PEPFAR-funded programs. USAID programs supported the CHW program in Tanzania, training plans for community health workers in Zambia, and provided initial support for the community health extension worker program in Ethiopia. USAID funding also supported the development of important tools including the Community Health Worker Assessment and Improvement Matrix and the CHW Coverage and Capacity Tool. New projects in design at the time of the stop work order would have supported strengthening of the kader system in Indonesia, refinements to the CHW program in Tanzania, and rolling out the CHW program in Uganda. The elimination of these investments will have profound effects on health systems and, more importantly, will negatively impact the health of populations that rely on CHWs for patient-centered services. To get a sense of what all this means at the country level, Mark Mwenda reports on what they are seeing in Kenya so far. 

The case of Kenya

As a Community Health Worker (CHW) based in Kenya, I have seen firsthand the invaluable role we play in supporting the health and well-being of our communities. From health promotion and disease prevention to early detection of health issues, our work forms the backbone of primary healthcare at the grassroots level.

The consequences are already being felt. Recently, we received a notification from the USAID-funded DREAMS project in our locality, which indicated that it would remain closed until further notice. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe), which focuses on combination HIV/AIDS prevention services for Adolescent Girls and Young Women (AGYW), heavily relies on CHWs to reach and support this population. Its closure is a stark reminder of the far-reaching impact of the aid freeze.

Recent news from one of the national newspapers in Kenya indicated that 24,577 Community Health Workers out of the 107,000 in the country face imminent layoffs. These CHWs are currently supported through remuneration provided by the President’s Emergency Plan for AIDS Relief (PEPFAR). The loss of their services would severely impact healthcare delivery, particularly in rural and underserved areas, and further exacerbate health challenges in the country. In 2024, USAID allocated Ksh 19.2 billion (approx $ 148.6 million) to its projects in Kenya.  In response to the USAID freeze, the Kenya Treasury Cabinet Secretary recently announced that funds previously allocated for other development projects in the financial year 2024-2025 will now be reallocated to critical health programs. This shift aims to ensure the continuity of vital healthcare services.

Beyond immediate service disruptions, there are broader implications for Kenya and global health in general. CHWs play a vital role in disease surveillance, identifying abnormal health trends before they escalate into widespread outbreaks. Our early intervention efforts were crucial during the COVID-19 pandemic; we raised awareness, dispelled myths and misconceptions, and provided care and support to infected patients. Without functioning CHW programs, Kenya and the world become more vulnerable to future pandemics and health crises.

Moreover, the loss of CHW programs undermines efforts to achieve health equity. CHWs are a bridge between marginalized communities and the formal healthcare system, ensuring that even those in the most remote areas have access to care. Their absence will widen existing health disparities, setting back progress made over the years.

This is a critical moment that demands urgent attention and action. With the US government pulling back on its support, others need to step in. Governments, development partners, and the private sector must come together to find sustainable solutions to keep CHW programs running. This means funds for stipends, drugs, equipment and supplies as well as funding and support for sustaining data systems, supervision and other support. Investments in CHWs are investments in healthier, more resilient communities and healthier communities lead to more productive and prosperous nations.