By JOHN NWOKOCHA

On Monday, August 4, The Gates Foundation announced $2.5 billion donation to improve global maternal and women’s health.

This comes amid a decline in global health funding.

Gates’ Interventions in Decades

However, Gates has consistently made significant commitments to bolster women’s healthcare access through financing for administering maternal health tailored programmes and initiatives. For the past decades, the Foundation has led with donations amounting to a trillion dollars.

Great strides have also been made in improving people’s health in recent years. Gates’ interventions in improving global health have become lifesaving for the vulnerable populations of the world. As of 2023, 133 countries have already met the SDG target on under-5 mortality. Effective HIV treatment has cut global AIDS-related deaths by half since 2010, and at least one neglected tropical disease has been eliminated in 54 countries by the end of 2024.

In other words, a considerable if not substantial part of the total financing has been coming from Gates. Still, the situations on the ground in many countries have not been improving. However, there is much Gates can accomplish alone as a single individual or organisation, underscoring the role governments, organisations, and wealthy individuals could play in contributing to improved funding. Since the start of the second term of the United States of America’s President Donald Trump, health financing has suffered major setbacks with key cuts in humanitarian aid, raising concerns across the world that premature deaths will increase drastically, and preventable diseases will spread uncontrollable not only around extreme poverty regions but also in economically advanced countries of the world.

Negative Outcomes

Mostly relying on humanitarian aid, the low and middle-income countries would post negative outcomes, including increased deaths, in the wake of the USAID funding cuts. Also, the funding cuts risk reversing two decades of progress in health in the vulnerable populations across the world.

But after Trump’s cuts were announced, the UK, France and Germany, and other countries followed suit, announcing their own reductions, compounding the dire consequences for poor countries.

For these poor countries, the aftermath of Trump’s humanitarian aid and health financing is already hitting hard.

Since April, the US funding cuts have generated heated debates around the world, with some analysts describing the action as "comparable in scale to a global pandemic or a major armed conflict”. This is not easy to look away from due to its likely severe effects.

The United Nations has condemned the cuts, calling the cancellation “dealing with the deepest funding cuts ever to hit the international humanitarian sector”.

USAID as Integral to the Global Aid System

The reason is that the USAID was integral to the global aid system. The US remained the world’s largest humanitarian aid provider. The US health benevolence has affected lives in more than 60 countries, largely through contractors. According to government data, it spent $68bn (£55bn) on international aid in 2023. The US interventions in supporting investments in the global health sector and humanitarian work cannot be underestimated.

But withdrawing its support at a critical time when many countries are battling economic downturns is a red flag and an ill wind for the majority of the less advanced populations.

80% of all programmes at USAID Cancelled

As of March, more than 80% of all programmes at the US Agency for International Development (USAID) had been paused o’ outrightly cancelled. The Trump administration has explained that it took the action to halt wasteful spending.

In the 21st century, an investment in health is too critical to be stopped abruptly. Chilling reports about the funding reversal have started to emerge.

Around the African continent, hardship and extreme poverty are fueling woeful human conditions.

Arms Conflicts Overwhelming Africa

Adding to the burden of hunger and extreme poverty, the continent is being overwhelmed by armed conflicts and the IDPs crisis.

Then the population faces corrupt leadership whose greed for amassing wealth has caused mismanagement of its natural resources, pushing the majority of Its population into miserable conditions. So the majority of the countries on the continent have not prioritised maternal and girl child health.

Governments in this part of the world focus on fighting against terrorism and insecurity, endangering the health of their citizens, mostly women and girl children. So maternal and women’s health has remained the worst casualty under the escalating arms conflicts and rising poverty, rather than remaining at the heart of humanitarian concern. Diseases and early deaths, fueled by neglect by their home governments, then take their toll on the vulnerable women. The rates of premature deaths are alarming and cannot be overlooked. In just about four months, funding shortages, inadequate health infrastructure, and limited outreach contribute to the crisis and threaten any lifesaving targets.

According to a publication by The Lancet medical journal, Trump’s global aid cuts could cause more than 14 million additional deaths, mostly among vulnerable populations, by 2030. Women, particularly during childbirth, and children are always at high risk of premature death.

Around June, the UN reports that hundreds of thousands of people were “slowly starving” in Kenyan refugee camps after US funding cuts reduced food rations to their lowest ever levels.

As the BBC reports, at a hospital in Kakuma, in northwestern Kenya, a baby who could barely move and was showing signs of malnutrition, including having parts of her skin wrinkled and peeling.

Meanwhile, a key action plan of the Sustainable Development Goals (SDGs) is to reduce extreme poverty and prioritize improved health.

Weak Economies and Debtor Continent

African economies are weak, crashing, and often cannot support their frontline investment programmes, much less a critical one like women’s healthcare, without foreign bailout loans. It remains a miracle that the COVID-19 pandemic didn’t do much harm in the continent’s vulnerable population as it did in the West, Europe, and parts of Asia.

Africa’s economy is at its low ebb while poverty rates soar with its sour taste.

Grappling with multiple factors, frustrating their focus on the provision of healthcare access, like economic meltdown, the continent leaders are forced to borrow loans from the World Bank, pushing Africa to a debtor continent.

Currently, Nigeria is the third-highest debtor country in the world. As the giant of Africa, Nigeria’s situation would reflect the condition in many countries on the continent.

According to a report in 2025, nearly 11.7 percent of the world’s population in extreme poverty, with the poverty threshold at 2.15 U.S. dollars a day, lived in Nigeria.

In 2025, Nigeria’s total budget allocation for health is N2.56 trillion, only, leaving a funding gap of N4.89 trillion.

Representing only 3 percent of the GDP and 5.03 percent of the total budget allocated to health, the Nigerian healthcare system faces significant challenges, and among these is that the African Union's recommended benchmark of 15 percent will be unmet.

Women are severely hit by the low performance of the budget, as a significant portion of the women’s population still lacks access to vital health services. In rural places, reducing maternal mortality and expanding universal health coverage have made zero progress, and millions of women were pushed or further pushed into extreme poverty due to out-of-pocket payments for health. On the basis of this, the funding cuts have remained controversial, facing more condemnations and criticisms.

Echoing the UN, Dr. Anita Zaidi, President of the Gender Equality Division at the Gates Foundation, said during the August 4 media briefing that she acknowledges the fund’s limited significance compared to the enormity of work needed to improve women’s health. Describing the donation as “a drop in the ocean”, Zaida said, “We need to prioritize the most to save the most lives”.

Recommendation

It raises a stronger appeal for the expansion of focus to cover more maternal and women’s health conditions.

All efforts towards reducing maternal mortality will significantly yield positive outcomes if advocates continue to accelerate the call for more commitment to women’s health investment from other funding agencies, governments, investors, entrepreneurs, researchers, academics, advocates, and other stakeholders remain sustained. Increased funding would not only address the needs of the girl child and women but also keep maternal and girl child health at the heart of humanitarian work.

•Nwokocha contributed this article from Abuja, Nigeria.