This is a shortened version of an open letter written by a collection of South African health advocacy groups. Read the full letter here. 

Dear Ministers Motsoaledi, Godongwana, and Lamola,

We are organisations and groups working on ensuring access to healthcare services and human rights in South Africa for all patients and communities.

We write at a time of chaos, uncertainty, and dire urgency due to the impact on healthcare services in our country as a result of the Trump Administration’s cruel and draconian 20 January 2025 Executive Order entitled “Reevaluating and Realigning United States Foreign Aid”. As you are aware, the Executive Order has led to funding freezes and stop-work orders. 

What we know

●       The Executive Order and its notice of implementation make it clear that all existing foreign assistance awards are subject to a 90-day review period, including all global health programmes and, importantly, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). During this review period, there have been multiple funding freezes and stop-work orders, severely impacting healthcare services in South Africa.

●       Following the chaos and uncertainty created by the Executive Order, on 28 January 2025 a temporary Waiver was issued, which permits the continuation of “core life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs” during the 90-day review period. The Waiver expressly excludes “activities that involve abortions, family planning, gender or [diversity, equality, and inclusion] ideology programs, transgender surgeries, or other non-life saving assistance”.

●       Despite the Waiver, we understand that most PEPFAR implementing partners have not received any direct or complete communications from the United States (U.S.) Government about the implications of the Executive Order and the Waiver leading to ongoing uncertainty. News reports also indicate that senior USAID officials have resigned or been placed on leave. These developments are likely to delay communication to implementing partners and lead to legal challenges against the decisions taken by the Trump administration.

The impact of the Executive Order and the Waiver

●       We are aware of the temporary closure of multiple organisations and facilities providing essential healthcare services to, among others, sex workers, members of the LGBTQI+ community, transgender persons, and other marginalised communities seeking sexual and reproductive health support. These facilities have been instrumental in delivering HIV prevention, treatment, and care services, inter alia.

●       On current estimates, and as a result of the stop-work orders issued as a result of the Executive Order, we understand that, right now, at least 900,000 patients living with HIV in four districts are directly impacted alongside thousands of patients in other districts too, the livelihoods and jobs of several thousand healthcare workers are at risk; and essential services like patient tracking and tracing have been suspended in some instances.

●       The Executive Order has been implemented without prior notice to any of the affected parties which has caused widespread fear and uncertainty. Many seeking medical assistance will only be made aware of such changes when they seek medical attention which will further violate their right to access health care in South Africa.

Urgent Emergency Plan

Worryingly, and in line with the ideological slant of the present U.S. government, services related to sexual and reproductive health and rights (SRHR), particularly termination of pregnancy care, and healthcare services to key populations, including LGBTIQ+ people, transgender people, sex workers, men who have sex with men, and other marginalised groups are not included in the Waiver. Where services were provided through U.S. funding (PEPFAR+), these at-risk populations presently do not have access to healthcare services.

We have no doubt that you are aware of all of this but we do not know what steps you have taken to start to remedy the catastrophic consequences of the Executive Order, if any. As you are aware, the National Department of Health and the Treasury (through its budget allocations) have a constitutional responsibility to ensure openness and accountability and access to healthcare services, including reproductive healthcare, for all people in South Africa, regardless of any prevailing ideologies emanating from the current U.S. government.

As a result, we call on the National Department of Health and the Treasury to urgently:

●       Establish an intergovernmental task team to develop a coordinated urgent emergency healthcare services plan. The task team should ideally include partners from civil society with a history of fighting for adequate access to health care and documenting access on the ground, and at the very least include the Treatment Action Campaign (TAC). A task team should be established by no later than 15 February 2025, with a draft of this plan to be finalised by 28 February 2025, at the latest. Thereafter it should be circulated for public comment.

●       Take all necessary urgent interim measures, including allocating sufficient budget, to ensure that all people not included in the Waiver, including LGBTIQ+ people, and especially transgender people, sex workers, men who have sex with men, and other vulnerable and marginalised groups, receive emergency healthcare services, including for HIV prevention.

●       Develop an emergency communications plan to adequately notify patients and others who rely on healthcare services affected by the Executive Order and ensuing chaos on steps being taken to mitigate the effect of the Executive Order, and guidance on where healthcare services are now available to them.

●       Proactively engage with healthcare organisations and facilities to enable open communications and information-sharing.

●       Ensure that accurate information is collected and pro-actively disclosed to the public to ensure enhanced and appropriate information sharing during this crisis.

●       Revisit and develop existing policies and budget allocations to anticipate and plan for the medium- to- long-term consequences of the suspension or cancellation of foreign assistance awards after the 90- day review period detailed in the Executive Order, including a plan on how to reduce reliance on foreign assistance awards in future.

●       We also call on President Cyril Ramaphosa, to address this issue in his State of the Nation Address to adequately inform all affected parties and assert Government’s commitment to ensure uninterrupted access to life-saving medication, testing, and care for all key populations; and to uphold the rights of all individuals, to access non-discriminatory healthcare services.

In addition to the above, we suggest that an urgent stakeholder meeting is convened between your respective departments with healthcare organisations and facilities (including with relevant multilateral institutions) to establish any other suitable interventions that may be necessary at this time.

This is something that the Executive can and must solve, now. We wait to hear from you.