Over the past few months, conversations around reductions in international donor funding for health programs in low- and middle-income countries (LMICs) — particularly in Africa — have been resurfacing. This issue feels especially urgent when you consider that many critical healthcare interventions in Nigeria (and across the Global South) are still heavily reliant on external funding sources.

Some argue that the gradual withdrawal of international donors could be a “blessing in disguise,” forcing African countries to take greater responsibility for their own development and reduce dependency on foreign aid. Others warn that this is a dangerous gamble with millions of lives at stake.

Having followed and participated in discussions around this topic, I wanted to share a few reflections.

The Case for Dependency Reduction: 

It’s true that African countries have not fully harnessed their own resources to meet pressing healthcare needs. Nigeria, for example, has recovered multiple tranches of the Abacha loot (millions of dollars stashed abroad by a former head of state), reportedly channeled into poverty alleviation programs and infrastructure. In addition, Nigeria is endowed with over 30 different mineral resources — and yet, healthcare remains chronically underfunded.

From this perspective, international donor withdrawal might be seen as a necessary catalyst. Perhaps the absence of a safety net could finally push African governments to prioritize domestic resource mobilization, fight corruption, and implement systems that are less donor-dependent. After all, is there ever really a “good” time to be ready for self-reliance?

The Case for Continued Donor Support: 

However, we cannot ignore the reality on the ground. In Nigeria, programs for HIV/AIDS, malaria, and tuberculosis — all highly transmissible diseases — are largely funded by external donors such as the Global Fund and PEPFAR (the US Government’s President’s Emergency Plan for AIDS Relief). These investments have saved millions of lives, expanded access to treatment, and built prevention programs that reduce future burden.

A sudden withdrawal or sharp reduction in donor support would have devastating consequences:

1. Increased mortality among people living with preventable or manageable diseases.
2. Rising infection rates due to the collapse of prevention programs.
3. Increased out-of-pocket payments can easily push households into poverty through catastrophic health expenditures (CHE).

While I agree that long-term sustainability requires domestic ownership and reduced donor dependence, the transition must be managed carefully. Abrupt withdrawal without a cushioning mechanism risks undoing decades of progress.

Where Does Effective Altruism Fit In?

This debate cuts to the heart of Effective Altruism’s concern: how can we do the most good, given limited resources and difficult trade-offs?

• Should EAs and global health advocates support continued donor funding as a bridge — even if it risks entrenching dependency?
• Or should efforts pivot more toward supporting domestic accountability, fiscal reforms, and systems that build resilience in African healthcare systems?
• What is the ethically optimal “exit strategy” for donor funding in contexts where lives hang in the balance?

My Position

I believe African countries must move toward self-reliance, but in the immediate term, millions of vulnerable lives cannot be gambled away in the hope of catalyzing reform. International donors should design soft landing strategies, ensuring that their exit is gradual, deliberate, and paired with investments in capacity-building, accountability, and domestic financing mechanisms.

The “dependency vs. self-reliance” debate is not a binary one — and Effective Altruism has a role in interrogating how to maximize both immediate impact (lives saved today) and long-term resilience (systems that sustain health tomorrow).

Note:  This post was inspired by my contributions to the conversation regarding funding cuts, especially for health programs in Nigeria. This occurred on the Effective Altruism Nigeria WhatsApp group