New Delhi: Mohan H.L., the chief executive officer of the Karnataka Health Project Trust, has been having sleepless nights since January this year. His non-governmental organisation runs tuberculosis control programmes across Karnataka, Bihar, Assam and Telangana.
Their efforts saw an abrupt end at the start of this year, thanks to the administration of US president Donald Trump deciding to cut funding for several United States Agency for International Development (USAID) programmes worldwide. Mohan’s programme joins the league of many international NGOs programmes of which have already terminated due to this move or are about to be.
Mohan received the first notice from USAID in January. “It said no new programme should be planned or any activity undertaken, except for disbursal of salaries to the staff members,” he told The Wire, describing the notice as “a bolt from the blue.”
By February-end, he said, he received a final termination letter to halt his programme that was run as part of the umbrella project, Break the Barriers.
One of the first executive orders that Trump signed on the first day of his second term was to freeze all foreign aid for 90 days.
The US government also withheld about US $ 2 billion that the US owed to NGOs and other development partners for work they had already completed. On February 13, a judge in a US district court, Amir Ali, ruled that the Trump administration must release the money that it had withheld.
The Trump administration challenged this judgement in the US Supreme Court. The apex court of the country ruled against the administration on March 5 and asked it to release the funds. The Supreme Court also referred the case back to Ali to decide on the compliance modalities. Following this, on March 11, Ali ruled that the Trump administration would have to release the withheld funds but stopped short of ruling that contracts for future work, which had been terminated, should also be restored.
The Wire had a conversation with Mohan before and a day after the US Supreme Court judgement. Asked if he saw a ray of hope after the judgement, he said he did not. “Many of the staff members of the USAID have been fired or have been given a deadline to leave the organisation,” he said.
Until December 2024, USAID in India would issue calls to NGOs like Mohan’s to apply for various projects. These would open the door for the likes of the Karnataka Health Project Trust to get funding. “USAID staff would also monitor the implementation of these projects. In their absence now, even if some funds get released, who is going to do all the necessary work?” Mohan asked.
Brian Wahl, an assistant professor of epidemiology at the Yale School of Public Health, said the people formerly working with USAID, are already looking for jobs. “They are not going to wait for the back and forth happening in various courts,” he said.
On March 10 – just a day before Ali’s ruling that did not specifically order restoration of the cancelled contracts – US Secretary of State, Marco Rubio, announced on X that the US government was finally, officially, cancelling 83% of the programmes at USAID. This affected about 5,300 contracts and appeared to be the final nail in the coffin. Staff strength of nearly 10,000 had to be reduced to a few hundreds. Rubio, however, did not clarify which programmes would survive.
Quoting a Congressional Research Service, BBC has reported that the agency had bases in 60 countries and used to work in a dozen others with a human resource of 10,000. The USAID works primarily in sub-Saharan Africa, followed by Asia and Europe.
And, as of now, there is no clarity if any single programme, which USAID sponsors in India, has made it to the list of the few remaining programmes that would continue worldwide. The Karnataka Health Project Trust’s USAID-sponsored programme has already shut down, for one.
Mohan said the Trust’s interventions in TB management were not medical but social. One of the key impediments in the fight against TB control is the stigma associated with it.
Mohan’s NGO brought communities together in the form of self-help groups to overcome stigma by inducing behaviour change. “We worked with panchayats and other groups and after years of groundwork, the notification of TB cases going up in some of our regions,” he said.
Because of stigma, many TB patients do not want to come out in the open and register with a health facility. Therefore, missing cases or subpar notification of cases is a key challenge in the fight against TB. The cases that are missed fail to get any treatment. Thus, they increase the burden of TB morbidity and mortality. Besides, untreated cases can also spread the infection to others, thus increasing the overall TB burden of the country which is already the highest in the world.
Currently, Mohan is in a fire-fighting mode to try and find ways to restart the programme, and ensure that he does not have to lay off any of his colleagues. His NGO which came into being 20 years ago, works in HIV, adolescent and maternal health as well. The USAID funded only its TB programme.
The Wire wrote to at least four civil society organisations that got funding from USAID for different projects. None of them, except the Karnataka Health Project Trust, agreed to speak, reflecting what is perhaps their level of anxiety.
A representative from one of them said, requesting anonymity, that so far no government has assured them of any additional support in the wake of USAID funding withdrawal.
Grassroots impact
Many experts, whom The Wire spoke to, said that government-run health programmes in India might not be deeply impacted. However, it would be the NGOs, which were providing grassroots-level services linked to healthcare schemes, that would feel the jolt.
The USAID aided projects through universities, research institutes, NGOs and enterprises based in the US and India. These implementing partners usually provided funds to local organisations to carry out the desired activities on the ground. These organisations, in turn, worked in tandem with the Union and state governments.
As per a rough estimate drawn from the US government’s website for the 2024-2025 fiscal year, the US government disbursed an estimated US $ 54.4 million to different NGOs for various healthcare programmes. The estimate might not include all healthcare programmes as some of them are combined with those which fall in categories other than healthcare.
All these programme were supposed to continue in the coming years. They would have elapsed by 2031 or before – depending on the programme. This estimate does not include the funding for those programmes, the tenure of which ended in 2024.
A major chunk of funding – an estimated US $ 16.9 million – came for various TB-related programmes in India.
For instance, the iDEFEAT TB project of the ‘The Union’, a civil society group fighting TB and lung disease, was disbursed ‘ US $ 2.92 million’. As part of this programme, ‘The Union’ provided technical assistance to the Government of India’s National Tuberculosis Elimination Programme (NTEP), supported it with new drugs and treatment regimens, did capacity building for rural healthcare workers, among other things.
Another key sector in which USAID supported various NGOs in India was HIV and other sexually transmitted diseases (STDs). According to a rough estimate done as per numbers available on the US government’s website, the US government provided aid worth US $ 15.9 million in the 2024-2025 fiscal year to such projects which were to continue in the coming years, in India.
For example, it gave substantial funds to Johns Hopkins University under the project ‘Accelerate’. The University implemented the programme through YR Gaitonde Centre for AIDS Research and Education and many local partners which partnered with the government’s National AIDS Control Organization (NACO) and State AIDS Prevention and Control Societies in various states to assist in HIV prevention as well as treatment.
Another USAID programme addressed patients who suffer from twin infections of HIV and TB. Under the ‘The National Initiative to Strengthen and Coordinate HIV-TB response’ ‘Share India’ received an estimated US $ 243,277 in 2024.
This programme was supported by what is known as ‘President’s Emergency Plan for AIDS Relief (PEPFAR)’. The programme aimed at ensuring a better access to drugs for managing HIV infections known as antiretroviral therapy (ART) drugs. ‘Share-India’ provided technical assistance to the NACO to that effect.
PEPFAR, incidentally, was the US government’s one of the biggest flagship healthcare programmes in the world. It addresses people living with HIV across 50 countries ensuring they get ART drugs that are key to their survival. With PEPFAR now suffering a blow, at least 900,000 HIV patients living in Africa alone are scrambling for help, many of whom are children.
Leena Menghaney, a lawyer with two decades of experience of working on various public health issues, worries about high-risk population groups like female sex workers, men who have sex with men and transgender individuals.
“The halt in USAID funding has severely impacted interventions for these vulnerable groups, as seen with the closure of the Mitr clinic in Hyderabad, which provided crucial HIV prevention and treatment services to the transgender community,” she said.
‘Maternal, child and reproductive health and family planning’ as a sector received an estimated US $ 13.2 million according to the US government’s website.
The ‘MOMENTUM suite of projects’ attempted to strengthen ‘routine immunisation programmes and mitigate disruption of immunisation services due to the COVID-19 pandemic’. Besides, USAID also funded two programmes that supported India’s polio immunisation drive.
USAID also funded multilateral agencies like World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS, Food and Agriculture Organisation and United Nations Children’s Fund, among others, for various healthcare programmes in India.
The Wire could not write to USAID as its website is not functioning.
Besides USAID, the Trump administration has also announced budget cuts and trimming of workforce of the US-CDC. It is one of the world’s premier health science and research institutes.
In India, the CDC plays a pivotal role in many areas.
“[The] CDC works with the [Indian] Ministry of Health and Family Welfare and other partners to build effective public health collaboration and partnerships, which strengthen the country’s core public health capabilities: data and surveillance, laboratory capacity, workforce and institutions, prevention and response, innovation and research, and policy, communications, and diplomacy,” states the CDC.
Much of CDC’s assistance came in the technical form – it provided consultancy services and key know-how.
“If and when these consultants go away, India’s big healthcare programmes like TB elimination and HIV control may suffer because they require good technical expertise both at the central and the state levels to monitor protocols, analyse implementation, and look at supply chains,” said Soumya Swaminathan, chairperson of M.S. Swaminathan Research Foundation and former WHO chief scientist.
Indian government
As far as the impact on the Indian government is concerned, all the experts that The Wire spoke to said it would be minimal.
“Unlike some of the African countries which depended on US funds almost completely for drugs, India has been procuring them of its own – so to that extent India will not feel any significant impact,” Swaminathan said.
Former head of Public Health Foundation of India K. Srinath Reddy echoed Swaminathan’s viewpoint and added, “Overall, the country has to prioritise health in public financing and focus on primary healthcare [which caters to rural areas]…Health financing must show a rise in both central and state budgets.”
Though the government programmes would remain largely unaffected, their implementation on the ground may suffer if the NGOs indeed withdraw because of USAID funds being wiped out.
The Wire wrote to Union health ministry’s secretary Punya Salila Srivastava asking if the government had made any assessment of the impact of USAID funding cuts on India, on March 4. The Wire also asked if any strategy has been prepared after the assessment. The ministry response will be added when it is received.
Opportunity for Global South
Experts believe that while the exit of US funding from critical healthcare programmes may spell a crisis, it is also an opportunity for countries in the Global South to have a better say on global health platforms. “The US would dominate the stage at multilateral agencies working in the area of health,” said former Union health secretary K. Sujatha Rao.
“It’s time for India now to increase the share of resources it contributes in various global healthcare initiatives,” she added. The former top official said that India may chip in by increasing WHO funding or making affordable generic medicines available to countries where USAID had provided assistance.
Swaminathan, who served as WHO’s chief scientist during the COVID-19 pandemic, says that the outbreak revealed that despite best efforts, initiatives like Covax – a global initiative to provide vaccines to African countries – did not deliver to the expected extent, as rich and powerful nations hoarded the vaccines at a time when they were badly needed.
“Therefore, we need regional cooperation – with stronger countries like India, Brazil and China – which have resources, technology and private sector, to really step up,” she said.
