USAID Suspension’s Impact on Critical Sector Funding in the DRC

This blog post was first published in French on March 5, 2025 by Ebuteli, the partner organization of the Congo Research Group in the Democratic Republic of Congo (DRC).

After his inauguration on January 20, Donald Trump temporarily suspended some USAID funding. As the world’s leading source of foreign aid, this decision particularly affects developing countries. In the Democratic Republic of Congo (DRC), where the east of the country is experiencing a serious humanitarian and health crisis, the impact could be significant, particularly on the public health sector. This blog analyzes the repercussions of this suspension on the country’s autonomy.

Dependence of the Congolese Health System on Foreign Aid

The United States is the DRC’s main bilateral donor. USAID injected more than USD 10 billion into the country between 2002 and 2021. In 2023 alone, more than USD 1 billion was mobilized by the United States Agency for International Development (USAID). This represents 23 percent of the total aid received by the DRC, far ahead of the World Bank, UNICEF, and the World Food Programme (WFP). In the same year, the DRC was among USAID’s top ten beneficiaries worldwide, and was the second largest beneficiary in Africa, behind Ethiopia.

The DRC’s top 10 sources of aid between 2002 and 2021 (in US dollars)

Sources: Georgia Savvidou Aaron, Sebastian Sadowski, Flavio Gortana, Lena Meintrup, Adis Dzebo, “Aid Atlas,” Stockholm Environment Institute (SEI), 2019, https://aid-atlas.org.

More than 80 percent of this aid is devoted to health and humanitarian assistance: USD 589 million was allocated to humanitarian assistance, while USD 251 million supported health initiatives in 2023. In addition, since 2018, USAID invested more than USD 300 million in the fight against Ebola epidemics, and the Presidential Malaria Initiative (PMI)—a US program to fight malaria—has injected more than USD600 million since 2010.

Distribution of USAID support by sector in the DRC, 2023

Source: Website, “Foreignassistance.gov,” US Department of State, https://foreignassistance.gov.

These massive investments demonstrate the scale of the financial needs of the Congolese health system. Despite the high prevalence of several diseases, the proportion of the budget allocated to health remains insufficient: in 2025, only 13 percent of the budget, or 2.11 billion dollars, was allocated to health, for a population of more than 100 million. Since 2003, state spending on health has never reached the 15 percent threshold recommended by the 2001 Abuja Declaration, and the budget implementation rate is very low.

The health infrastructure is also inadequate: according to the national health development plan (2019–2022), of more than 8,000 health centers identified across the country, only 1,006 are built with sustainable materials, and several are in an advanced state of disrepair.

In a context where the Congolese state has largely delegated the health sector to donors, some of which depend on US funding, the disappearance or dramatic reduction of projects in this sector is now a real possibility. Furthermore, the future of the government’s program for universal health coverage could also be affected. The DRC is thus at risk of becoming even more vulnerable to endemic diseases or epidemics.

Humanitarian Crisis

Beyond the health sector, USAID is also involved in humanitarian aid throughout the country. In 2024, for example, following the floods that affected more than 600,000 people in Tshopo province and nearly 1.4 million in Nord-Ubangi, USAID released USD 2 million in emergency aid for, among other things, the construction of shelters for more than 44,000 affected people. Similarly, between 2023 and 2024, USAID allocated more than 800 million dollars to help populations facing conflict, mass displacement and food insecurity in several provinces, including North and South Kivu, Tanganyika, Maniema, and Nord-Ubangi. Humanitarian needs are constantly increasing and the situation has worsened considerably since the start of the conflict with the M23. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), the provinces of North Kivu and South Kivu alone are home to 4.6 million displaced persons, making the DRC one of the largest centers of internal displacement in the world. The indirect consequences of the conflict – epidemics, limited access to water and overburdened health systems—often cost more lives than the direct violence.

In this context, USAID’s assistance remains essential to address these complex humanitarian challenges. However, although financial needs have increased dramatically, from USD 690 million in 2016 to USD 2.53 billion in 2025, funding is struggling to keep pace. The average deficit over this period was USD 1.8 billion. In 2024, for example, of the USD 2.5 billion needed, only USD 1.3 billion was mobilized, leaving a gap of USD1.2 billion. This financial gap has a very significant human cost: nearly 50 percent of humanitarian aid in 2024 was allocated to the fight against food insecurity, a situation that affects more than 20 million people in food emergencies, and around 4.5 million children suffering from malnutrition.

The gap in humanitarian aid, 2016–2025

Source: Website, “OCHA financial tracking service,” UNOCHA, https://fts.unocha.org.

A Wake-Up Call for the DRC

If the USAID aid suspension became permanent, it would raise crucial questions about the DRC’s ability to ensure its autonomy in vital sectors such as health. After more than six decades of USAID’s presence in the DRC, the country is still unable to reduce its dependence on development aid. This dependence is particularly visible in the health sector, where external funding has increased from 34 percent in 2008 to 43 percent in 2016, while households continue to bear around 34% of health expenses. Recent reform initiatives, such as free maternity and newborn care, while commendable, also depend on external funding, particularly from USAID, the World Health Organization, and the World Bank.

Development aid, whether humanitarian assistance, strengthening of public health, or economic support, is neither permanent nor unconditional. The decisions of donor countries are often influenced by their internal policies, which can evolve with changes in government or according to geopolitical calculations, as illustrated by the decision of the Trump administration.

For the DRC, continually depending on donor countries, especially for vital sectors such as health, is not a sustainable solution. The path to disengagement is certainly complex, and breaking with this deeply rooted dependence will not happen overnight. However, this should be a wake-up call for the Congolese authorities to develop self-sufficiency in essential sectors, such as health, on which millions of lives depend. A key element lies not only in the mobilization of domestic funds, but also in their transparent management and rational allocation. The DRC is a country rich in natural resources that can achieve great things in various fields, provided it focuses on public policies to build a Congolese state that truly serves its people.