After a funding lifeline was abruptly withdrawn earlier this year, the Western Cape is rethinking its response to two of its most pressing public health challenges, HIV and tuberculosis (TB). But instead of despair, a quiet determination is growing.
The province’s battle against HIV and TB faces a critical turning point after the loss of key international donor support earlier this year.
In response, provincial leaders are accelerating efforts to build a more sustainable, targeted response using data and technology to ensure no one is left behind.
On 24 June, the Western Cape Provincial Council on AIDS and TB convened to address the fallout from the withdrawal of USAID funding in January, which had supported a wide network of community health programmes. The funding cut has severely impacted several non-governmental organisations (NGOs) and non-profits organisations (NPOs) that delivered HIV and TB services to some of the province’s most vulnerable communities.
Premier Alan Winde, speaking at the council meeting, called the situation a “devastating setback” but emphasised the province’s commitment to adapt. “It has led to a major setback in the critical work done by our government and the non-governmental and non-profit sector in addressing HIV-AIDS and TB in our province. But as we have shown in the past, we are confronting this challenge together.”
The Western Cape Department of Health and Wellness has already begun scenario planning to stabilise the health system, laying out a multi-pronged strategy to stretch limited resources.
This includes digitising HIV and TB patient registers to improve service tracking, expanding e-scripting and medication access points, and refocusing attention on high-burden areas where infection rates are highest.
Amelia Mfiki, co-chair of the council, said the current challenge is also an opportunity to rebuild stronger, smarter systems. “Access to healthcare facilities remains one of the biggest barriers in our community response, particularly for those who want to re-engage with the health system,” she said. “If we can reach people in ways that reflect their realities, by bringing services closer and cutting red tape, we can do more with less.”
The USAID withdrawal has left many NGOs in limbo, with some scaling back outreach activities or closing community clinics. This threatens to reverse gains made over the past decade in testing, treatment adherence, and public awareness. Community health workers and local clinics, often the first point of contact for marginalised people, are stretched thin. In townships and rural areas, patients who previously relied on these networks now face long travel distances or treatment interruptions.
Despite these challenges, provincial health officials say the crisis has galvanised a new focus on efficiency, sustainability, and local innovation. Officials stress that rebuilding efforts will be rooted in evidence and community engagement, with a drive to integrate HIV and TB services more seamlessly into primary care.
