From senior staff writer Emily Belz: Almost every day I hear from doctors around the globe who are facing worsening health systems because of the sudden US foreign aid cuts. These are tough people accustomed to tough circumstances, but their emotions come through as they describe medicine shortages, staff shortages, and an uncertainty that has people hoarding lifesaving drugs. 

I’ve also heard from American readers who wonder why local governments aren’t stepping in to pay for their own countries’ health care, which is a fair question. One answer is that the US withdrawal shattered health systems overnight, and local institutions can’t rebuild those systems quickly. But also, different countries receiving US aid have different capacities to sustain their own systems. 

At a recent congressional hearing on the HIV/AIDS program, PEPFAR, researcher Mark Dybul said he believed South Africa was well-positioned to take on its own HIV treatment in the next year or two. But he emphasized that systems needed to be handed over with "planning and benchmarks" rather than the current chaos. 

Meanwhile poorer countries like Malawi, covered in today’s piece, will need outside aid longer. Malawi, too, wants to sustain its own systems, but institution building can be slow. Patience is difficult in the face of cuts to lifesaving care for many mothers and children in Africa, but one source noted to me that Christian health clinics "were there before PEPFAR, and they’ll be there after."