ICN warns of healthcare crisis as USAID funding cuts devastate nursing initiatives in the world’s most vulnerable regions

The International Council of Nurses (ICN) has documented alarming firsthand evidence of widespread disruption and collapse of essential health care services following the sudden withdrawal of USAID and other funding. National nurses’ associations (NNAs) and healthcare organizations around the world have made reports to ICN that demonstrate especially severe impacts on nurse-led programmes on a range of critical issues including maternal health, HIV/AIDS care, and TB, leprosy, and other infectious disease prevention, from vulnerable countries including Malawi, Nigeria, Cambodia, Togo, Ethiopia, Kenya, Senegal, Côte d'Ivoire, Tanzania, South Sudan, and Somaliland, among others.

Nurses have always been essential for delivering health services to their communities, sometimes providing the only access to health care in remote areas or to traditionally marginalized communities. With the World Health Assembly approaching in May, ICN stresses that it is more important than ever for countries to support extending the WHO Global Strategic Directions for Nursing and Midwifery 2021-2025 and invest in nursing as the key to building equitable and resilient global health systems.

ICN’s President Dr. Pamela Cipriano said:

“The abrupt termination of USAID support has created immediate health care crises in many of the world’s most fragile communities and health systems. Essential programmes are suddenly shutting down or being scaled down overnight, nurses working to provide vital health care are losing their jobs, life-saving medications are becoming unavailable, and enormous numbers of patients are losing access to necessary care.

‘Nurses, who are on the frontlines of healthcare delivery in these regions, are telling us of devastating impacts. These include the termination or scaling down of HIV/AIDS and maternal and child health services and research as well as the collapse of initiatives focused on preventive care and treatment for chronic diseases and mental health issues.

‘Several critical programmes that were strengthening nursing education and leadership and improving care quality have been abandoned mid-implementation, leaving nurses without essential support for professional development and leaving health systems with gaps in quality care delivery.

‘ICN previously warned that the US decision to withdraw USAID funding and withdraw from WHO would severely impact global health at multiple levels. We are now seeing the enormous human and social costs of these cuts, which are further widening gaps between high- and low-income countries.

‘ICN urges the United States to reinstate this essential funding and restore its commitment to global health partnerships, and calls on the international health community to take decisive action to support nursing and health care, including at the upcoming World Health Assembly. Without immediate investment in nursing and health care, especially in regions where health systems are already strained, we risk undoing decades of progress towards global health equity and threatening the achievement of Universal Health Coverage and our global health goals.”

Nurses from across affected regions have described to ICN how these funding cuts have directly affected crucial nursing initiatives and left many nurses suddenly unemployed. They have warned that the cuts are not only threatening immediate healthcare delivery but also long-term health security and emergency preparedness.

As one nurse leader from Somaliland explained:

“The funding was a bridge that people used to cross over to a safe healthy present and future. However the biggest shock to me is how these numbers reflect massive populations left unprotected from diseases, conflict zones, and economical tornados.”

Nursing leaders across the region expressed particular concern about the long-term implications of these cuts for sustainable development and poverty reduction.

“Dismantling USAID and cutting funding for all the wonderful projects that were going on around the world is an endangerment to the lives of millions, and not only the beneficiaries whose lives could have been made better, but also the workers who passionately served populations across the globe.

The fight for an equitable world has further been derailed by this policy and the effort towards achieving the Sustainable Development Goals, especially the health related ones, has also been further set back in years. It is my hope that the United States of America will reconsider its stands and reignite the source of hope for many countries who rely on these funds to recover from disaster, prevent poverty and engage in democratic reforms.”

— Perpetual Ofori-Ampofo, President, Ghana Registered Nurses and Midwives Association

Nursing leadership, education and skills development is another area that has been hit hard by the USAID funding withdrawals.

ICN heard that funding has been cut for an important Nursing Leadership Initiative designed to equip nurses in 7 African countries (Nigeria, Botswana, Côte d’Ivoire, Eswatini, Malawi, South Africa, and Zambia), under the President’s Emergency Plan for AIDS Relief (PEPFAR), with many projects left unfinished or unstarted.

Organizations reported to ICN that the abrupt end of the programme would have severe consequences, impacting the development of critical skills which will ultimately affect the quality of patients' care, limiting opportunities for nurses’ professional development, and, ultimately, potentially contributing to low retention and recruitment of the nursing workforce.

One Nigerian nursing leader told ICN:

“The Nursing Leadership Initiative offered crucial opportunities for collaborative learning across countries. It would have supported the development of nursing research contributing to improved HIV services, and would have elevated the profile of Nigerian nurses working in the HIV/AIDS space.”

A nurse leader from Malawi shared:

“The implementation of the project activities under each domain stopped immediately after the announcement of the stop orders. Unimplemented activities focused on building capacity of nurse leadership in budgeting, procurement, mentorship, public health emergency management in order to sustain gains in HIV/AIDS as well as mental health programmes. The resources were also intended to support key activities on digitalizing the integrated nursing and midwifery supervision checklist to include mental health and public health emergencies and advancing solutions for issues affecting nursing and midwifery.

The impact will mean the country is grappling with nursing leadership capacities to plan, coordinate and manage nursing and midwifery services, crucial to provision of quality care and improved health outcomes, and limiting nursing leadership with acquisition of the necessary skills, knowledge and attitude key to attaining UHC and SDG by 2030.”

ICN’s CEO, Mr Howard Catton, is currently participating in the UN Commission on the Status of Women (CSW69) meetings in New York, where ICN’s delegation has been highlighting the catastrophic impacts of USAID funding cuts.

Speaking at a CSW69 side event on Monday 17th March, Mr Catton remarked:

‘It is important to note that recent US funding withdrawal decisions are not just impacting nurses overseas but also threatening nursing research and education at home in the US. Research funding cuts are directly affecting the early-career nurse scholars who will become the nurse educators of tomorrow and whose research is vital for improving health care delivery and population health. These cuts will weaken the faculty and education pipeline at a time when the nursing education workforce is already under immense and unsustainable pressure. Without strong nursing faculty, we cannot prepare the next generation of registered nurses that health care systems so desperately need.

These far-reaching USAID cuts are impacting nursing and global health at every level. This moment requires decisive action to protect both current and future nursing workforces, before we irreversibly damage global healthcare delivery for decades to come.”