Examining the effects of US funding withdrawal on Zimbabwe’s HIV, TB, malaria medicines supply chain

Abstract

Zimbabwe’s health sector has relied heavily on United States donor funding for procurement and distribution of essential medicines. The withdrawal of this funding early in 2025 posed significant risks for medicine security and patient access. This study examined the effects of the withdrawal on medicine availability, procurement and distribution efficiency, coping mechanisms by facilities as well as effects on access to care by recipients of care. A mixed-methods research design was adopted, combining structured questionnaires with Key Informant Interviews and a Focus Group Discussion conducted across public health facilities in Harare, Manicaland and Matabeleland North. Data was analysed using descriptive statistics and thematic analysis with triangulation. The withdrawal resulted in observed shortages of selected commodities, notably male condoms and Tenofovir/Emtricitabine, increased procurement lead-time variability, partial deliveries, and heightened logistical unpredictability. Institutions employed short-term coping strategies including stock redistribution, rationing as well as emergency top-ups. Patients experienced increased travel frequency, private pharmacy purchases, and treatment uncertainty, with rural residents disproportionately affected. The findings indicate that donor withdrawal magnified pre-existing systemic and economic vulnerabilities. Sustainable financing frameworks strengthened procurement systems, equity-sensitive stock allocation policies, and planned donor transitions are essential to ensure continued medicine availability.