U.S. Health Aid Pays South African Clinic Wages—With No Backup Plan

PEPFAR funds thousands of health worker salaries directly inside South African government hospitals and clinics. If U.S. funding lapses, those positions don't automatically transfer to provincial budgets. South Africa spends 8–9% of GDP on health, but faces constrained finances and an exceptional treatment burden: 5.5 million people on antiretroviral therapy. After two decades of integration, the gap between program design and reality has widened.