

































 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF 
CHALLENGES AND OPPORTUNITES 

 

Obiora Peters, Emeka PhD 
School of Postgraduate Studies,Kigali Independent University ULK, Kigali,Rwanda 

 
 

Executive Summary 

The systematic review looked into the economic, healthcare, and education 

opportunities and issues before and after withdrawal of USAID in Africa. It detects 

considerable economic upheavals, damaged healthcare system, and failures in access 

and quality of education. Nevertheless, the possible cases of sustainable development 

can be seen as the emerging local initiatives and greater cooperation in the region. It is 

important to make strategic policy changes in order to reduce adverse effects. 

Abstract 

This review synthesizes studies conducted on the economic, healthcare, and education 

difficulties and opportunities in the aftermath of USAID withdrawal in Africa to 

discuss the complex effects of donor exit on the institutional and socio-economic 

systems. The review assessed economic implications, benchmark adaptations to 

healthcare systems, determine the weak spots of education, examine alternative 

financing structures, and compare policy reactions after the USAID exit. A mixed-

method investigations in sub-Saharan Africa, which were composed of econometric, 

qualitative, and policy examinations were used. Evidence shows that the difficulties 

of USAID withdrawal include moderate economic growth and fiscal gaps  but the 

resilience of health systems relies on the sustainable domestic financing, corruption 

reduction, and reinforced infrastructure. The effects of education sector are 

understudied yet may imply indirect interference related to health crises and reveal the 

necessity to harmonize health-educational investments. Innovative financing systems 

provide some very important opportunities to decrease the dependence on donors, 

depending on the political and institutional preparedness. Policy frameworks focus on 

better governance and multi-sector strategies, and evaluations of actions about the 

effectiveness of reforms are rare. The findings cumulatively support the need to 

employ a peculiar-sensitive design with integrated strategies to maintain health and 

education gains through a donor transition. The review guides policy and strategic 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

actions to prepare sustainable domestic resource and institutional capacity needed to 

ameliorate negative economic and social impacts after the withdrawal of USAID in 

Africa. 

1.0 Introduction 

USAID has been a key development driver in Africa, disbursing over US$400 billion 

globally since 1961, with Sub-Saharan Africa receiving the largest share—US$12.1 

billion in 2023 alone (USAID, 2024; CRS, 2025).The departure of USAID in Africa 

can be detrimental to economic development, healthcare funding, and education in the 

region considering the region depends greatly on external assistance and having their 

systems that are already weak before the aid in Africa (Apeagyei et al., 2024; 

Nonvignon et al., 2024; Mhazo & Maponga, 2024; Uwaezuoke, 2020). The burdens 

of diseases, interruption of education and poor health expenditure further raise the 

concern as donor funding is decreasing (Agyei & Kumah, 2024; Ifeagwu et al., 2021; 

Ly et al., 2017), especially when many countries are facing the inability to sustain 

quality of service (Onyango et al., 2024; Atim et al., 2020). Little is known about 

long-term consequences (Dolan et al., 2020; Ko et al., 2024; Dianda, 2020), and there 

is a debate on whether withdrawal is a sustainable move or will exacerbate 

inequalities (Nonvignon et al., 2024; Mhazo & Maponga, 2024), which would be a 

step backward in UHC, affordability and human capital (Ifeagwu et al., 2021; Brown 

& Essi, 20 With the aid of a framework built on SDGs and health systems (Cerf, 2019; 

Arhin et al., 2023; Ly et al., 2017; Sukran et al., 2023), this review pulls 

multidisciplinary evidence to sustain policy-focused transitions (Brikci, 2023; 

Hollingworth et al., 2023; Dzingirai, 2023; Omaghomi et al., 2023). 

The 2025 Executive Order 14169 cut US$27.7 billion in funding, suspending 90% of 

projects and threatening decades of progress, with forecasts of 5.7 million more in 

extreme poverty and 14 million preventable deaths (Africa Practice, 2025; The Lancet, 

2025; ISS Africa, 2025). While the withdrawal poses severe risks, it also offers 

opportunities for self-reliance through AfCFTA trade growth, expanding African 

DFIs, US$53 billion in diaspora remittances, and fintech-enabled capital flows (World 

Bank, 2024; AfDB, 2025; GSMA, 2024). However, research gaps remain on Africa’s 

adaptive capacity, alternative financing, and sectoral resilience, as prior studies 

emphasize aid dependency and disruptions (Moyo, 2023; Okonkwo, 2025; Kariuki, 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

2025; Abebe, 2023; Karamoko & Diallo, 2022; Van der Merwe, 2024; Ssenyonga, 

2024) without exploring endogenous solutions (Nelson & Adeyemi, 2023; Tadesse & 

Asiedu, 2025; Gomez & Hearn, 2024). This study addresses both the challenges and 

opportunities of USAID’s withdrawal to guide Africa’s shift from dependency to 

resilience by bridging fragmented peer-reviewed literature across sectors. 

1.2  Purpose and Scope of the Review 

This reviews critically evaluate the study of the consequences of the withdrawal of 

USAID in Africa in terms of healthcare, education, and economical stability, 

including the multiple influences on the institutional integrity and social economic 

stability. Policies and methods that support resilient health and education systems 

while reducing adverse economic consequences are intended to be informed by the 

synthesis of evidence on the constraints and new opportunities. A thorough body of 

information is included in the review to help stakeholders manage the shift from 

foreign aid to sustainable domestic funding and governance and research direction. 

Specifically,the review measures what is presently known about the economic 

consequences of USAID withdrawal in Africa; benchmarks established strategies to 

healthcare system adaptation and resilience USAID exit in Africa; determines and 

analysis of challenges and opportunities, facing education sector, after declines in 

external aid. Also, deconstructs alternative financing mechanisms used to maintain 

health and education at a post USAID pull-out level; and weighs the policies and 

institutional reforms undertaken to reduce the excruciating effects of  aid stoppage in 

the social areas. 

2.0  Methodology of Literature Selection 

The review used economic impact, healthcare, and education challenges and 

opportunities following USAID withdrawal in Africa and expand it into multiple, 

more specific search statements. It ensures that literature search is 

both comprehensive as not to miss niche or jargon specific studies 

and manageable where each query returns a set of papers tightly aligned with a 

particular facet of the topic. The transformed querries were; economic impact, 

healthcare, and education challenges and opportunities following USAID withdrawal 

in Africa; impact of economic policy changes on healthcare system resilience and 

educational reforms in Africa after the reduction of external aid; Assessing the 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH 

( ISSN 2811-2466 )                                                                           

https://ijojournals.com/                                                      
“USAID WITHDRAWAL IN AFRICA: A META

 

resilience of healthcare and educational systems in Africa post

alternative financing models and their economic implications. The 

queries applied inclusion &exclusion criteria to retrieve a focused 30 papers. The 

review identified additional relevant works through Citation Chaining through 

Backward and forward citation chaining and this uncovered emerging debates, 

replication studies, and recent methodological advances.A total of 126 additional 

papers are found during this process. On relevance scoring and sorting, 156 candidate 

papers (30 from search 

relevance ranking so that the most pertinent studies rise to the top of our final papers 

table. We found 150 papers that were relevant to the research query. Out of 150 

papers, 50 were highly relevant.

2.1 Flow chart 

Fig.1: Meta Analysis chart  

3.0 Findings 

The results are a synthesis of various research on the economic, healthcare, and 

education effects of USAID withdrawal in Africa, which have turned out to be 

dimensional consequences, response mechanisms, and financing models that can 

shape long-term transition policies.

3.1 Table 1: Descriptive Summary

Study Economic 
Impact 
Assessment 

Healthcare System 
Resilience

(Apeagye
i et al., 
2024) 

Moderate GDP 
growth; donor 
funding decline 
risks fiscal gaps 

Low health spending 
prioritization; 
moderate government 
health spending 
growth

INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH 

2466 )                                                                                          Obiora Peters, Emeka PhD

                                                      Volume 08 || Issue 09 || September
USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES

resilience of healthcare and educational systems in Africa post-USAID withd

alternative financing models and their economic implications. The 

queries applied inclusion &exclusion criteria to retrieve a focused 30 papers. The 

dentified additional relevant works through Citation Chaining through 

nd forward citation chaining and this uncovered emerging debates, 

replication studies, and recent methodological advances.A total of 126 additional 

papers are found during this process. On relevance scoring and sorting, 156 candidate 

 queries and 126 from citation chaining) and impose a 

relevance ranking so that the most pertinent studies rise to the top of our final papers 

table. We found 150 papers that were relevant to the research query. Out of 150 

papers, 50 were highly relevant.  

  

  fig 2:  PRISMA Chart 

The results are a synthesis of various research on the economic, healthcare, and 

education effects of USAID withdrawal in Africa, which have turned out to be 

dimensional consequences, response mechanisms, and financing models that can 

term transition policies. 

Table 1: Descriptive Summary 

Healthcare System 
Resilience 

Education 
Sector 
Adaptation 

Financing Model 
Effectiveness 

Policy and 
Institutional 
Response

Low health spending 
prioritization; 
moderate government 
health spending 
growth 

Not addressed Limited donor aid; 
need for domestic 
financing growth 

Calls for 
governance reforms 
and health 
prioritization

INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
Obiora Peters, Emeka PhD*  

September, 2025 || 
ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

USAID withdrawal: 

alternative financing models and their economic implications. The transformed 

queries applied inclusion &exclusion criteria to retrieve a focused 30 papers. The 

dentified additional relevant works through Citation Chaining through 

nd forward citation chaining and this uncovered emerging debates, 

replication studies, and recent methodological advances.A total of 126 additional 

papers are found during this process. On relevance scoring and sorting, 156 candidate 

queries and 126 from citation chaining) and impose a 

relevance ranking so that the most pertinent studies rise to the top of our final papers 

table. We found 150 papers that were relevant to the research query. Out of 150 

 

The results are a synthesis of various research on the economic, healthcare, and 

education effects of USAID withdrawal in Africa, which have turned out to be multi-

dimensional consequences, response mechanisms, and financing models that can 

Policy and 
Institutional 
Response 

Calls for 
governance reforms 
and health 
prioritization 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

Study Economic 
Impact 
Assessment 

Healthcare System 
Resilience 

Education 
Sector 
Adaptation 

Financing Model 
Effectiveness 

Policy and 
Institutional 
Response 

(Nonvign
on et al., 
2024) 

DAH doubled 
but may 
substitute 
domestic 
funding; uneven 
regional impact 

DAH unevenly 
distributed; limited 
increase during 
COVID-19; UHC 
progress modest 

Not addressed DAH substitution 
effects; need for 
domestic 
financing focus 

Urgent ODA 
transformation; 
country-centered 
aid use 

(Onyango 
et al., 
2024) 

Economic shift 
challenges 
sustaining health 
interventions 
post-donor exit 

Declines in service 
coverage post-
funding; political 
leadership and 
policies mitigate 

Not addressed Increased 
domestic funding 
and policy support 
critical 

Stakeholder 
engagement 
improved; policy 
frameworks vital 

(Mhazo 
& 
Maponga, 
2024) 

External 
assistance 
supports but 
does not 
strengthen 
health system 

COVID-19 exposed 
system bottlenecks; 
funding fragile and 
unsustainable 

Not addressed Domestic resource 
mobilization 
potential 
highlighted 

Need for 
government 
stewardship; re-
examination of 
donor roles 

(Agyei & 
Kumah, 
2024) 

Economic 
growth potential 
linked to 
healthcare 
improvements 

Healthcare financing, 
governance, 
infrastructure key for 
resilience 

Not addressed Emphasis on 
strengthening 
financing and 
governance 

Multi-sector 
collaboration 
needed for 
sustainable 
progress 

(Arhin et 
al., 2023) 

GDP growth 
linked to health 
spending 
efficiency; UHC 
progress 
variable 

Efficiency influenced 
by education, 
governance, financing 
models 

Not addressed Reducing out-of-
pocket payments; 
less donor reliance 
advised 

Governance quality 
and financing 
reforms 
recommended 

(Hutchins
on et al., 
2024) 

Workforce 
surplus amid 
shortages affects 
economic 
productivity 

Health worker 
unemployment and 
migration challenge 
system resilience 

Not addressed Governance and 
labor market 
reforms needed 

Policy gaps in 
workforce 
management 
identified 

(Dzingirai
, 2023) 

Economic 
fragility and 
corruption 
hinder health 
financing 

Budget constraints 
and political 
commitment affect 
system sustainability 

Not addressed Calls for improved 
financial 
management and 
anti-corruption 

Policy 
recommendations 
to enhance 
financing stability 

(Nandaku
mar & 
Farag, 
2024) 

Health 
expenditure 
driven by 
income, 
technology, and 
donor aid 

Donor aid distorts 
domestic investment; 
COVID-19 increased 
health spending 

Not addressed Donor aid impact 
complex; 
insurance 
increases spending 

Need for balanced 
financing and 
technology 
adoption 

(Atim et 
al., 2020) 

Domestic 
financing gains 
stronger than 
donor aid; 
borrowing 
viable short-
term 

Fiscal space limited; 
borrowing constrained 
by debt sustainability 

Not addressed Tax reforms and 
borrowing as 
financing options 

Calls for innovative 
domestic resource 
mobilization 

(Brikci, Limited revenue Political and Not addressed Taxes on mobile Need for policy 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

Study Economic 
Impact 
Assessment 

Healthcare System 
Resilience 

Education 
Sector 
Adaptation 

Financing Model 
Effectiveness 

Policy and 
Institutional 
Response 

2023) from innovative 
domestic 
financing 
mechanisms 

institutional readiness 
critical for 
implementation 

phones, alcohol, 
money transfers 
explored 

dialogue between 
health and finance 
sectors 

(Limong, 
2023) 

COVID-19 
caused 
economic 
hardship; 
lockdowns 
impacted 
livelihoods 

Pandemic exposed 
weak health 
infrastructure and 
political will 

Education 
disrupted; 
psychosocial 
impacts on 
children 

Economic safety 
nets and 
community 
involvement 
needed 

Emphasis on 
community health 
workers and 
gender-based 
violence 

(Kabajuli
zi, 2022) 

COVID-19 
containment 
reduced sector 
output; welfare 
declined 

Increased healthcare 
spending expanded 
health output but 
unevenly 

Not addressed Calls for rural 
infrastructure and 
domestic 
production 

Policy focus on 
integrated rural 
economy 
development 

(Uwaezuo
ke, 2020) 

Pandemic 
highlighted 
health system 
weaknesses; 
funding 
increased 

Shift towards 
infrastructure and 
workforce motivation 
post-COVID 

Not addressed Increased funding 
for health 
insurance and 
training 

Peer-review 
mechanisms 
suggested for 
sustained funding 

(Ifeagwu 
et al., 
2021) 

Donor funding 
dominant; out-
of-pocket 
payments high; 
UHC progress 
uneven 

Dependency on donor 
funding challenges 
sustainability 

Enrollment 
and quality 
gaps noted; 
rural 
disparities 

Emphasis on 
equitable national 
health insurance 
schemes 

Need for multi-
sectoral strategies 
and policy dialogue 

(Hollingw
orth et al., 
2023) 

Economic 
evaluations 
limited by data 
quality; capacity 
building needed 

Data quality affects 
health system 
efficiency assessments 

Not addressed Calls for improved 
local data and 
evaluation 
capacity 

Strengthening 
health technology 
assessment 
recommended 

(Achieng 
& 
Ogundain
i, 2024) 

Not directly 
addressed 

Digital infrastructure 
gaps hinder disease 
surveillance 

Not addressed Big data analytics 
potential for 
surveillance 
emphasized 

Regulatory 
frameworks and 
skills development 
needed 

(Arewa, 
2024) 

COVID-19 led 
to sovereign 
debt crises; 
economic 
distress severe 

Pandemic policies 
reflected exclusion 
and colonial legacies 

Not addressed Economic impact 
compounded by 
policy exclusion 

Calls for addressing 
systemic 
inequalities in 
policy design 

(Berardi 
et al., 
2024) 

Economic crises 
induce health 
system reforms; 
spending 
fluctuates 

Re-centralization and 
temporary spending 
increases post-crisis 

Not addressed Reforms aim to 
enhance resilience 
and efficiency 

Understanding 
reform dynamics 
critical for future 
shocks 

(Oppong 
et al., 
2021) 

Innovation 
mitigated 
economic 
impact of 
COVID-19 

Resourcefulness in 
disease control noted 

Not addressed Innovation as 
opportunity amid 
crisis 

Need for scholarly 
attention on 
African innovations 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

Study Economic 
Impact 
Assessment 

Healthcare System 
Resilience 

Education 
Sector 
Adaptation 

Financing Model 
Effectiveness 

Policy and 
Institutional 
Response 

(Oppong, 
2020) 

Not directly 
addressed 

Disruptive 
technologies offer 
healthcare access 
solutions 

Not addressed Telemedicine and 
drones potential; 
infrastructure 
needed 

Policy support 
essential for 
technology 
deployment 

(Cerf, 
2019) 

Economic 
stability key for 
health outcomes 
and UHC 

Environment-
economic-health 
nexus critical for 
implementation 

Not addressed Integrated SDG 
approach supports 
health financing 

Global partnerships 
and knowledge 
sharing vital 

(Ly et al., 
2017) 

Domestic 
resource 
mobilization 
essential amid 
donor decline 

Health spending 
projections vary; out-
of-pocket payments 
persist 

Not addressed Policy 
opportunities 
tailored to country 
contexts 

Emphasis on 
progressive 
pragmatism in 
financing 

(Hailemic
hael et al., 
2011) 

Workforce 
shortages and 
attrition affect 
economic 
productivity 

Deployment 
imbalances and 
attrition rates 
challenge system 

Not addressed Budget constraints 
and career 
development 
issues 

Need for retention 
and equitable 
distribution policies 

(Masiye 
et al., 
2020) 

Informal 
payments 
impose 
economic 
burdens on 
patients 

Resource shortages 
drive informal 
charges; urban 
facilities more 
affected 

Not addressed Increased budgets 
and staffing 
recommended 

Informal payments 
undermine trust in 
free healthcare 

(Owolabi 
& Tijani, 
n.d.) 

Not directly 
addressed 

Medical education 
resilience critical for 
health system 
sustainability 

Education 
delivery and 
quality 
affected by 
COVID-19 

Infrastructure and 
institutional 
culture reforms 
needed 

Focus on pedagogy 
and resource 
allocation 

(Moatti & 
Ventelou, 
2009) 

Economic 
growth linked to 
health 
improvements; 
paradigm shifts 
noted 

Shift from cost 
recovery to risk 
insurance emphasized 

Not addressed Vertical programs 
as leverage for 
system 
strengthening 

Theoretical and 
empirical paradigm 
limitations 
discussed 

(D, 1999) HIV/AIDS 
impacts 
workforce 
productivity and 
economic costs 

Workplace 
management critical 
to mitigate economic 
losses 

Not addressed Holistic solutions 
needed for 
epidemic impact 

Collaboration 
between 
management and 
labor essential 

(Dolan et 
al., 2020) 

Aid transition 
effects on child 
health funding 
inconclusive 

Donor exit may affect 
health service 
alignment 

Education 
impacts 
implied via 
health 
outcomes 

Transition 
challenges in 
financing child 
health 

Need for further 
research on aid 
transition effects 

(Datta, 
2023) 

Pandemic 
shocks affect 
financial 
markets and 
economic 
stability 

Unmet investments in 
preparedness 
highlighted 

Not addressed Insurance and 
spending pattern 
shifts anticipated 

Calls for research 
on post-pandemic 
financial agendas 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

Study Economic 
Impact 
Assessment 

Healthcare System 
Resilience 

Education 
Sector 
Adaptation 

Financing Model 
Effectiveness 

Policy and 
Institutional 
Response 

(Nyambur
a, 2024) 

Malaria burden 
hampers 
economic 
productivity in 
Northern 
Uganda 

Infrastructure and 
access barriers limit 
health service use 

Not addressed Strengthening 
infrastructure and 
delivery systems 
needed 

Multi-stakeholder 
collaboration 
essential 

(Willis & 
Khan, 
2009) 

Health sector 
reforms 
influenced by 
neoliberal 
policies 

Decentralization and 
user fees impact 
equity and access 

Education 
reforms 
linked to 
health sector 
changes 

Mixed effects on 
financing and 
service delivery 

Socioeconomic 
inequalities persist 
post-reform 

(Fleming, 
2023) 

Economic 
austerity 
reduced health 
workforce 
resilience 

Workforce morale and 
motivation declined 
post-2008 crisis 

Not addressed Transparent 
communication 
and value-driven 
policies needed 

Lessons for future 
health system 
shocks 

(Cn & Ej, 
2000) 

HIV/AIDS 
causes 
significant 
productivity 
losses in 
industry 

Direct and indirect 
costs burden 
employers 

Not addressed Economic impact 
grows as epidemic 
matures 

Workplace 
interventions 
critical 

(Kabajuli
zi, 2016) 

Health financing 
reforms boost 
GDP and reduce 
poverty 

Fiscal space from 
prioritization, taxes, 
and aid analyzed 

Not addressed Increased health 
sector resources 
recommended 

Health investment 
linked to economic 
growth 

(Bello & 
Ijaiya, 
2012) 

HIV/AIDS 
treatment costs 
substantial; 
economic 
burden high 

Prevalence affects 
national income and 
productivity 

Not addressed Long-run anti-
prevalence 
policies needed 

Regional 
cooperation 
emphasized 

(Brown & 
Essi, 
2021) 

Communicable 
diseases 
negatively affect 
GDP growth 

Health expenditure 
positively correlates 
with economic 
performance 

Not addressed Prevention and 
control improve 
economic 
outcomes 

Mixed effects of 
TB and HIV on 
GDP noted 

(Quamruz
zaman, 
2017) 

Infrastructure 
provisioning 
enhances health 
service use 

Governance quality 
influences access and 
utilization 

Not addressed Governance 
improvements 
needed alongside 
infrastructure 

Multi-level 
governance focus 
recommended 

(Omagho
mi et al., 
2023) 

Telemedicine 
improves rural 
healthcare 
access and 
outcomes 

Infrastructure and 
policy barriers limit 
deployment 

Not addressed Telemedicine 
reduces travel 
costs and enhances 
diagnostics 

Training and 
integration into 
health systems vital 

(Cavagne
ro et al., 
2008) 

Aid inflows risk 
inflation and 
economic 
competitiveness 

Macroeconomic risks 
depend on aid 
spending patterns 

Not addressed Fiscal space linked 
to aid management 

Dutch disease 
concerns in health 
aid discussed 

(Haacker, 
2004) 

HIV/AIDS 
reduces labor 
supply and 

Economic and social 
impacts extend 
beyond health sector 

Not addressed Poverty and 
education access 
affected 

Long-term 
economic 
development 

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 IJO- INTERNATIONAL JOURNAL OF SOCIAL SCIENCE AND HUMANITIES RESEARCH  
( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

https://ijojournals.com/                                                      Volume 08 || Issue 09 || September, 2025 || 
“USAID WITHDRAWAL IN AFRICA: A META-ANALYSIS OF CHALLENGES AND OPPORTUNITES" 

 

 

Study Economic 
Impact 
Assessment 

Healthcare System 
Resilience 

Education 
Sector 
Adaptation 

Financing Model 
Effectiveness 

Policy and 
Institutional 
Response 

human capital challenged 

(Odugbes
an & 
Rjoub, 
2020) 

HIV/AIDS 
prevalence 
negatively 
impacts 
sustainable 
development 

Health expenditure 
influences epidemic 
control 

Education 
indirectly 
affected via 
health 
outcomes 

Bi-directional 
causality between 
health and 
development 

Increased health 
spending needed 
for sustainability 

(Ko et al., 
2024) 

Sanctions 
reduce child 
vaccination 
rates; economic 
effects severe 

Health spending 
mitigates sanctions' 
adverse effects 

Education 
disruptions 
linked to 
health service 
access 

Policy needed to 
protect health 
resources under 
sanctions 

Poorer countries 
disproportionately 
affected 

(Conteh 
et al., 
2024) 

Emergency 
response 
capacity affects 
economic and 
health outcomes 

Trained health 
workforce improves 
system resilience 

Not addressed Multi-sectoral 
approaches 
enhance 
emergency 
response 

Financial 
constraints 
challenge 
implementation 

(Paul et 
al., 2020) 

Budget 
constraints limit 
health insurance 
expansion 

Operational 
inefficiencies affect 
service delivery 

Education not 
directly 
addressed 

Financing 
fragmentation and 
inefficiencies 
noted 

Inclusive policy 
dialogue needed for 
reform success 

(Haacker, 
2002) 

HIV/AIDS 
reduces per 
capita income 
via human 
capital loss 

Health sector and 
education impacts 
analyzed 

Not addressed Economic growth 
affected by 
epidemic severity 

Policy focus on 
human capital 
preservation 

(Russo & 
Bloom, 
2017) 

Economic 
downturns 
threaten health 
financing 
sustainability 

Resource-dependent 
countries face 
coverage challenges 

Education 
system 
vulnerabilities 
implied 

Need for resilient 
health financing 
models 

Policy responses 
critical for coping 
with shocks 

(Resch et 
al., 2011) 

ART 
investments 
yield economic 
returns 
exceeding costs 

Productivity gains and 
cost offsets substantial 

Not addressed Donor and 
domestic funding 
critical for ART 
sustainability 

Economic rationale 
supports continued 
investment 

(Sukran 
et al., 
2023) 

Government 
health spending 
improves human 
resource quality 

Education spending 
effects less clear 

Education 
quality linked 
to health 
investment 

Coordinated long-
term investments 
recommended 

Sharia perspective 
on human capital 
development 

(Dianda, 
2020) 

Political factors 
influence 
government 
health spending 
levels 

Democracy and 
accountability 
increase health 
expenditure 

Education 
sector not 
directly 
analyzed 

Political stability 
supports financing 
reforms 

Governance 
improvements 
essential for health 
funding 

 
3.2 Thematic Synthesis 
Economic impact Assessment 
 

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About 30 studies have revealed that withdrawal of USAID or decreasing donors 

results in moderate GDP growth obstacles or fiscal deficits or an economic recession , 

communicable diseases and pandemics enhance economic weaknesses(Apeagyei et al., 

2024)(Nonvignon et al., 2024)(Brown & Essi, 2021). Some articles pointed out the 

negative economic impacts of HIV/AIDS and other ailments on labor supply, 

productivity and income and indicate a necessity to invest continuously in health to 

curb some losses(Bello & Ijaiya, 2012)(Haacker, 2004)(Haacker, 2002).In some 

studies, the possibility of economic recovery and growth in terms of health financing 

reforms and investments in ART, reveal a positive outcome in terms of returns on 

investments in the health sector(Kabajulizi, 2016)(Resch et al., 2011). 

Healthcare System Resilience 

About 25 studies pointed out that sustainability financing, good governance, and 

infrastructure reinforcement are vital in ensuring resilience in the health system in the 

aftermath of the withdrawal of the USAID(Apeagyei et al., 2024)(Mhazo & Maponga, 

2024)(Arhin et al., 2023).Effects of donor aid replacement and regional imbalance in 

the supply of assistance, occurrence of health systems performance and universal 

health coverage (Nonvignon et al., 2024)(Ifeagwu et al., 2021). Innovations relating to 

telemedicine and analytics of large data are known as opportunities to improve 

surveillance and delivering of service not minding infrastructural and policy 

barriers(Achieng & Ogundaini, 2024)(Omaghomi et al., 2023). 

Education Sector Adaptation: 

There is a lack of research on the adaptation of the education sector as such, but 

COVID interruptions of health services and pandemics cause indirect impacts that can 

impair enrollment, quality, and psychosocial wellbeing (Limong, 2023)(Dolan et al., 

2020). The association between health investments and advances in the quality of 

human resources was established in some reviewed studies, which indicates that 

aligned health and education expenditures seem beneficial(Sukran et al., 2023). 

Weaknesses of the education system are recorded in situations of financial crisis and 

health crises, which means that sectoral responses should be integrated(Russo & 

Bloom, 2017). 

Financing Effectiveness Models 

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More than 20 works examine the models of financing, and it is observed that donor 

dependence has its limitations, and domestic resource mobilization, innovative taxes, 

and public-private collaborations are important (Atim et al., 2020)(Brikci, 

2023)(Ifeagwu et al., 2021).The creative sources of funds are not promising in terms 

of revenue potential, yet they create an opportunity to pursue tax restructuring and 

diversification(Brikci, 2023). Governance and Political factors greatly refocuseshow 

effective and sustainable health investment becomes(Dianda, 2020). 

The institutional and Policy Response 

According to many studies, governance reforms, stakeholder and inclusive policy 

processes are emphasized to control transitions in donor aid(Onyango et al., 

2024)(Mhazo & Maponga, 2024)(Paul et al., 2020). Some examples of policy 

responses to economic and health shocks are re-centralization policies, emergency 

response capacity building policies, and health system strengthening policies(Berardi 

et al., 2024)(Conteh et al., 2024). Political will, transparency, and social consultation 

are some of the challenges that influenced the success of health financing reforms and 

institutional adaptations (Dzingirai, 2023)(Paul et al., 2020). 

3.3 Synthesis and Critical Analysis 

The study of the implications of the economic impact, healthcare and educational 

spheres that ensued after the withdrawal of the USAID in Africa, exposes a 

complicated interplay between factors affecting health system resilience, economic 

stability, and education development. The quality of data, methodological rigor, and 

context sensitivity remains lacking although it is evidenced that considerable research 

has insightful information regarding the source of financing, changes in the health 

system, and policy responses. Even though the overall focus of the research is an 

imperative need of sustainable domestic financial and governance reforms, the 

research often fails to provide in-depth evaluation of cross-sectoral integration and 

long-term outcomes. In addition, the heterogeneity of the African setting and the 

evolving health environment, especially after COVID-19, makes generalising of 

results and policy advice complex. 

Table2: Synthesis and Critical Analysis 
Aspect Strengths Weaknesses 

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( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

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Economic 
Impact 
Assessment 

Several studies employ robust 
econometric and computable general 
equilibrium models to quantify the 
macroeconomic effects of health 
financing reforms and disease 
burdens, providing nuanced insights 
into GDP growth, fiscal space, and 
poverty reduction potentials(Atim et 
al., 2020)(Kabajulizi, 2016). The 
integration of health expenditure data 
with economic indicators offers a 
comprehensive view of economic 
trajectories post-donor 
withdrawal(Apeagyei et al., 
2024)(Brown & Essi, 2021). 

Despite methodological sophistication, many 
analyses rely on limited or aggregated data, 
constraining the granularity and accuracy of 
economic impact estimations(Hollingworth et 
al., 2023)(Atim et al., 2020). There is often 
insufficient consideration of informal economies 
and sectoral heterogeneity, which are critical in 
African contexts. Additionally, the dynamic 
effects of donor exit on private sector 
engagement and labor markets remain 
underexplored(Dolan et al., 2020)(Haacker, 
2004). 

Healthcare 
System 
Challenges and 
Adaptation 

Empirical case studies, such as 
Kenya’s Output-Based Voucher 
Scheme, highlight practical 
challenges and adaptive strategies 
including political leadership and 
policy frameworks that sustain health 
interventions post-USAID 
withdrawal(Onyango et al., 2024). 
Reviews emphasize the importance of 
governance, infrastructure, and 
workforce management in 
maintaining service delivery(Agyei & 
Kumah, 2024)(Hailemichael et al., 
2011). The recognition of health 
system fragility and the call for 
domestic resource mobilization are 
well articulated(Mhazo & Maponga, 
2024)(Dzingirai, 2023). 

Many studies focus predominantly on short-term 
outcomes or specific programs, limiting 
understanding of systemic resilience and long-
term sustainability(Mhazo & Maponga, 
2024)(Ifeagwu et al., 2021). There is a tendency 
to conflate external support with system 
strengthening, overlooking structural bottlenecks 
and governance deficits(Mhazo & Maponga, 
2024). Workforce issues such as paradoxical 
surpluses and unemployment are insufficiently 
integrated into health system 
analyses(Hutchinson et al., 2024). Moreover, the 
impact of informal payments and corruption on 
service access is underreported(Masiye et al., 
2020). 

Education 
Sector 
Challenges and 
Opportunities 

Research acknowledges the critical 
role of education in human capital 
development and the adverse effects 
of aid withdrawal on educational 
quality and access(Sukran et al., 
2023). Some studies emphasize 
coordinated investment in education 
and health as synergistic for human 
resource development(Sukran et al., 
2023). 

There is a paucity of focused empirical studies 
on education sector responses to USAID 
withdrawal, with limited data on policy reforms, 
financing innovations, or adaptive strategies 
specific to education(Owolabi & Tijani, n.d.). 
The intersection between health shocks and 
educational disruptions, especially post-
pandemic, is inadequately addressed(Limong, 
2023). This gap limits comprehensive 
understanding of education sector vulnerabilities 
and opportunities. 

Alternative 
Financing 
Mechanisms 

Innovative domestic financing 
approaches, including taxes on 
mobile phones and money transfers, 
are identified as potential avenues to 
diversify health financing and reduce 
donor dependence(Brikci, 2023). 
Studies highlight the importance of 
political acceptability and 
institutional readiness in 
implementing such 
mechanisms(Brikci, 2023). Fiscal 
space analyses suggest tax reforms 
and improved public financial 
management as viable strategies(Atim 
et al., 2020). 

The revenue potential of innovative financing 
mechanisms is often modest and implementation 
remains limited, raising questions about their 
scalability and impact(Brikci, 2023). Political 
and administrative complexities, including 
earmarking challenges and equity 
considerations, are insufficiently 
resolved(Brikci, 2023). There is also limited 
empirical evidence on the effectiveness of these 
mechanisms in sustaining health and education 
services post-USAID withdrawal(Brikci, 
2023)(Atim et al., 2020). 

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( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

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Policy 
Frameworks 
and 
Institutional 
Reforms 

Literature underscores the necessity 
of policy realignment towards 
domestic financing, governance 
improvements, and health system 
strengthening to mitigate aid 
withdrawal impacts(Nonvignon et al., 
2024)(Mhazo & Maponga, 
2024)(Ifeagwu et al., 2021). The call 
for transparent frameworks and multi-
sectoral strategies tailored to country 
contexts is recurrent(Ifeagwu et al., 
2021)(Cerf, 2019). Post-pandemic 
reforms emphasize increased funding, 
capacity building, and institutional 
accountability(Uwaezuoke, 
2020)(Berardi et al., 2024). 

Despite policy recommendations, empirical 
evaluations of reform implementation and 
effectiveness are scarce(Ifeagwu et al., 2021). 
Many studies highlight the fragility and 
unsustainability of external funding without 
providing detailed pathways for institutional 
transformation(Mhazo & Maponga, 2024). 
Political determinants of health spending are 
acknowledged but underexplored in 
depth(Dianda, 2020). The heterogeneity of 
policy responses across African countries 
complicates the formulation of generalized 
strategies(Nonvignon et al., 2024)(Russo & 
Bloom, 2017). 

Data Quality 
and 
Methodological 
Rigor 

Some studies demonstrate adherence 
to rigorous reporting standards and 
utilize mixed-methods approaches to 
triangulate findings, enhancing 
validity(Onyango et al., 
2024)(Hollingworth et al., 2023). The 
use of systematic reviews and 
econometric modeling contributes to 
evidence synthesis and policy 
relevance(Ifeagwu et al., 
2021)(Hollingworth et al., 2023). 

A recurrent limitation is the reliance on 
incomplete, outdated, or non-country-specific 
data, which undermines the robustness of 
conclusions(Hollingworth et al., 2023)(Atim et 
al., 2020). Methodological inconsistencies and 
limited longitudinal data restrict the ability to 
capture dynamic effects of USAID 
withdrawal(Ifeagwu et al., 2021). Publication 
bias and overrepresentation of certain countries 
(e.g., Kenya, Nigeria) skew regional 
generalizations(Ifeagwu et al., 2021). The lack 
of integration of qualitative insights into 
quantitative models reduces contextual 
depth(Hollingworth et al., 2023). 

Cross-sectoral 
Integration and 
Long-term 
Sustainability 

The literature recognizes the 
interconnectedness of economic, 
health, and education sectors and the 
importance of integrated approaches 
for sustainable development(Cerf, 
2019)(Ly et al., 2017). Some studies 
advocate for coordinated domestic 
resource mobilization and governance 
reforms to sustain progress post-
donor exit(Ly et al., 2017)(Sukran et 
al., 2023). 

However, there is limited empirical research 
explicitly addressing the cross-sectoral impacts 
of USAID withdrawal, particularly on education 
and economic sectors in tandem with 
health(Owolabi & Tijani, n.d.)(Dolan et al., 
2020). Long-term sustainability assessments are 
often absent, with a focus on immediate post-
withdrawal effects rather than enduring 
institutional and socio-economic 
transformations(Mhazo & Maponga, 
2024)(Ifeagwu et al., 2021). This gap hinders 
comprehensive policy formulation for resilient 
transitions. 

 
 

 

3.4 Thematic Review of Literature 

Literature evidence reveals that the effects of USAID withdrawal in Africa on health 

financing, system resilience, and socio-economic stability are affected and key themes 

beyond these effects are donor dependence, domestic resource mobilization, 

innovative financing, workforce issues, technological acceptance, and economic 

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losses of diseases, which all influence the process of moving toward sustainable 

domestic governance. 

 
Table 3: Thematic Review of Literature 
 

Theme Appears In Theme Description 

Health Financing 
Challenges and 
Innovations 

15/50 Papers 

Extensive research indicates persistent challenges in health financing 
across African countries, characterized by donor dependence, low 
domestic spending prioritization, and the necessity for innovative 
financing mechanisms such as sin taxes, health insurance schemes, and 
public-private partnerships to enhance fiscal space and sustain health 
services post-USAID withdrawal(Apeagyei et al., 2024)(Nonvignon et 
al., 2024)(Dzingirai, 2023)(Atim et al., 2020)(Brikci, 2023)(Ifeagwu et 
al., 2021). Studies emphasize the need for tailored, country-specific 
strategies and highlight the risk of regressive financing methods like 
out-of-pocket payments undermining universal health coverage 
goals(Ifeagwu et al., 2021). 

Healthcare System 
Resilience and 
Adaptation 

14/50 Papers 

The withdrawal of donor funding has exposed fragilities in healthcare 
systems, prompting adaptive strategies focused on governance reforms, 
political commitment, and technological innovations such as 
telemedicine and big data analytics to enhance disease surveillance and 
service delivery(Onyango et al., 2024)(Mhazo & Maponga, 
2024)(Agyei & Kumah, 2024)(Achieng & Ogundaini, 2024)(Oppong, 
2020)(Fleming, 2023)(Omaghomi et al., 2023). Workforce challenges, 
including paradoxical surpluses and attrition, complicate these efforts, 
necessitating strategic deployment and retention policies(Hutchinson et 
al., 2024)(Hailemichael et al., 2011). The COVID-19 pandemic further 
highlighted systemic weaknesses but also opportunities for sustainable 
health systems strengthening(Limong, 2023)(Uwaezuoke, 
2020)(Conteh et al., 2024). 

Economic Impact of 
Health Crises and Aid 
Withdrawal 

12/50 Papers 

Research documents significant macroeconomic repercussions due to 
health crises like HIV/AIDS and pandemics, with impacts on labor 
productivity, GDP growth, social fabric, and fiscal 
sustainability(Kabajulizi, 2022)(Bello & Ijaiya, 2012)(Brown & Essi, 
2021)(Haacker, 2004)(Haacker, 2002)(Resch et al., 2011). The 
reduction of USAID and other aid funding exacerbates these effects, 
stressing the importance of domestic resource mobilization and 
efficient allocation to mitigate adverse economic outcomes(Apeagyei et 
al., 2024)(Ly et al., 2017)(Datta, 2023)(Russo & Bloom, 2017). 
Economic evaluations reinforce the benefits of sustained investments in 
treatment programs for long-term economic gains(Resch et al., 2011). 

Education Sector 
Challenges and 
Opportunities Post-Aid 
Withdrawal 

5/50 Papers 

Literature addressing education highlights disruptions due to reduced 
external funding, with impacts on medical education quality and 
continuity, especially amid pandemics(Owolabi & Tijani, n.d.). 
Challenges include infrastructure deficits and the need for resilient 
systems and innovative pedagogies to sustain educational outcomes in 
health-related fields, critical for maintaining healthcare workforce 
capacity(Owolabi & Tijani, n.d.). 

Policy and Institutional 
Reforms for Sustainable 
Financing 

10/50 Papers 

Studies underscore evolving policy frameworks and institutional 
reforms aimed at reducing donor dependency by enhancing domestic 
financing mechanisms, improving governance, and fostering 
stakeholder engagement(Nonvignon et al., 2024)(Atim et al., 
2020)(Ifeagwu et al., 2021)(Paul et al., 2020)(Dianda, 2020). Political 
factors such as democratic governance and accountability are linked to 
increased public health expenditure, highlighting the interplay between 
political environment and health financing sustainability(Dianda, 
2020). 

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Theme Appears In Theme Description 

Impact of 
Communicable Diseases 
on Economic and Social 
Systems 

7/50 Papers 

The persistent burden of communicable diseases like HIV/AIDS and 
malaria exerts substantial economic and social strain, affecting 
workforce capacity, healthcare costs, and overall development(D, 
1999)(Nyambura, 2024)(Bello & Ijaiya, 2012)(Brown & Essi, 
2021)(Haacker, 2004)(Odugbesan & Rjoub, 2020)(Haacker, 2002). 
Effective control and treatment programs demonstrate positive returns 
on investment, emphasizing the necessity of integrated disease 
management post-donor withdrawal(Resch et al., 2011). 

Technological 
Innovations in 
Healthcare Delivery 

4/50 Papers 

Emerging technologies such as telemedicine, medical drones, and big 
data analytics are highlighted as transformative tools to enhance 
healthcare access and disease surveillance in resource-constrained 
settings(Achieng & Ogundaini, 2024)(Oppong, 2020)(Omaghomi et 
al., 2023). However, successful deployment requires supportive 
infrastructure, regulatory frameworks, and skilled personnel(Oppong, 
2020)(Omaghomi et al., 2023). 

Socioeconomic and 
Community-level 
Implications of Aid 
Withdrawal 

3/50 Papers 

The literature identifies community involvement and socio-cultural 
factors as critical in health and education service continuity, 
particularly in pandemic contexts where lockdowns and economic 
hardships disproportionately affect vulnerable populations(Limong, 
2023)(Masiye et al., 2020)(Ko et al., 2024). Informal payments and 
resource scarcity further undermine trust and access to services(Masiye 
et al., 2020). 

Macroeconomic Policy 
Responses to Aid 
Fluctuations 

3/50 Papers 

Analyses explore macroeconomic policy adjustments in response to 
fluctuating aid, including concerns about inflation, exchange rates, and 
fiscal space constraints that influence sustainable health and social 
service financing(Cavagnero et al., 2008)(Berardi et al., 2024)(Datta, 
2023). Strategic allocation and efficiency improvements are 
recommended to mitigate negative economic consequences. 

 
3.5 Chronological Literature Review 

Over time, literature in the area of economic impact, issues related to health care and 

education opportunities and challenges post-USAID withdrawal in Africa has greatly 

changed. The initial researches mainly looked at the macroeconomic impacts of health 

epidemics like HIV/AIDS and the contribution of foreign support in the health 

funding. Entering the second decade of 2000s, studies broadened to encompass more 

complex analyses of health system funding, workforce issues and the impact of 

shocks to the health services provision. Subsequent efforts have focused on the shift 

to self finance, rather than donors, in domestic financing, the role of pandemics such 

as COVID-19 on health systems and healthcare innovations in delivery and funding. 

This chronological overview traces how impact character has evolved, moving 

through perceptions of base-level impacts through to policy-sponse and adaptive 

options within a changing aid environment. 

 

 

Table 4: Chronological Literature Review 

Year Range Research Direction Description 

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Year Range Research Direction Description 

1999–2004 
Early Focus on HIV/AIDS Economic 
and Social Impact 

Initial research concentrated on quantifying the economic 
costs of HIV/AIDS on labor productivity, healthcare 
spending, and broader social consequences in African 
countries, highlighting the urgency of addressing this 
epidemic’s macroeconomic effects. These studies 
underscored the need for proactive workplace and public 
health interventions to mitigate rising treatment costs and 
lost productivity. 

2008–2012 
Donor Aid and Health Financing 
Challenges 

This period featured analyses of development assistance 
for health and its macroeconomic implications, including 
concerns about aid dependency and fiscal sustainability. 
Studies explored the balance between external funding 
and domestic health spending, emphasizing the risk of 
aid substitution and the necessity for improved 
governance and health system strengthening. 

2013–2017 
Health Systems Reform and Economic 
Transitions 

Research focused on health system reforms, workforce 
deployment, and the economic transitions affecting 
health financing in Africa. Key themes included 
decentralization impacts, health workforce shortages and 
attrition, and the challenges of mobilizing domestic 
resources amid changing economic conditions and donor 
dynamics. The shift towards progressive pragmatism in 
health financing was advocated to address emerging 
fiscal constraints. 

2018–2020 
Pandemic Exposure and Health System 
Resilience 

The emergence of COVID-19 brought attention to the 
fragility of African health systems, revealing gaps in 
infrastructure, governance, and financing. Studies 
highlighted the need for increased investment in health 
infrastructure, workforce motivation, and universal health 
coverage to build resilience. The pandemic's socio-
economic fallout also prompted calls for integrated 
emergency response mechanisms and more strategic 
health budgeting. 

2021–2024 
Transition from Donor Dependence to 
Sustainable Domestic Financing and 
Innovation 

Recent literature emphasizes the decline of development 
assistance and the imperative for African countries to 
strengthen domestic financing mechanisms for health and 
education sectors. Innovations such as telemedicine, big 
data analytics for disease surveillance, and alternative 
financing models have been explored. Research also 
scrutinizes policy adaptations, health system governance, 
and the interplay between economic growth and health 
investment in a post-USAID withdrawal context. 

 
 

3.6 Alignment and Divergence of studies 

Many studies agreed that USAID withdrawal created huge gap in economy,health 

care and education. Also they agreed on the urgent need for local sustainable 

financing and institutional reforms to ameloriate the negative effects and leverage 

emergent opportunities. Dissimilarly,divergence exists in how effective the model of 

finance, sustainability of healthcare system post donor exit and the size of economic 

woos. Theses variations springs from methodological strategies,regional settings,and 

focus of the studies. 

Table 5: Alignment and Divergent studies 

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Comparison 
Criterion 

Studies in Agreement Studies in Divergence Potential 
Explanations 

Economic 
Impact 

Assessment 

Most studies agree that the withdrawal 
of donor aid such as USAID leads to 

notable economic challenges, including 
slowed GDP growth and fiscal strains, 
especially due to health burdens like 
HIV/AIDS and pandemics affecting 

workforce and productivity (Apeagyei 
et al., 2024) (Brown & Essi, 

2021) (Odugbesan & Rjoub, 2020). 
The need to scale up domestic resource 

mobilization is consistently 
emphasized (Atim et al., 2020) (Ly et 

al., 2017). 

Some studies find mixed impacts, 
such as positive effects of increased 
government health spending on GDP 
in certain countries or a paradoxical 
positive correlation of TB incidence 
with GDP, suggesting nuanced local 
economic dynamics (Brown & Essi, 

2021). There is inconclusive 
evidence on the alignment of aid 

post-transition on child health 
needs (Dolan et al., 2020). 

Variations arise 
from country-

specific economic 
structures, disease 

burden profiles, and 
methodological 
differences like 

econometric 
modeling versus 
qualitative case 

studies. The time 
frame and scale of 

analysis also 
influence observable 
economic outcomes. 

Healthcare 
System 

Resilience 

There is consensus that healthcare 
systems in Africa experience 

considerable strain following donor 
exit, with risks of funding gaps, 

reduced service coverage, and fragile 
infrastructure, necessitating 

strengthened governance and policy 
reforms (Nonvignon et al., 
2024) (Mhazo & Maponga, 

2024) (Uwaezuoke, 2020) (Ifeagwu et 
al., 2021). Universal Health Coverage 

(UHC) is a central goal requiring 
innovative health financing and 

improved system efficiency (Arhin et 
al., 2023) (Ifeagwu et al., 2021). 

Divergence appears in the success 
stories of adaptation, for example, 
Kenya's Output-Based Voucher 

scheme showed declines post-donor 
funding but was partially offset by 
political commitment and domestic 
initiatives (Onyango et al., 2024), 

while Zimbabwe’s experience 
suggests external funding often 
supports rather than strengthens 

systems (Mhazo & Maponga, 2024). 
The role of donor substitution 
effects on domestic funding is 

debated (Nonvignon et al., 2024). 

Differences emerge 
due to country-

specific political 
will, economic 

capacity, and health 
system governance. 
The nature of donor 

exit (gradual vs. 
abrupt) and the 

presence of 
domestic policies 

like social insurance 
schemes influence 

resilience outcomes. 

Education 
Sector 

Adaptation 

Studies highlight education sector 
vulnerabilities post-aid reduction, 

including disruptions during COVID-
19 and challenges in maintaining 

enrollment and quality, emphasizing 
the need for integrated social 

protection (Limong, 2023) (Dolan et 
al., 2020). There is acknowledgment of 
the importance of sustained investment 

to safeguard human capital 
development (Sukran et al., 2023). 

There is less extensive consensus on 
specific education financing 

mechanisms or empirical 
evaluations of post-USAID 

withdrawal education outcomes, 
reflecting a research gap in this area. 
Some analyses focus more on health 
than education (Atim et al., 2020). 

Gaps reflect limited 
data and fewer 
studies directly 

addressing 
education post-

donor exit. 
Variability in 

national education 
policies, socio-

cultural factors, and 
pandemic-related 

disruptions 
complicate 

generalization. 

Financing 
Model 

Effectiveness 

A strong agreement exists on the 
importance of increasing domestic 

financing for health through tax 
reforms, innovative mechanisms, and 
public-private partnerships to reduce 

donor dependency (Atim et al., 
2020) (Brikci, 2023) (Ifeagwu et al., 

2021). Innovative financing such as sin 
taxes and mobile levies are explored as 
supplementary avenues (Brikci, 2023). 

However, the actual revenue 
potential and implementation 

success of innovative financing is 
debated, with some studies pointing 

to limited revenue gains and 
political-administrative 

challenges (Brikci, 2023). The 
substitutive effect of donor aid on 

domestic spending is also 
contested (Nonvignon et al., 2024). 

Variability in 
institutional 

capacity, political 
acceptance, and 

economic contexts 
explains differences. 

Some innovations 
remain theoretical or 

pilot-phase, with 
real-world scaling 
posing challenges. 

Methodologies 
focusing on 

projections versus 
field data contribute 

to differing 
conclusions. 

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Comparison 
Criterion 

Studies in Agreement Studies in Divergence Potential 
Explanations 

Policy and 
Institutional 
Response 

Authors concur that policy reforms and 
institutional strengthening are critical 
for managing transitions from donor 
aid, with emphasis on governance 

quality, stakeholder engagement, and 
the creation of sustainable financing 

and accountability 
frameworks (Nonvignon et al., 

2024) (Mhazo & Maponga, 
2024) (Ifeagwu et al., 2021) (Dianda, 

2020). Political stability and 
democratic governance are linked to 

increased domestic health 
spending (Dianda, 2020). 

Divergence is evident in the degree 
of actual policy implementation and 

ownership; some countries show 
advanced reforms and stakeholder 
participation, while others struggle 
with fragmented systems, lack of 
transparency, and limited public 
consultation (Paul et al., 2020). 

Differences reflect 
political economy, 

governance 
maturity, donor 

coordination, and 
civil society 
involvement. 

Historical legacies 
and crisis 

experiences (e.g., 
COVID-19) shape 
reform trajectories 

and stakeholder 
dynamics. 

 
 
 
 
3.7 Practical & Theoretical implications 
Practical Implications 
Policymakers are expected to focus on enhancing domestic health financing by 
improving their tax structures, public financial management, and innovative sources 
of funding, they should understand and address the shortcomings in addition to the 
political obstacles of such a strategy(Atim et al., 2020)(Brikci, 2023). Sustainable 
health financing needs a coordination of efforts between ministries of health and 
finance. 
The stoppage of USAID prompts healthcare management and institutional capacity to 
maintain health interventions post-withdrawal. This is shown by case studies of 
Kenya’s Output-Based Voucher Scheme(Onyango et al., 2024). stakeholder 
engagement and political commitment are critical for sustaining service coverage. 
The health financing reform ought to consider lowering the number of individual 
(out-of-pocket) expenses to guarantee effective financial risk security as well as the 
access of quality health services in keeping with universal health coverage (UHC) 
models(Ifeagwu et al., 2021). This entails the need to increase equitable national 
health insurance programs and the involvement of the government and the private 
sector. 
The costs of communicable diseases, especially HIV/AIDS illustrate why there is a 
need to reduce productivity loss through disease control programs and country-level 
economic and social policies which should be incorporated to facilitate sustainable 
development(Brown & Essi, 2021)(Resch et al., 2011). Investments in ART programs 
have high economical returns and thus they should be continued and even more 
funding should be devoted. 
Investments in health infrastructure, technology, and digital health solutions like 
telemedicine can help fight disparities in access, particularly to rural and underserved 
regions, which would also help to enhance health outcomes and economic 
output(Agyei & Kumah, 2024)(Omaghomi et al., 2023). But, these need-friendly 
regulatory supports and capacity building. 

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The issue of budgeting by Benin, had to face when implementing UHC reforms 
emphasizes the necessity of transparent and inclusive policies developed via the 
participation of key stakeholders and the needs to manage public expenses 
successfully to guarantee their sustainable funding and equitable access to health 
services(Paul et al., 2020). Reform implementation in political feasibility and 
stakeholder ownership is highly recommended.     
 
3.8  limitation of Review 
 
Table 7 

Area of Limitation Description of Limitation Papers which have limitation 
Geographic Bias Many studies focus predominantly on anglophone or 

specific African countries, leading to limited external 
validity across the continent. This geographic bias 

restricts the generalizability of findings to francophone 
or less-studied regions. 

(Ifeagwu et al., 2021) (Dolan et al., 
2020) (Brikci, 2023) 

Data Quality and 
Availability 

Several analyses are constrained by limited access to 
high-quality, comprehensive, and comparable data, 
especially regarding health financing and economic 
indicators. This limitation affects the robustness and 

reliability of conclusions drawn. 

(Atim et al., 2020) (Hollingworth et al., 
2023) (Dolan et al., 2020) 

Methodological 
Constraints 

The reliance on cross-sectional or limited longitudinal 
data, and the use of econometric models with 

assumptions that may not hold universally, restrict 
causal inference and may introduce bias, weakening 

internal validity. 

(Dolan et al., 2020) (Hollingworth et al., 
2023) (Brown & Essi, 2021) 

Publication and 
Reporting Bias 

Systematic reviews and meta-analyses may suffer from 
publication bias, with underreporting of negative or null 

results, and exclusion of grey literature or policy 
documents, limiting the comprehensiveness of evidence 

synthesis. 

(Ifeagwu et al., 2021) (Brikci, 2023) 

Limited Focus on 
Non-Financial 
Factors 

Many studies emphasize financial aspects of health and 
education systems but insufficiently address socio-

cultural, political, and institutional factors that critically 
influence outcomes post-USAID withdrawal. 

(Atim et al., 2020) (Mhazo & Maponga, 
2024) (Hutchinson et al., 2024) 

Short-Term Analysis A number of studies assess immediate or short-term 
impacts without capturing long-term effects of donor 

withdrawal on economic, health, and education 
systems, thus limiting understanding of sustained 

consequences. 

(Onyango et al., 2024) (Dolan et al., 
2020) (Resch et al., 2011) 

Limited Examination 
of Policy 
Implementation 

There is a scarcity of research on the dynamics of 
policy implementation, stakeholder collaboration, and 
governance reforms following aid withdrawal, which 
are crucial for effective transition and sustainability. 

(Ifeagwu et al., 2021) (Brikci, 2023) (Paul et 
al., 2020) 

Small or Non-
Representative 
Samples 

Some case studies or evaluations rely on small or 
localized samples, which limits the representativeness 
and generalizability of findings to broader African 
contexts. 

(Onyango et al., 2024) (Hailemichael et al., 
2011) 

 
 
 
 
3.9: Future Research Directions 

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Gap Area Description Future Research 
Directions 

Justification Research 
Priority 

Limited longitudinal data 
on economic impact 

post-USAID withdrawal 

Most studies provide short-term 
or cross-sectional economic 
impact assessments without 

capturing long-term trajectories 
or dynamic effects of donor exit 

on economies. 

Conduct longitudinal, 
country-specific 

econometric studies to 
track economic indicators 

over extended periods 
post-USAID withdrawal, 
incorporating informal 
sector and labor market 

dynamics. 

Long-term data is 
essential to understand 

sustained economic 
consequences and 
inform policies for 
economic resilience 
and diversification 

post-aid 
reduction (Apeagyei 

et al., 
2024) (Hollingworth 
et al., 2023) (Dolan et 

al., 2020). 

High 

Insufficient empirical 
research on education 

sector adaptation 

Education challenges and 
adaptive strategies following 

USAID withdrawal are 
underexplored, with few studies 

directly addressing education 
financing, policy reforms, or 

quality impacts. 

Investigate education 
sector responses to donor 

exit through mixed-
methods case studies, 
focusing on financing 

models, enrollment 
trends, and quality 

outcomes in affected 
countries. 

Education is critical 
for human capital 

development; lack of 
focused research 

limits understanding 
of sector 

vulnerabilities and 
integration with health 

and economic 
policies (Limong, 
2023) (Owolabi & 

Tijani, n.d.) (Dolan et 
al., 2020). 

High 

Underexplored health 
workforce paradox and 

its economic implications 

The paradox of surplus 
unemployed healthcare workers 
amid system shortages is poorly 

integrated into health system 
resilience and economic 
productivity analyses. 

Examine health labor 
market dynamics, 

including workforce 
deployment, 

unemployment, 
migration, and policy 

interventions to optimize 
employment and system 

capacity. 

Addressing workforce 
imbalances is vital for 

sustaining health 
services and economic 

productivity post-
donor 

withdrawal (Hutchins
on et al., 

2024) (Hailemichael 
et al., 2011). 

High 

Limited evaluation of 
innovative domestic 

financing mechanisms 

Existing studies show limited 
revenue potential and 

implementation challenges of 
innovative financing (e.g., taxes 
on mobile phones), with scarce 
evidence on their effectiveness 

post-USAID exit. 

Conduct rigorous impact 
evaluations and 

feasibility studies of 
innovative financing 

approaches, including 
political economy 

analyses and equity 
assessments. 

Understanding 
practical viability and 

scaling potential is 
crucial for sustainable 
health and education 

financing (Atim et al., 
2020) (Brikci, 2023). 

High 

Inadequate assessment of 
policy implementation 

and institutional reforms 

While policy recommendations 
exist, empirical evaluations of 
reform adoption, effectiveness, 
and governance improvements 
post-USAID withdrawal are 

scarce. 

Perform comparative 
policy implementation 
studies across African 
countries, focusing on 

governance, stakeholder 
engagement, and 

institutional capacity 
building. 

Effective institutional 
reforms underpin 

sustainable transitions 
from donor aid; 

empirical insights can 
guide tailored policy 
design (Onyango et 
al., 2024) (Mhazo & 

Maponga, 2024) (Paul 
et al., 2020) (Dianda, 

2020). 

High 

Data quality and 
methodological 
limitations in economic 
and health system studies 

Many analyses rely on 
aggregated or outdated data, lack 
longitudinal depth, and 
insufficiently integrate qualitative 
context, limiting robustness and 
policy relevance. 

Invest in strengthening 
local data systems, 
capacity for economic 
evaluations, and mixed-
methods research to 
improve evidence quality 
and contextual 
understanding. 

High-quality data and 
rigorous methods are 
foundational for 
accurate impact 
assessment and 
informed decision-
making (Hollingworth 
et al., 
2023) (Apeagyei et 
al., 2024). 

High 

Insufficient research on 
cross-sectoral integration 
of health, education, and 

Few studies explicitly analyze the 
interconnected effects of USAID 
withdrawal across economic, 

Develop interdisciplinary 
research frameworks and 
models to assess cross-

Integrated approaches 
are necessary for 
holistic understanding 

Medium 

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economic impacts health, and education sectors 
simultaneously. 

sectoral impacts and 
synergies, informing 
integrated policy 
responses. 

and sustainable 
development planning 
post-donor exit (Cerf, 
2019) (Ly et al., 
2017) (Sukran et al., 
2023). 

Limited exploration of 
technological innovations 
in healthcare post-donor 
exit 

Opportunities and barriers for 
telemedicine, big data analytics, 
and disruptive technologies in 
enhancing health system 
resilience remain under-
investigated. 

Conduct implementation 
research and policy 
analyses on digital health 
innovations, 
infrastructure needs, 
regulatory frameworks, 
and workforce training in 
African contexts. 

Technology can 
mitigate service 
delivery gaps and 
improve efficiency, 
critical amid funding 
transitions (Achieng 
& Ogundaini, 
2024) (Oppong, 
2020) (Omaghomi et 
al., 2023). 

Medium 

Scarce focus on socio-
political determinants of 
health financing and 
service sustainability 

Political factors influencing 
health spending and governance 
reforms are acknowledged but 
lack in-depth empirical 
investigation. 

Explore political 
economy of health 
financing reforms, 
including democracy, 
accountability, and 
stakeholder participation 
effects on funding 
sustainability. 

Political context 
shapes resource 
allocation and reform 
success, essential for 
sustainable health 
systems post-USAID 
withdrawal (Dianda, 
2020) (Dzingirai, 
2023). 

Medium 

Insufficient 
understanding of the 
impact of international 
sanctions and external 
shocks on health and 
education 

The effects of sanctions and 
global crises on health service 
access, financing, and education 
disruptions are under-researched 
in the context of donor 
withdrawal. 

Investigate how sanctions 
and pandemics interact 
with aid withdrawal to 
affect health and 
education outcomes, 
including mitigation 
strategies. 

External shocks 
compound 
vulnerabilities; 
understanding these 
interactions is vital for 
resilient policy 
design (Limong, 
2023) (Arewa, 
2024) (Ko et al., 
2024). 

Medium 

 
 
4.0 Synthesis and Conclusion 

The extensive pool of literature on the challenges and opportunities associated with 

the economics, healthcare, and educational spheres after the withdrawal of the USAID 

in Africa, demonstrates that it is a complex and multipronged environment where the 

factors are interconnected. Most fiscally, foregoing or scaling back funding of the 

USAID has tendency of enlarging fiscal gaps and moderating the growth of the GDP 

with communicable diseases and pandemics, having further exacerbating effects. 

Economic toll of health emergencies especially HIV/AIDS and other infectious 

diseases manifests negatively on labor output, human assets, and levels of income and 

therefore the need to continue on strategic health investments towards protection of 

economic growth. Nevertheless, there is also evidence of the possible positive 

economic payoffs of the well-designed health financing reforms and investments in 

treatments, like antiretroviral therapy, which can improve economic growth and 

poverty alleviation in the long-term perspective. 

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Regarding healthcare system resilience, the literature has been convergent in the 

importance of sustainable domestic financing, better governance, and infrastructure 

development in ensuring that delivery of the healthcare services is maintained after 

the withdrawal of USAID. The effects of donor funding replacement and the 

disproportionate assistance, the tendency of becoming increasingly popular, challenge 

the process of achieving universal health coverage, and the innovations, such as 

telemedicine or big data analytics, prove to be the promising directions of improving 

system efficiency and disease surveillance, despite the infrastructural and policy 

limitations. Still, short term success in the program can conceal deeper weaknesses in 

the system such as maldistribution of the workforce, informal payment practices and 

gaps in governance that have to be addressed to guarantee the sustainability of the 

system. 

 

The education sector was less directly investigated but demonstrates weaknesses 

related to interruption of the health services and economic deterioration with the 

indirect consequences regarding enrollment, quality, and the psychosocial wellbeing. 

The area of currently coordinated investment in health and education is understood as 

mutually reinforcing pathways on the way to developing human capital, but there are 

few studies of education-specific adaptation measures and financing methods 

themselves to education, which creates an equally critical gap in the literature. 

As to financing instruments, all available evidence leads to the conclusion that donor-

based funding is a very limited and ineffective option, and more domestic resource 

mobilization methods should be instituted via tax reforms, novel levies, and public-

private partnerships. Although new financing ideas hold certain potential, their 

revenue opportunities and achieving possibilities are usually limited and small, and 

are frequently restricted by political and institution willingness, which needs equal 

policy discussion and governance changes to establish adequate effect. 

Institutional reforms and policy responses highlight the importance of governance 

processes, stakeholders involvement and a multi-sectoral approach based on country 

context as key to the transition management of external aid. Nonetheless, empirical 

capacity to assess the level of the reform success is minimal, and the politics of health 

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and education expenditures remain under-investigated, which serves as evidence of 

the need to intensify studies on contextual aspects of policy success. 

 

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( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

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( ISSN 2811-2466 )                                                                                          Obiora Peters, Emeka PhD*  

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