By Sheila Macharia, Alex Omari, and Kerubo Onsoti

On January 24, 2025, the US State Department issued a stop-work order on USAID. The memo put a pause on new foreign aid spending, as well as a stop-work order for existing grants and contracts, and this affected country operations. FP2030 collaborates with governments to implement the FP2030 commitments. In response to this executive order, FP2030 ESA hub held a series of virtual meetings in February and March 2025 with seven FP2030 commitment countries—namely Ethiopia, Kenya, Rwanda, Tanzania, Uganda, Zambia and Malawi—from the East and Southern Africa Region to understand the magnitude and nature of disruptions affecting the health services sector and in particular the Sexual and Reproductive Health services including family planning programs. There is agreement with the commitment countries and FP2030 ESA that the gains for the 2030 family planning goals should not be lost. Secondly, FP’s domestic resource mobilization efforts, which started in 2024, must be accelerated in 2025. The initial report from countries concerning the effect of the loss of funding was that the health services systems had been affected immediately to varying degrees as follows:

National Health Information Systems, dependent on technical assistance from partners for maintenance, had to make new arrangements for that support. Health information is still being collected, albeit with some challenges.
Logistics Management Information Systems, which are important for the contraceptive commodity supply information, have lost technical maintenance support. Countries are responding to ensure the supply chain remains strong.
Family planning commodity financing has reduced significantly, and governments will need a domestic resource mobilization response to procure contraceptives. Many countries estimate that by June 2025, there may be a stockout at national and sub-regional levels. UNFPA is following up on a global response to this situation. Most countries in the region are donor-dependent for the procurement of contraceptives, with governments’ contributions remaining in the minority amongst the partner contributions.
Procurement of contraceptive commodities by USAID was halted, affecting contraceptive commodity security.
Family planning services have been affected. Financial support for social behavior change, youth family planning services, training of health workers, quality improvement for services, planning, monitoring, and outreach services to ensure equitable access to services was no longer available for a vast number of countries. In some countries, this has been compounded by reduced funding from European donors in the first half of 2025.
Governments from the countries had responded quickly with internal meetings to address these broad challenges to the health system, but the process was ongoing. Being mid-stream in the financial year, it would not be easy to re-allocate funds from other sectors to the health sector. Still, governments were holding discussions internally and with other funders to determine what could be done urgently.
The membership of the FP2030 focal point committees, which provide oversight for the FP2030 commitments, has changed with the loss of USAID implementing partners. Therefore, FP2030 ESA agreed with countries that they use the most relevant forum to review the commitment regularly, e.g., the FP technical working groups. ESA will hold regular country meetings to support those accountability efforts. At the global level, FP2030 has mounted a campaign to raise new funds, champions, and an enhanced movement for family planning called the Made Possible by Family Planning campaign.

In April and May 2025, the FP2030 ESA hub convened the second round of calls with countries namely, Uganda, Kenya, Tanzania, Malawi, Zambia and Rwanda to get an update on the country response to the change in health sector particularly the family planning program and to determine the best way that FP2030 ESA could provide assistance as an important partner of the countries. Between 2023 and 2024, FP2030 ESA has partnered with USAID implementing partners and other in-country partners to finance activities in these commitment countries, including action planning and SMART Advocacy trainings to support the domestic resource mobilization efforts for family planning in several countries. In the absence of those partners, FP2030 ESA is defining a direct way of providing technical assistance either with other funded partners in the countries or as the ESA Hub.

Between February 2025 and May 2025, national governments have collated the gaps left by the shift in donor financing, moved swiftly to secure smooth continuation of health services by using an integrated approach, in some cases re-allocated government finances to forestall challenges, reached out to other funders, and began to develop a longer-term response plan. In most instances, these meetings held by FP2030 ESA turned out to be the first comprehensive meetings the Ministries of Health have had with partners to review the gap and the response for the family planning program. FP2030 ESA has the advantage of being a convening partner with many countries.

In the second round of country meetings, in April and May 2025, many had more updates about the changes being carried out in the health sector to ensure smooth service delivery, especially for sexual and reproductive health services. Kenya developed a report on the shift in donor financing and the country’s response early in 2025, setting a good example for the region. Other countries have been finalizing their plans, although the documents are not in the public domain per se.

Three countries had secured in-country partner support to transfer the USAID procured contraceptive commodities from the implementing partners’ custody to the MOH’s custody and plans for warehousing and distribution were ongoing. Other countries began making those arrangements because contraceptive commodity stocks had already set in. Many countries have begun domestic resource mobilization efforts for the FP program since national governments are now preparing the budget policies and plans for the 2025/26 financial year. It will not be easy to secure additional funding for FP, so they indicated alternative financing modalities, e.g., philanthropy contributions, development bonds, and other entities, will have to be considered. The GFF was discussed as a great opportunity for the FP program, given the integration of services that most countries have adopted.

The funding gaps have not only threatened commodity security but also interfered with demand generation efforts and reduced access to adolescent-friendly services. Youth-led CSOs, which have been working to support AYSRH, have lost funding and can no longer offer the innovative youth SRH service models. The initial interruption of the PEPFAR DREAMS activities had rendered AYSRH services redundant in many settings. AYSRH services will need urgent attention to prevent poor outcomes for young people.

Based on the update, meetings with countries, the ESA Hub continues to identify areas where it can provide technical assistance. The initial follow-up plan is as follows:

Collaboration with Malawi MOH to hold a meeting in mid-May 2025 with partners including UNFPA, Amref Malawi, and others to document the health systems gaps in the FP/RH services, develop a response plan, including in-country modalities for DRM.
Collaboration with the Zambia MOH will be used to conduct a fiscal space analysis towards the end of May 2025 to develop a road map for resource mapping and domestic resource mobilization efforts. In response to a request late last year, FP2030 ESA will provide a Consultant to work with the MOH and partners and define an efficient way to monitor progress on the FP2030 goals.
South Africa is now seeking to operationalize the FP2030 commitment. FP2030 ESA participated in an MOH-led meeting in collaboration with UNFPA South Africa, UNFPA ESA, CHAI, and other partners. The Executive Director of FP2030 attended the meeting in person, and the ESA Hub participated virtually. Among the follow-ups for FP2030 ESA is to work with MOH as they establish a coordinating mechanism for oversight of the FP2030 commitment, including an action plan and working with in-country partners.
Countries have determined to document self-reports on the progress achieved in 2024 towards the FP2030 commitment goals. ESA will support these countries’ requests and help to collate the success stories as part of a south-to-south learning effort.

FP2030 ESA began collaborating with RHSC in late 2024 and had the opportunity to contribute strategic ideas to their work for the ESA region. In April 2024, RHSC requested the ESA hub to provide an entry point for them with the commitment countries to provide information about the GHSC-PSM project funded by USAID, which is closing in May 2025. They needed to communicate this information to a broader audience in the countries. FP2030 ESA was happy to provide this platform and invited RHSC to attend the individual country meetings with partners in April and May 2025 as described above. RHSC then shared information with countries concerning a 6-month grace period where they will pay for the VAN tool, an update on when the GHSC-PSM was ending, and finally, that USAID contraceptive procurements would no longer occur.