Low-income countries are reeling from the sudden and wide-ranging cuts to U.S. government foreign assistance, as well as from announcements that several European donor governments are also reducing their contributions. Among the worst affected is South Sudan, a country which is experiencing multiple, intersecting crises. These crises include a breakdown in the 2018 revitalised peace agreement, a severe economic recession made worse by the war in neighbouring Sudan, a food crisis, widespread chronic flooding and outbreaks of disease. Some groups of people are particularly vulnerable, such as internally displaced people, returnees and refugees from Sudan, Ethiopia and other countries who are living in South Sudan. South Sudan relies on international assistance to provide basic services to its people and support civil society-led peacebuilding efforts to avoid a return to war.
To discuss these challenges and reflect upon how they have been amplified by recent global aid funding cuts, SSHAP and the University of Juba organised a roundtable discussion. Government actors, academics, development partners and journalists shared their reflections on the sweeping impacts on people and programmes in South Sudan.
This report summarises the contributions from participants who were asked to reflect on the following topics:
- How are funding cuts to global aid affecting people and programmes?
- How is renewed conflict changing needs and programmes?
- What research or information may be needed to understand the changes going forward?
A call for South Sudan’s government to review and change priorities
The roundtable participants expressed alarm at the unfolding, devastating impact of aid cuts, especially by the U.S. government, on the developmental and humanitarian landscape in South Sudan. The cuts have particularly affected the health sector. The participants called upon the South Sudan government and aid organisations to:
- Adopt a policy shift that reduces the country’s overdependence on external funding and prioritises domestic investment in critical sectors;
- Focus on co-financing programmes in the health and other sectors, such as the Health Sector Transformation Project; and
- Explore alternative funding sources, such as the African Development Bank and the World Bank, to sustain gains from key externally funded programmes, particularly in peacebuilding.
A senior academic at the Graduate College of the University of Juba succinctly vocalised the thoughts of many participants when he asserted that the cuts serve as a wake-up call to steer the country towards a direction of strategic self-reliance. Participants observed that for far too long the government has not paid enough attention to basic service delivery despite repeated expressions of commitment to address health, education and other basic needs of the people of South Sudan.
Current spending on health
Almost half the financing for the health sector in South Sudan has come from external donors in recent years, while public expenditure from South Sudan’s government as a proportion of the gross domestic product is the lowest in the World Health Organization African Region. According to a senior medical official, less than 2% of the government’s budget in 2023/2024 was allocated to health. In 2022, 49% of health spending came from external sources (of which 43% came from the U.S. government), 9% from domestic revenues, 34% was from out-of-pocket spending by patients and 8% from other sources.
Out-of-pocket spending by patients reduces healthcare access and causes financial impoverishment for some households, while it also compensates for facilities’ revenue shortfalls. Before funding cuts to the United States Agency for International Development (USAID), a participant shared that primary healthcare facilities only received around USD 50 per month to cover operating costs. Since the cuts, operating budgets across the health system have been further reduced. Funds transfers to medical facilities, including Juba Teaching Hospital, have been losing value or purchasing power for several years and since the funding cuts they have become even more irregular. Government salary payments are also frequently delayed, sometimes up to six months, causing hardships for health workers. Funding for community health workers through the government’s main Boma Health Initiative is also limited: the funding covered only 40% of health facilities nationwide before the aid cuts.
The biggest area of USAID investment for health in the last three years has been in nutrition (53%), followed by maternal and child health, HIV/AIDS, family planning and reproductive health, pandemic preparedness and response, and water, sanitation and hygiene (WASH). Over half of USAID health funding went to multilateral assistance (55%), while 41% went to nongovernmental organisations (NGOs) and faith-based organisations.
Compounded impacts on the health sector
The withdrawal of donor funding has impacted the country’s capacity to deliver life-saving services. Meeting participants shared examples, including the loss of jobs for health workers, the reversal of progress made in controlling HIV and AIDS, and the end of extension (outreach) nutrition services. With the lean season (the period when food stocks run low between April when rains began and August when the new harvests begin) just now beginning, people speak openly and widely of the lack of any health services and the current food insecurity, understanding that the most difficult period is still ahead of them. The aid funding cuts will worsen the country’s already dismal health indicators, including high mortality rates (especially of children), and its ability to prevent and respond to epidemics.
The country is grappling with an outbreak of cholera that has crossed international borders and claimed 1,000 lives as of May 2025. Save the Children has linked the deaths of children walking to a hospital for cholera treatment in flood- and conflict-affected Akobo, Jonglei, to health facility closures. While oral cholera vaccines have so far reached 5,000 people at risk in some settlements for displaced people, transmission is expected to continue and worsen with the June rains. Large-scale WASH infrastructure projects – most needed to prevent the spread of cholera – have been put on hold since the USAID cuts.
NGOs have managed health facilities across the country, including in remote areas, and these facilities are now closing or facing the prospect of closing. A director-general for aid coordination at the Ministry of Humanitarian Affairs and Disaster Management reported to the participants that several international and national organisations were not renewing their operational licences. This indicates that the NGOs had run out of funds and so were scaling back or entirely closing programmes. This is also in addition to challenges the World Bank- and UNICEF-led Health Sector Transformation Project had in 2024 to secure implementing partner NGOs to keep some hospitals open in the global economic recession following the COVID-19 pandemic. In 2025, worsening conflict has further reduced healthcare access, especially in the north-west of the country. Médecins Sans Frontières had to suspend outreach services in January and hospital services in April after attacks on their programmes in Ulang, Upper Nile State. In May, a Médecins Sans Frontières hospital was bombed in Old Fangak in Jonglei State – this is likely to have a substantial impact on partners’ future willingness and ability to respond in the most insecure areas.
Responses to the funding cuts
As outside funding for critical health and other infrastructure dries up, participants stated that it is inevitable that the government steps in to fill the gap. While participants recognised the need to fund the security sector, which has consumed most of the country’s annual budget allocations for many years, they reiterated the importance of allocating sufficient resources to basic service delivery, especially healthcare. Failing to do so would have negative security implications. Health service disruptions in recent years have been the focus of public protests to draw attention to the lack of government solutions.
Some participants proposed that the government should convene a high-level taskforce to revisit the country’s funding strategies, especially of the health sector. The taskforce could identify new strategies to mitigate the unfolding negative consequences of over-reliance on the increasingly unreliable support from the international community.
While it is crucial for the government to change course, some participants recognised that it is going to take time for efforts to shift to domestic funding of critical infrastructure. One reason time is needed is because the flow of oil to international markets, on which the country depends, has been disrupted by the fighting in Sudan. Hence, some participants called on the government to exert efforts to mobilise funds from other sources, especially the African Development Bank and the World Bank. Diplomatic efforts to ensure that funds can be sourced are ongoing, but there is still a need to redouble ongoing efforts.
Moreover, some participants credit the government for engaging in some co-financing arrangements – such as the Health Sector Transformation Project and with Gavi, the Vaccine Alliance – and urged the government to enhance these arrangements. The participants observed that when the government demonstrates intent to put its resources to the right uses, potential funders will likely be more willing to provide support.
Impacts on local economies and societies
Researchers described important short- and long-term effects of aid cuts for communities already impacted by decades of crises. The researchers have been working with NGOs and the observations are from different studies across South Sudan.
In Leer, Upper Nile State, people endured mass displacements in 1991 after the split in the Sudan People’s Liberation Movement/Army, in the late 1990s during the oil wars and since the recent civil war began in 2013. Cattle keeping was a central part of the economy and organised society, but widespread cattle looting over the last 12 years, along with the unpredictability of flooding since 2019, has led many people to abandon this. Many people have turned to market livelihoods, and Leer people are said to have gained a reputation for climate adaptation. Leer has been a humanitarian hub for southern Unity State, and NGO jobs have also been important for market liquidity and for making Leer’s reinvention sustainable. As a result of USAID cuts, however, over 500 jobs have been lost in Leer this year, with profound effects on the town. Extended families depend on this money for food, and shops depend on it for custom.
The impacts of aid cuts will likely be gendered and have long-term consequences. The changes of the past few years have given women more work but counterintuitively also less power. New versions of customary law enforce father/husband control of women’s earnings and enable violence against women. Women are expected to make money and raise families, while it is easier for men to divorce women and separate them from their children. More young men are likely to be drafted into the checkpoint and looting economy, as women, men and their children need to reinvent their livelihoods again, quickly. Family planning programmes (which help women manage reproductive choices) and woman-and-girl-friendly spaces (which support societal resilience) have both benefitted from USAID support. Participants worry that ongoing humanitarian prioritisation exercises, which must favour life-saving services, will sacrifice these other programmes for women, leaving them alone in a time of terrifying and fast change.
In central areas of the country across Warrap, Unity, Lakes and Western Bar el Ghazal States, the United Nations Mission in South Sudan (UNMISS) previously had a widespread presence. Actors in the UN cluster system actively supported locally rooted conflict prevention and resolution mechanisms to help implement the 2018 peace agreement. This conflict prevention was a painstaking process, which involved bringing together diverse actors with different world views – such as cattle camp youth, traditional spiritual leaders, state authorities, intellectuals and NGO staff – into regular conversation. Foreign aid provided resources for transportation and telecommunications in very remote areas to facilitate frequent meetings and outreach for peacebuilding. Between 2021 and 2023, communities at the border of Lakes and Unity States attributed improvements in security in part to externally supported local conflict prevention mechanisms. Since the recent and widespread donor cuts, however, there has been minimal interaction between international actors or the government and communities for preventive actions. Meeting participants described recent, preventable shootings, which they attributed to small-scale disputes going unresolved, and saw local implementation of the peace process unravelling.
The importance of continued foreign assistance to support civil society, peacebuilding and independent journalism
Journalists participating in the roundtable discussion described how independent community radio and online reporting contribute to both humanitarian programming and peacebuilding. Independent media in South Sudan have historically been supported by foreign aid. The independent media regularly engage communities on key issues of interest to humanitarian and development actors, such as health, nutrition, education, protection and gender-based violence. Independent media counter misinformation and disinformation during disease outbreaks.
Radio platforms provide an accessible space for dialogue, allowing communities to voice concerns and express their needs. Radio call-in programmes engage people at the local level to talk about the security situation, including to discuss whether the peace agreement is being violated, to highlight where food is not being distributed and to share how local people think interventions can be better developed.
Journalists are key in holding government actors to account, providing balanced reporting in a context of limited press freedom. Journalists also provide an alternative narrative to counter hate-speech, which can fuel conflict, on the radio and online. As described in a recent SSHAP blog, USAID funding cuts have threatened this kind of coordinated, trusted two-way communication across the wider response in South Sudan – likely to have real consequences for people’s access to services, support and protection.
Meeting participants underlined the vital importance of the continued financial, technical and political support of external actors for an independent media, a local conflict prevention and resolution mechanism, and programmes for women’s and children’s rights. External support is vital given the role of South Sudan’s government in propagating conflict. These kinds of programmes support long-term peacebuilding – an essential ambition to enable progress in all areas of humanitarian response and so that South Sudan does not slip back into war.
A need for continued information collection and situational monitoring
Humanitarian and development actors in South Sudan have once again found themselves in a period of uncertainty. Meeting participants described a high volume of meetings, information-collecting and other activities taking place to investigate the full extent of USAID funding cuts on programming. These activities follow an exhausting several years of continual regrouping to respond to new and major crises affecting the region. UN and government coordination mechanisms are responding to the sudden gaps in funding by adjusting projections of humanitarian need and understanding which organisations can continue to deliver on service delivery contracts and be counted on in new strategic planning.
Given the funding instability, there is a need to focus on life-saving services. There is a need to monitor which health and nutrition services remain operational, what gaps have emerged and how these gaps vary in relation to conflict dynamics and accessibility. The monitoring includes assessing potential inequities in service delivery, such as whether certain populations (including specific ethnic groups or communities in insecure or hard-to-reach areas) are receiving fewer services or being excluded from assessments, and evaluating how service quality and coverage are being impacted overall.
There are now fewer partners with funding to conduct needs assessments, such as SMART surveys, which measure malnutrition and mortality and aid government responses to the rising food insecurity. Targeted data collection should focus on areas that remain inaccessible due to insecurity or terrain, where existing information is sparse and where indicators are likely to be worse than currently measured.
Universities in South Sudan, including the University of Juba, enjoy a trusted relationship with the government. The universities provide important technical training to the country’s workforce and are periodically called on to strengthen capacities in the Ministry of Humanitarian Affairs for emergency needs assessments in times of crisis. As the government re-examines its priorities and takes on increasing leadership in basic services financing, meeting participants called on South Sudanese academic institutions and think tanks to play their role and conduct research to provide evidence on the impact of foreign aid cuts to guide policy priorities.
Roundtable discussion participants
Chair: Leben Moro (University of Juba, South Sudan, SSHAP)
With: Jennifer Palmer (London School of Hygiene & Tropical Medicine, United Kingdom, SSHAP)
Rapporteur: Madel Thiong, (University of Juba, South Sudan)
Participants:
John Pasquale Rumunu (Director General of Research, Ministry of Health, South Sudan)
Lawrence Akola (Director General of Planning, Training & Coordination, Ministry of Humanitarian Affairs)
Sarah Jokuil (Ministry of Humanitarian Affairs, South Sudan)
Richard Tito Longa (Director General of Humanitarian Coordination, South Sudan Relief & Rehabilitation Commission)
John Jieu Auek (South Sudan Relief & Rehabilitation Commission)
Isaac Cleto Rial (Deputy Vice Chancellor for Academic Affairs, University of Juba)
Maxwell Adea (Acting Principal of Graduate College, University of Juba)
Deng Malual (Acting Dean of School of Medicine, University of Juba)
Johnathan Majok (Head of Department of Community Medicine, University of Juba)
Mohamed Sulieman Ali (Deputy Dean of School of Pharmacy, University of Juba)
Jacob Thon Bor (School of Pharmacy, University of Juba)
Kiden Mary (Accountant, University of Juba)
Ann Poni (University of Juba)
Akuei Kuol (University of Juba)
Richard Oryen (University of Juba)
Gonda Taban (University of Juba)
Eddie Thomas (Independent researcher, UK)
Wol Athuai (Executive Director, Bridge Network Organisation, South Sudan)
Rembe Seme (Liaison Officer, NGO Forum, South Sudan)
Tot Janguan (Strategic Coordination, NGO Forum, South Sudan)
Simon Thuong (Field Manager for Walgak-Akobo East & West, Save the Children South Sudan)
Abdullahi Aden (Field Manager for Abyei, Save the Children South Sudan)
Sophie Chambers (Programme Development & Quality Director, Save the Children South Sudan)
Asaminew Kassa (Business Development Manager, Oxfam South Sudan)
Stephen Omiri (Eye Radio, South Sudan)
Sarah Poni Subandrio (Community Engagement Network, South Sudan)
Chris Marol (The Radio Community, South Sudan)
Martin Ahimbisibwe (Incoming Head of Nutrition, World Food Programme South Sudan)
Olakitan Abdulrasheed Jinadu (Development Economist, World Bank, Nigeria)
Ayesha Ragunathan (Health advisor, British Embassy, South Sudan)
Peggitty Davey (Humanitarian advisor, British Embassy, South Sudan)
Pippa Ranger (Behavioural Science Advisor, United Kingdom’s Foreign, Commonwealth and Development Office, UK)
Gillian McKay (Senior Humanitarian Health Research Advisor, Elrha, UK)
Shivani (Elrha, UK)
Hayley MacGregor (Institute of Development Studies, SSHAP, UK)
Juliet Bedford (Anthrologica, SSHAP, UK)
Melissa Parker (London School of Hygiene & Tropical Medicine, SSHAP, UK)
Authors: Leben Nelson Moro (University of Juba, SSHAP) and Jennifer Palmer (London School of Hygiene & Tropical Medicine, SSHAP)
Acknowledgements: We thank all participants for joining the discussion, and Madel Thiong for acting as rapporteur. This brief is the responsibility of SSHAP.
Suggested citation: Moro, L. N. and Palmer, J. (2025). Meeting report: The impact of global aid funding cuts on people and programmes in South Sudan. Social Science in Humanitarian Action Platform (SSHAP). www.doi.org/10.19088/SSHAP.2025.031
Published by the Institute of Development Studies: June 2025.
Copyright: © Institute of Development Studies 2025. This is an Open Access paper distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY 4.0). Except where otherwise stated, this permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited and any modifications or adaptations are indicated.
Contact: If you have a direct request concerning the brief, tools, additional technical expertise or remote analysis, or should you like to be considered for the network of advisers, please contact the Social Science in Humanitarian Action Platform by emailing Annie Lowden ([email protected]) or Juliet Bedford ([email protected]).
About SSHAP: The Social Science in Humanitarian Action (SSHAP) is a partnership between the Institute of Development Studies, Anthrologica , CRCF Senegal, Gulu University, Le Groupe d’Etudes sur les Conflits et la Sécurité Humaine (GEC-SH), the London School of Hygiene and Tropical Medicine, the Sierra Leone Urban Research Centre, University of Ibadan, and the University of Juba. This work was supported by the UK Foreign, Commonwealth & Development Office (FCDO) and Wellcome 225449/Z/22/Z. The views expressed are those of the authors and do not necessarily reflect those of the funders, or the views or policies of the project partners.
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