When the Donor Walks Away

# Overview African leaders in New York urged countries to take greater control of their health systems. Ghanaian President John Mahama released A Sovereign Future for Health, which argues that health priorities should be set by national needs rather than reorganising around outside funders. The call is straightforward, but the practical problem is what happens to medicines, clinics and personnel when donors leave.

# The Zambia example

# Why self-reliance can't be instant Calls for self-reliance are valid but incomplete. Strengthening domestic financing, building local manufacturing, improving procurement transparency and defining national priorities are necessary. They do not, however, immediately restock an empty pharmacy or sustain a disrupted programme. When aid runs on short funding cycles, it mismatches long-term conditions such as diabetes, hypertension, cancer and kidney disease that require continuous care, ongoing supplies and functioning laboratories.

# How aid became dependence Aid has saved lives: vaccination, HIV treatment, malaria control, maternal health and workforce training all benefited. But many projects were designed as pilots with vehicles, allowances and staff that communities came to depend on. When funding ends, services often shrink or disappear. Programmatic success has too often been measured by immediate targets rather than what remains after the final report is filed.

# Domestic choices and political incentives

# Role of diaspora and charities

# What donors must do when leaving Donors share responsibility. Abrupt withdrawal in response to governance failures may satisfy accountability demands but can turn patients into collateral damage. Transitions need time, clear plans and protections for essential services. The Accra Reset report recommends international cooperation that strengthens country-defined systems rather than building parallel projects and reporting structures.

# Practical next steps

• Prioritise domestic revenue mobilisation and budget protections for essential medicines and chronic care.
• Design donor programmes to integrate with national systems and leave clear, sustainable capacities behind.
• Invest in transparent procurement and local manufacturing where feasible to reduce supply vulnerabilities.
• Plan donor exits with phased handovers, safeguards for patient access and support for accountability improvements.

# Bottom line Sovereignty over health is a necessary objective. Achieving it requires patient political choices, new financing models and donor transitions that protect services during change. Without those practical steps, declarations of self-reliance risk leaving patients and front-line health workers to shoulder the consequences when the donor walks away.