The United States Agency for International Development (USAID) has historically played a pivotal role in supporting health systems across Southern Africa, particularly through its contributions to HIV/AIDS, tuberculosis, maternal and child health, and health systems strengthening. However, recent abrupt funding cuts-especially to the President’s Emergency Plan for AIDS Relief (PEPFAR)-have triggered significant disruptions in service delivery, research, and public health infrastructure across the region. In South Africa, the withdrawal has jeopardized HIV treatment continuity, research programs, and community-based care models. Zimbabwe, Mozambique, and Malawi-countries with high HIV prevalence and fragile health systems-have experienced similar or more severe consequences, including clinic closures, staff layoffs, and interruptions in antiretroviral therapy (ART) distribution.

This desk study aims to provide a comprehensive overview of the immediate and projected impacts of USAID’s withdrawal on the health sectors of these four countries, with a focus on vulnerable populations and national health system resilience.

Objectives

The primary objectives of the desk study are:

• To document the scale and scope of USAID-supported health programs in South Africa, Zimbabwe, Mozambique, and Malawi prior to the withdrawal.
• To assess the immediate and medium-term impacts of USAID’s withdrawal on health service delivery, particularly in HIV/AIDS, TB, malaria, and maternal-child health.
• To identify the most affected populations and regions, with attention to gender, rural/urban disparities, and marginalized groups.
• To evaluate national and international responses to mitigate the funding gap.
• To provide recommendations for policy, advocacy, and donor engagement.

Scope of Work

The consultant or research team will:

• Conduct a literature review of peer-reviewed articles, grey literature, government reports, and donor communication.
• Analyze country-specific data on health outcomes, service coverage, and funding flows pre-and post-USAID withdrawal.
• Map key stakeholders and interventions affected by the funding cuts.
• Identify gaps in service delivery and emerging risks to public health.
• Synthesize findings into a comparative regional analysis.

3.     Methodology

This will be a desk-based qualitative and quantitative study, relying on:

• Secondary data from UNAIDS, WHO, national health ministries, and USAID reports.
• Policy documents, media coverage, and civil society statements.
• Comparative analysis across the four countries to identify common patterns and divergences.

4.     Deliverables

• Inception Report (5 pages): outlining methodology, sources, and work place.
• Draft Desk Study Report (15-20 pages): including executive summary, country chapters, and cross-cutting analysis.
• Final Report incorporating feedback from stakeholders.
• Presentation of findings to commissioning organization and partners.

5.     Timeline

The study is expected to take 6 weeks, with the following milestones:

6.     Qualifications

The consultant(s) should have:

• Proven expertise in global health policy, particularly in HIV/AIDS TB, malaria, and maternal-child health and donor-funded programs.
• Experience with desk-based research and regional comparative analysis.
• Strong writing and analytical skills.
• Familiarity with the Southern African health landscape.

7.      Reporting and Oversight

The consultant will report to the Rosa Luxemburg Stiftung-South Africa office.

8.     Application process

• A technical proposal outlining their approach (2-page max).
• A financial quotation covering all costs from conception to final delivery (1-page)

Proposals must be submitted to Fredson Guilengue (fredson.guilengue@rosalux.org) no later than 13:00 on 21 November,2025.

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