Funding Cuts Threaten South Sudan’s Fight Against TB and HIV

(JUBA) – A quiet health crisis is unfolding in South Sudan, where the growing resurgence of tuberculosis (TB) and HIV is threatening the lives of millions already burdened by years of conflict, flooding and mass displacement. According to health officials, dwindling international support could reverse hard won gains in preventing and treating these diseases.

“TB and HIV are not in the news,” says Gerald Agaba, TB/HIV Programme Manager for Cordaid South Sudan. “But they are spreading.”

Agaba warns that with no other major partner besides the Global Fund supporting TB and HIV care at this scale, any cut in funding could collapse the entire system.

South Sudan is already under immense pressure from the ongoing conflict in neighbouring Sudan, which has displaced over two million people. Many families now live in cramped conditions in displacement camps or makeshift settlements with limited access to even basic healthcare, making disease transmission harder to control.

The country’s healthcare system is extremely fragile, with only one doctor for every 65,000 people, according to the GEMS Development Foundation. Only 25 percent of health facilities are equipped to treat TB, and access to HIV services is even more limited. Just 53 GeneXpert machines, used for TB diagnosis and HIV testing, serve the entire population.

“Some communities are unreachable during the rainy season. In certain areas, patients must walk more than 40 kilometres, an eight hour journey, to access TB treatment,” says Agaba.

Since 2016, Cordaid has implemented life saving TB and HIV programmes as a sub-recipient of Global Fund support. Today, Cordaid supports 183 facilities, covering 70 percent of the country’s TB treatment capacity.

In 2024 alone, nearly 20,000 TB patients were started on treatment, with an 85 percent treatment success rate, the highest in years.

The programme’s reach extends beyond hospitals and clinics. Cordaid has trained over 1,500 community health workers to screen, refer, and offer basic treatment at the household level. These community workers are not doctors, but are known and trusted locally, offering vital frontline support.

Cordaid also trains “expert clients” i.e. people living with HIV or those who have recovered from TB to act as community champions. By sharing their stories, they help combat stigma and encourage others to seek treatment.

The programme has also introduced innovations to improve efficiency and transparency. One of the key breakthroughs has been biometric payments for health workers, using fingerprint identification to eliminate ghost workers and double payments.

To support real time monitoring and reporting, Cordaid distributed 470 tablets loaded with data bundles to health facilities across the country. Staff use the devices to log patient data, access the electronic TB register, and participate in virtual learning sessions via WhatsApp with senior health officials. If a facility stops reporting for two days, programme teams are immediately notified.

Cordaid has renovated and solar powered 21 GeneXpert laboratories across South Sudan, improving diagnosis for TB and HIV viral load testing, and enabling early infant diagnosis.

The organisation works closely with local partners, community leaders and government institutions. Rather than running separate systems, Cordaid’s activities are integrated within South Sudan’s public health structures. This includes supporting government staff, using national reporting systems, and facilitating performance based top-up payments to existing health workers.

However, this progress is now under serious threat. The Global Fund, South Sudan’s primary funder for TB and HIV services, has reduced funding for 2024 to 2026 by around 11 percent. This includes a direct reduction of $1 million (approx. SSP 4.6 billion) for Cordaid’s project.

The cutbacks come at a time when global Official Development Assistance (ODA) is being deprioritised, despite rising health needs in fragile countries like South Sudan. The Global Fund’s eighth replenishment campaign, which aims to raise $18 billion for the 2027–2029 period, is ongoing.

“We are not just saving lives. We are restoring dignity and stability,” Agaba emphasises. “Every clinic that stays open, every health worker who gets paid, every mother who doesn’t have to walk eight hours with a sick child, that is what global solidarity looks like.”

Cordaid warns that without urgent action and renewed investment, South Sudan could face a new epidemic.

“We could see a full blown TB crisis,” Agaba says. “And it wouldn’t stay here. Diseases don’t know borders.”

Key Health Indicators in South Sudan