The Stop Stockouts Project (SSP) releases a new report titled: Impact, Adaptation and Opportunity – South Africa’s Health System Post-PEPFAR. For over two decades, the United States used PEPFAR to support South Africa’s response to the HIV/AIDS epidemic. This support was abruptly withdrawn in January 2025. This report assesses the impact of the abrupt withdrawal on South Africa’s health system, particularly on public healthcare users. It assesses the state of HIV testing services and the availability of contraception pre-and post the PEPFAR withdrawal in eThekwini, King Cetshwayo and uMgungundlovu, three districts in KwaZulu-Natal that have high HIV prevalence.
The report finds that members of key populations such as adolescent girls and young women were the first to experience reduced access when services come under pressure, as health systems prioritised treatment continuity over prevention and sexual and reproductive health services. This is reflected in early service disruptions, including declining HIV testing and emerging barriers to contraceptive access in the months following the funding withdrawal.
Contraceptive services showed the clearest signs of deterioration. In April–June 2025, the number of patients who were unable to access their preferred contraceptive method increased sharply across all three districts. Prior to PEPFAR disruptions, health care users across all three districts were able to access their contraceptive of choice. However, between April and June 2025, this changed with 5% of the health care users in King Cetshwayo reporting not being able to do so.
Despite no reported shortages of HIV test kits, 25–45% of facilities reported fewer staff available for HIV testing, leading to missed opportunities for diagnosis. Patient data shows only 37% of patients in uMgungundlovu and 28% in King Cetshwayo were offered an HIV test during facility visits.
Antiretroviral drugs and treatment (ART) collection systems demonstrated resilience through differentiated service delivery models, including external pickup points, which over 97% of patients reported as timesaving. However, efficiency declined in some areas. Health care users reported having longer collection time in the period following PEPFAR withdrawal. This can be attributed to the loss of human resources that were supported by PEPFAR funding. In eThekwini, 87% of patients using facility pickup points were still required to visit additional service points before collecting medication, increasing congestion and staff workload.
Refill practices also shifted. The proportion of patients receiving one-month ART refills increased across all three districts, while three-month refills decreased. This suggests that the districts responded to PEPFAR disruptions by shortening dispensing intervals, likely to manage uncertain supply or to address staff shortages. Shortened dispensing intervals result in more frequent clinic visits by health care users.
The report highlights uneven district experiences. uMgungundlovu maintained relatively stable services, reflecting stronger preparedness and decanting systems, while eThekwini and King Cetshwayo experienced sharper disruptions in testing, contraceptive access and refill lengths. These differences mask a common trend: facilities are absorbing the loss of PEPFAR-funded staff by redistributing existing Department of Health personnel, leaving less room to respond to future shocks.
The report recommends that government:
- expedite staff recruitment to fill vacancies in affected districts, such as uMgungundlovu and eThekwini, and developing a rapid redeployment plan for staff from lower-burden to high-burden facilities
- Optimise care models – including conducting assessments to streamline service delivery, expanding external pickup points, and integrating HIV testing into routine services
- Secure contraceptive supply chains by improving stock management and training staff to provide alternatives during stockouts
- Strengthen data systems with quarterly surveys and integrating key performance indicators will help to detect early pressure points.
The report concludes that short-term mitigation should not be mistaken for system stability. Without renewed investment in human resources, commodities and integrated service support, pressures are likely to intensify – particularly for HIV prevention, testing and sexual and reproductive health services that were already under strain before the funding withdrawal.
Click here for the full report.
For media enquiries contact:
SECTION27: Pearl Nicodemus | nicodemus@section27.org.za | 082 298 2636
MSF: Jane Rabothata | Jane.Rabothata@joburg.msf.org | 071 287 3613
RHAP | Russell Rensburg | Russell@rhap.org.za | 076 309 4261
More about Stop Stockouts Project
Established in 2013, the Stop Stockouts Project is a consortium of five civil society organisations Doctors Without Borders (MSF), Rural Doctors Association of South Africa (RuDASA), Rural Health Advocacy Project (RHAP), SECTION27, and the Treatment Action Campaign (TAC) that aims to monitor and report on medicine and vaccine shortages and stockouts at primary healthcare facilities.
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