Part two: If Marco Rubio came here “we could show him the evidence” of deaths, says villager

After the abrupt termination of American aid, the health system in central Mozambique descended into chaos.

In part 1 of this series, Spotlight and GroundUp explained how children with HIV had been abandoned by US-funded case workers.

In part two, we describe how the funding cuts affected hospitals, where key staff were dismissed and deliveries of new medicines were halted. In the ensuing turmoil, children died.
Below, we tell their stories.

On the hilly outskirts of Manica town in central Mozambique, Costancia Maherepa sits on a reed mat beside her mudbrick home and weeps over the death of her 11-year old daughter, Paciencia.

For years, their family had depended on the support of a US-funded organisation called ANDA (the National Association for Self-Sustained Development). It employed a network of case workers and health staff to care for vulnerable children living with HIV. Paciencia had been one of them.

“When the programme was running, all the kids in this area were healthy and taking their medication,” says Costancia. But now, everything has changed. The American aid that once financed ANDA’s work is gone and Costancia’s family has suffered the consequences.

Paciencia had a difficult life. Her father died six years ago, and Costancia struggled to grow enough food to keep her well-fed. Around 2021, a case worker employed by ANDA saw that Paciencia was malnourished, and took her for an HIV test. It came back positive.

But despite this, Costancia says her daughter was calm and resourceful. When Costancia was out farming, it was Paciencia who acted as household head, cleaning and cooking for her younger sister, aged nine. When facing hunger it was Paciencia who came up with a way to find food for the family, often by reaching out to neighbours.

And with the help of the case worker from ANDA, Paciencia started antiretroviral (ARV) treatment and began to recover. She put on weight and even improved her marks at school.
At the beginning of this year, she was getting ready to start grade six.

But at the same time, an election was taking place thousands of kilometres away from Pacienca’s mudhut in Manica. A new US president was sworn in, and a slew of executive orders were issued.

Shortly after, the institutions that had kept Paciencia alive would crumble.
Children given the “wrong medicines”
Mozambique is an overwhelmingly aid-dependent country. Its ARV medication is procured by the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international organisation.

Until a few months ago, the distribution of these drugs to Mozambique’s hospitals was heavily financed by US aid agencies, as was the transport of blood samples and specimens to the country’s labs.
US-funded organisations also employed much of the workforce at government health facilities, as well as the case workers who operate within communities.

When US President Donald Trump decided in January to suspend the US government’s global aid programmes, the health system in central Mozambique was up-ended.

Most of ANDA’s staff lost their jobs, including Ivone Mupacocha, the case worker who had been assisting Paciencia. But Mupacocha continued occasionally checking up on the children she once supported. When she reached Pacienca’s home some time after the funding cuts began, she found that the child had fallen ill.

The cause was clear, according to Mupacocha. When the 11-year old went to the health facility, she had been administered the wrong ARVs, and her body was reacting badly.

Others in the town of Manica told me similar stories.

HIV patients arrived at health facilities following the US funding cuts to find that everything had changed. Many of the health workers they knew were gone, and the queues stretched endlessly. After hours of waiting, they were handed drugs that differed from their usual prescription or were given much smaller doses of their medication than usual.

For instance, elsewhere in the town, another mother told me that her HIV-positive child was given a different regimen of medication after the funding cuts, and the new drugs made him feel ill.

The technical director of ANDA, Prince Mulondo, says that because US money funded the transport of drugs to health facilities, many hospitals in the region faced medicine stockouts following the aid suspension. Among the drugs which ran out were some ARVs. So health workers used alternatives that they still had in stock, or simply began rationing people’s medication.

In other cases, it appears that hospital staff simply didn’t know what drugs patients had been on. The data capturers that managed patient files were overwhelmingly US-funded and many were now gone, as were facilitators who acted as the first point of contact for vulnerable children like Paciencia.

Within a month after she was put on a different treatment regimen, Paciencia grew increasingly ill. On 10 March she was admitted to hospital, where she stayed for over three weeks. On 3 April, the 11-year old girl, who had successfully jumped over so many hurdles in her short life, died in hospital.

She was not the only one.