The United States is restructuring how it delivers life-saving medical supplies for HIV and malaria to low-income countries, a shift that officials and health experts warn could disrupt treatment access across parts of Africa and Asia.

The changes centre on winding down the Global Health Supply Chain Program – Procurement and Supply Management, a U.S.-funded initiative run by Chemonics, which has coordinated the delivery of critical medicines and prevention tools since 2016. According to internal communications and multiple sources familiar with the matter, U.S. officials have been instructed to begin halting implementation of the programme by May 30.

From its inception through 2024, the programme distributed more than $5 billion worth of HIV and malaria-related commodities to 90 countries, with a primary focus on sub-Saharan Africa and parts of Asia. The supplies included antiretroviral drugs, malaria treatments and insecticide-treated bed nets, forming a key component of global disease control efforts.The restructuring follows broader changes to U.S.

foreign aid policy under the administration of Donald Trump, which has prioritised reducing reliance on contractors, cutting budgets and shifting toward direct agreements with recipient governments. The overhaul also comes after the dismantling of the United States Agency for International Development, which had previously overseen much of Washington’s development assistance.

Five sources familiar with the transition said the pace of the changes risks creating supply gaps for essential medicines, particularly in countries with fragile health systems. An internal email reviewed by Reuters warned that accelerating the transition without a clear implementation plan could jeopardise continuity of services.

The communication, sent by the U.S. State Department to staff in 17 African countries and Haiti, directed country teams to prepare for the end of programme operations while outlining potential risks. It did not provide a detailed roadmap for replacement mechanisms, instead asking local offices to identify vulnerabilities and report back to Washington.

A State Department spokesperson said the agency had not issued technical instructions for Chemonics to cease operations by May 30, though the contract is set to expire on September 30 in line with other USAID awards. The official end date is listed as November.

The uncertainty has revived concerns stemming from earlier disruptions. In January last year, a freeze on international aid left millions of dollars’ worth of medical supplies stranded in ports and warehouses worldwide, including HIV drugs and malaria prevention tools. Distribution resumed only after waivers were granted for life-saving interventions.

Six sources said the United States has been in discussions with the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using its procurement and distribution systems to replace the existing programme. The Geneva-based institution already manages approximately $2 billion in annual purchases for HIV, tuberculosis and malaria programmes through partnerships with national governments and implementing agencies.

However, two sources said earlier plans had envisaged a transition timeline extending to November 2027, allowing sufficient time for procurement cycles and logistical adjustments. Compressing this timeline into a matter of months could create operational bottlenecks, they said, noting that delivering medical supplies to remote areas can take up to a year from order to distribution.

The Global Fund declined to comment on the discussions. The State Department did not directly confirm the talks but said it would rely on pooled procurement mechanisms to secure supplies at competitive prices from private manufacturers.The policy shift is part of a broader “America First” approach to global health funding, which aims to reduce what officials describe as inefficiencies in the existing system.

A strategy document released in September argued that contractor-led programmes had contributed to waste and inflated costs, and emphasised direct funding for frontline services and national governments.

Under the new approach, Washington has signed 28 bilateral health agreements with partner countries and is increasingly channeling funds directly to national authorities. It also plans to use private logistics firms to handle distribution rather than relying on large development contractors.

Recent agreements with countries such as Kenya, Rwanda and Uganda include commitments to increase domestic health spending alongside U.S. funding. However, implementation has encountered obstacles. In Kenya, a proposed deal faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have been delayed as officials seek to safeguard national interests.

Health experts and aid practitioners say the transition risks compounding existing vulnerabilities in global disease control programmes. Previous disruptions linked to funding changes have already contributed to shortages of malaria treatments for children and gaps in HIV prevention services in several countries.

The State Department defended the overhaul, describing the current system as outdated and inefficient. A spokesperson said the new model would prioritise value for American taxpayers while maintaining support for critical health interventions.

Despite those assurances, several sources involved in programme delivery said the lack of a detailed transition plan remains a central concern. They warned that without clear coordination between donors, governments and implementing partners, the shift could interrupt supply chains that millions depend on for survival.

Zuwaira Hanafi stood outside a healthcare facility in Kaita, in Nigeria’s northern Katsina state, as medical staff hurried into a ward where her eight-month-old daughter lay semiconscious, underscoring the urgency confronting health workers in a region grappling with rising levels of severe malnutrition.

At the entrance, clinicians used colour-coded measuring tapes to assess the mid-upper arm circumference of children, a standard method for diagnosing malnutrition.

A steady flow of mothers, including teenagers, arrived with infants in critical condition, reflecting what humanitarian agencies describe as a deepening hunger crisis affecting large parts of the country.The International Federation of Red Cross and Red Crescent Societies has warned that as many as 33 million Nigerians could face severe hunger in 2026, a record level.

Data from the United Nations Office for the Coordination of Humanitarian Affairs indicates that approximately 6.4 million children in Nigeria are expected to be acutely malnourished by the end of the year, with the burden concentrated in northern regions such as Katsina.

Dr Soma Bahonan, head of the Nigeria mission for the Alliance for International Medical Action (Alima), which operates the Kaita facility in partnership with local authorities, said the crisis is expanding beyond children. Increasing numbers of mothers are also presenting with acute malnutrition, compounding the risks to infant health and survival.

Alima has expanded its operations to include mobile clinics designed to reach remote populations unable to travel to fixed facilities. These services include transport support for critical cases from surrounding communities.

However, Bahonan described the scale of need as exceeding operational capacity, particularly in Katsina, which has become a focal point of what aid workers describe as an intergenerational hunger crisis.Longstanding drivers of food insecurity, including climate variability and structural governance challenges, have been intensified by rising insecurity.

Attacks by jihadist groups and other non-state actors have disrupted farming activities and restricted access to agricultural land, further weakening household food production and income stability.The strain on the healthcare system is evident in workforce shortages. Nigeria’s doctor-to-patient ratio is estimated at roughly 1:9,000, significantly below the World Health Organization’s recommended ratio of 1:600.

Medical professionals continue to leave the country, citing delayed salary payments and limited career prospects, further reducing service capacity in already underserved areas.While digital health startups and private-sector partnerships have made progress in urban centres such as Lagos and Abuja, their reach remains limited in rural and conflict-affected regions due to infrastructure deficits and high inflation.

This uneven distribution of innovation has widened disparities in healthcare access.Analysts describe Nigeria’s current situation as a convergence of multiple crises. Joachim MacEbong, a senior analyst at Control Risks in Lagos, said the country faces overlapping economic, security, and human development challenges that reinforce one another.

He noted that these interconnected pressures are contributing to deteriorating health outcomes and weakening institutional response capacity.Humanitarian organisations have begun planning for the annual lean season, typically spanning June to September, when food stocks decline and malnutrition rates tend to rise.

The period is expected to place additional stress on already constrained health and nutrition services.Policy interventions have been introduced, though their impact remains uncertain.

In 2025, the Nigerian government partnered with the World Bank to implement the Accelerating Nutrition Results in Nigeria project, aimed at delivering basic nutrition services to vulnerable households.

A second phase of the programme is currently under way, but experts say broader structural reforms are required to improve food affordability and strengthen social protection systems.Supply chain inefficiencies continue to limit access to essential medicines and equipment.

Peter Bunor Jr, co-founder and head of growth at Field Intelligence, a health technology company focused on pharmaceutical logistics in Africa, said disruptions in global and domestic supply chains are contributing to shortages at the point of care.

Patients often travel long distances only to find that prescribed drugs are unavailable or replaced with alternatives, frequently at higher cost.Bunor said the impact of these shortages is amplified during a hunger crisis, as malnourished individuals are more susceptible to infections and require timely medical intervention.

He emphasised the need for better data integration and forecasting to prevent stockouts.In 2018, Field Intelligence launched the Nigeria Health Logistics Management Information System, a platform designed to track pharmaceutical supply data across public health programmes.

The system, now managed by the federal health ministry, has been expanded with support from UNICEF, and stakeholders are encouraging wider adoption among health agencies to improve coordination and anticipate shortages.Funding constraints remain a central concern.

Nigeria allocated approximately 5.2% of its 47.9 trillion naira national budget to the health sector, well below the 15% target set under the Abuja Declaration by African Union member states. Per capita health spending remains among the lowest on the continent.

In February, Health Minister Muhammad Ali Pate disclosed that of the 218 billion naira allocated for operations and capital projects under the ministry, only 36 million naira had been released. The figure, representing a small fraction of the approved budget, has raised concerns about implementation capacity and fiscal prioritisation.

MacEbong said the funding gap illustrates broader structural challenges in public finance management, noting that limited budget execution undermines service delivery even where allocations exist. He added that the scale of the crisis requires sustained government attention, particularly in sectors directly linked to human capital development.

Aid organisations continue to call for increased domestic investment in health and nutrition, alongside improved coordination with international partners.

As conditions in northern Nigeria worsen, frontline health workers face mounting pressure to manage a growing caseload with limited resources, highlighting systemic vulnerabilities in one of Africa’s largest economies.

“We condemn what the Gaza Strip is facing from military assault, targeting of civilians, the violations of international law by the Israeli occupation authorities,” Crown Prince Mohammed Bin Salman said during the African-Saudi summit in the kingdom’s capital.

“We stress on the need to stop this war and the forced displacement of Palestinians,” he added.

Israeli air strikes hit three Gaza hospitals and a school on Friday, killing at least 27 people, and a ground battle was underway near another hospital, Palestinian officials said, as Israel’s forces took on Hamas in the heart of the enclave.

Palestinian officials said 11,078 Gaza residents had been killed as of Thursday, about 40% of them children, in air and artillery strikes, with many others wounded.

Israel says 1,400 people were killed by Hamas in Israel, mostly civilians, and about 240 were taken hostage on Oct. 7, while 39 soldiers have been killed in combat since.

Leaders attending the African-Saudi summit in a joint declaration said military operations in the occupied Palestinian territories needed to stop and civilians must be protected, the state Saudi Press Agency (SPA) reported.

Leaders who attended the summit included the presidents of Nigeria, Kenya, Zambia, Djibouti and Mauritania, the prime ministers of Ethiopia and Niger, and the foreign minister of Egypt.

The leaders “stressed the need to end the real cause of the conflict represented by the Israeli occupation,” calling for intensified efforts to end the Israeli-Palestinian conflict based on a two-state solution “to guarantee the Palestinian people their right to establish their independent state on the 1967 borders, with East Jerusalem as its capital,” according to SPA.

They said the international community must play an important role in pressuring Israel to “stop Israeli attacks and the forced displacement of Palestinians from the Gaza Strip,” which it called “a flagrant violation of international humanitarian law and international laws.”

Israel says its goal is to dismantle Hamas’ military and governance capabilities following the group’s Oct. 7 rampage in southern Israel.

The hospitals attacked on Friday are in northern Gaza, where Israel says the Hamas militants are concentrated, and are full of displaced people as well as patients and doctors. Israel says Hamas is using them as human shields, which the group denies.

The African-Saudi leaders, in the “Riyadh Declaration”, called for relief organizations, including the United Nations Palestinian refugees agency UNRWA, to be supported in their efforts.

Saudi Arabia, as part of its Vision 2030 plan to overhaul its economy, will invest about $25 billion in Africa by the end of the decade, SPA said.

Saudi exports to the continent worth $10 billion will be financed and insured through 2030, and the Saudi Fund for Development will finance development projects worth about $5 billion in the same time frame, SPA added.

More than 50 deals and preliminary agreements were signed during the summit in fields including tourism, energy, finance, mining and logistics, SPA said.

“We are working with partners to support Ghana and other countries regarding their debt,” Jadaan added.

Saudi Investment Minister Khalid Al-Falih later said at the same conference the kingdom’s over $700 billion wealth fund, the Public Investment Fund, will make some “game changing” investments in Africa.

Saudi Energy Minister Prince Abdulaziz bin Salman, also at the conference, signed preliminary agreements with African countries including Nigeria, Senegal, Chad and Ethiopia on energy-related cooperation.

Biden will host a second summit with leaders of the Pacific Islands Forum at the White House on Monday as part of his efforts to step up engagement with a region where the U.S. is in a battle for influence with China.

The summit with the 18-member forum will take place on Monday and Tuesday in Washington.

“We are disappointed that PM Sogavare of the Solomons does not plan to attend,” a Biden Administration official said.

The Australian broadcaster ABC reported Solomon Islands Foreign Minister Jeremiah Manele will attend the summit instead.

The Solomon Islands Prime Ministers Office did not respond to a Reuters request for comment.

Sogavare spoke at the United Nations General Assembly on Friday in New York, where he praised China’s development cooperation as “less restrictive, more responsive and aligned to our national needs”, and said Beijing was its lead infrastructure partner.

Sogavare said he reached an understanding with President Xi Jinping during a July visit to China for Solomon Islands to achieve development through China’s policies, including the Belt and Road Initiative and Global Security Initiative.

Vanuatu Prime Minister Sato Kilman also will not attend the meeting, an official from his office told Reuters on Friday, because all Vanuatu government lawmakers need to be in parliament on Monday for a no-confidence vote.

But Bilan, the media house where Ahmed works as chief editor, is far from a punchline, producing a daily mix of hard news and in-depth features for local and sometimes international audiences.

In its almost 18 months of operation Bilan, which means “to shine a light”, has overcome prejudice and insecurity to illuminate some of the most taboo subjects in Somalia, including a female drug epidemic, albinism, women living with HIV and period shame.

“Sometimes my soul tells me I cannot continue the work because of insecurity and societal pressure. However, it is a career that I loved since my childhood and a dream which still lives in me,” Ahmed said.

Although it is supported by the United Nations Development Programme (UNDP), success has not come easy or risk-free for Ahmed and her team.

With more than 50 journalists killed since 2010, Somalia is the most dangerous country for journalists in Africa, according to Reporters Without Borders.

The Committee to Protect Journalists ranks Somalia last in its Global Impunity Index, which measures the number of unsolved journalist murders as a percentage of a country’s population.

As a deeply patriarchal society, some people find it difficult to discuss women’s issues publicly, Ahmed said. Others complain Bilan’s stories blemish the country’s reputation.

“We know Somalis, for them girls’ issues are shameful,” she said. “For example, signs of adolescence like menstruation, periods. Girls are not taught the symptoms of womanhood in the classroom.”

A story about the stigma surrounding menstruation became one of Bilan’s most viral when it was broadcast earlier this year, garnering more than 130,000 views and dozens of comments on Facebook.

“I used to feel fear when I wanted to share my personal problems with the teacher. I failed to express my problem,” said Maria Abdullahi Jama, a 19-year-old student at Bondhere School in Mogadishu. “I urge students not to feel shame and fear.”

The story prompted the Ministry of Women to offer to work together on an advocacy campaign, and has won over at least one Islamic cleric, a group that often holds the most conservative views in Somali society.

“It is good to give awareness to the girls about period and how to stay clean so they see it as something natural that all women have,” said Sheikh Abdi Hayi, who preaches at the Omar Ibnu Khadab Mosque.

Bilan has revolutionised the news agenda in Somalia, said Abdallah Al Dardari, director of the United Nations Development Programme Regional Bureau for Arab States.

“With their unique voice and the growing reach of the Bilan Media brand, they’re creating a demand for change and better treatment of women and girls that can’t be ignored,” Al Dardari said.

Storm Daniel barrelled across the Mediterranean into a country divided and crumbling after more than a decade of conflict.

Thousands of people were killed and at least 10,000 were missing in Libya in floods caused by a huge Mediterranean storm that burst dams, swept away buildings and wiped out as much as a quarter of the eastern coastal city of Derna.

A senior medic in Derna told Reuters that more than 2,000 people were dead, while eastern Libya officials cited by local television were estimating a toll above 5,000.

Storm Daniel barrelled across the Mediterranean into a country divided and crumbling after more than a decade of conflict.

In Derna, a city of around 125,000 inhabitants, Reuters journalists saw wrecked neighbourhoods, their buildings washed out and cars flipped on their roofs in streets covered in mud and rubble left by a wide torrent after dams burst.

Mohamad al-Qabisi, director of the Wahda Hospital, said 1,700 people had died in one of the city’s two districts and 500 had died in the other.

Reuters journalists saw many bodies laid out on the ground in the hospital corridors. As more bodies were brought to the hospital people looked at them, trying to identify missing family members.

“Bodies are lying everywhere – in the sea, in the valleys, under the buildings,” Hichem Abu Chkiouat, minister of civil aviation in the administration that controls the east, told Reuters by phone shortly after visiting Derna.

“I am not exaggerating when I say that 25% of the city has disappeared. Many, many buildings have collapsed.”

The local al-Masar television said the eastern administration’s interior minister had said more than 5,000 people died.

Other eastern cities, including Libya’s second biggest city Benghazi, were also hit by the storm. Tamer Ramadan, head of a delegation of the International Federation of the Red Cross and Red Crescent Societies, said the death toll would be “huge”.

“We can confirm from our independent sources of information that the number of missing people is hitting 10,000 so far,” he told reporters via video link.

The United Nations Office for the Coordination of Humanitarian Affairs said emergency response teams had been mobilised to help on the ground.

As Turkey and other countries rushed aid to Libya, including search and rescue vehicles, rescue boats, generators and food, distraught Derna citizens rushed home in search of loved ones.

‘Never Felt As Frightened’

In Derna, Mostafa Salem, 39, said he had lost 30 of his relatives. “Most people were sleeping. Nobody was ready,” Salem told Reuters.

Raja Sassi, 39, survived the flood with his wife and small daughter after water had reached an upper floor, but the rest of his family had died, he said.

“At first we just thought it was heavy rain but at midnight we heard a huge explosion and it was the dam bursting,” he said.

At Tripoli airport in northwest Libya, a woman wailed as she received a call saying most of her family were dead or missing. Her brother-in-law, Walid Abdulati, said: “We are not speaking about one or two people dead, but up to 10 members of each family dead.”

Karim al-Obaidi, a passenger on a plane from Tripoli to the east, said: “I have never felt as frightened as I do now … I lost contact with all my family, friends and neighbours.”

An interior ministry spokesperson told Al Jazeera that naval teams were searching for the “many families that were swept into the sea in the city of Derna”.

Flood Warning

Derna is bisected by a seasonal river that flows from highlands to the south, and normally protected from flooding by dams.

A video posted on social media showed remnants of a collapsed dam 11.5 km (7 miles) upstream of the city where two river valleys converged, now surrounded by huge pools of mud-coloured water.

“There used to be a dam,” a voice can be heard saying in the video. Reuters confirmed the location based on the images.

In a research paper published last year, hydrologist Abdelwanees A. R. Ashoor of Libya’s Omar Al-Mukhtar University said repeated flooding of the seasonal riverbed, or wadi, was a threat to Derna. He cited five floods since 1942, and called for immediate steps to ensure regular maintenance of the dams.

“If a huge flood happens the result will be catastrophic for the people of the wadi and the city,” the paper said.

Pope Francis was among world leaders who said they were deeply saddened by the deaths and destruction in Libya. U.S. President Joe Biden sent his condolences and said Washington was sending emergency funds to relief organisations.

Libya is politically split between east and west and public services have fallen apart since a 2011 NATO-backed uprising that prompted years of factional conflict.

The internationally recognised government in Tripoli does not control eastern areas but has dispatched aid to Derna, with at least one relief flight leaving from the western city of Misrata on Tuesday, a Reuters journalist on the plane said.

Nigeria, with a population of more than 200 million people, has installed power generation capacity of 12,500 megawatts (MW) but produces a fraction of that, leaving millions of households and businesses reliant on petrol and diesel generators.

Mini grids, made up of small-scale electricity generating units, typically range in a size from a few kilowatts to up to 10 MW, enough to power some 200 households.

Speaking during a visit to a mini grid site on the outskirts of the capital Abuja, Banga told reporters that nearly 150 mini grids had been built, partly funded by the World Bank, to bring power to communities without access to electricity.

“We are putting another 300 in, but our ambition with the government is to go all the way to 1,000. We’re talking about hundreds of millions of dollars that are being invested,” said Banga, without giving a timeline.

“Now the idea is not for the World Bank to be the only person putting the money. We put part of the money like a subsidy.”

World Bank data shows that in sub-Saharan Africa, 568 million people still lack access to electricity. Globally, nearly 8 out of 10 people without electricity live in Africa.

French Foreign Minister Catherine Colonna met with Niger Prime Minister Ouhoumoudou Mahamadou and the Niger ambassador in Paris on Saturday.

Earlier, Colonna said the junta in Niamey had until Sunday to hand back power, otherwise a threat by member countries of the Economic Community of West African States (ECOWAS) to stage a military intervention had to be taken “very seriously”.

“The threat is credible,” she said on French public radio.

France did not specify whether its backing would entail military support for an ECOWAS intervention in Niger.

Heads of state of the 15-member Economic Community of West African States (ECOWAS), and the eight-member West African Economic and Monetary Union could suspend Niger from its institutions, cut off the country from the regional central bank and financial market, and close borders.

Niger’s eastern neighbour Chad, a non-member of both regional organisations, has been invited to the ECOWAS summit, a statement from the Chadian president’s office said on Saturday.

Niger is one of the poorest countries in the world, receiving close to $2 billion a year in official development assistance, according to the World Bank. It is also a security partner of former colonial power France and the United States, which both use it as a base to fight an Islamist insurgency in West and Central Africa’s wider Sahel region.

The West African leaders could also for the first time, consider a military intervention to restore President Mohamed Bazoum who was ousted when General Abdourahamane Tiani was declared the new head of state on Friday.

Ahead of the Sunday summit, the military leaders in Niger on Saturday night, warned in a statement read on Niger national television on Saturday night against any military intervention.

“The objective of the (ECOWAS) meeting is to approve a plan of aggression against Niger through an imminent military intervention in Niamey in collaboration with other African countries that are non-members of ECOWAS, and certain western countries,” junta spokesman Colonel Amadou Abdramane said.

“We want to once more remind ECOWAS or any other adventurer, of our firm determination to defend our homeland,” he said.

The junta issued a second statement on Saturday night inviting citizens in the capital take to the streets from 7 a.m. local time (0600 GMT) to protest against ECOWAS and show support for the new military leaders.

The military coup in Niger has been widely condemned by its neighbours and international partners who have refused to recognise the new leaders and have demanded that Bazoum be restored to power.

Bazoum has not been heard from since early Thursday when he was confined within the presidential palace, although the European Union, France and others say they still recognize him as the legitimate president.

The European Union and France have cut off financial support to Niger and the United States has threatened to do the same.

After an emergency meeting on Friday, the African Union issued a statement demanding that the military return to their barracks and restore constitutional order within 15 days. It did not say what would happen after that.