Ghana was among the first countries in Africa to introduce the RTS,S malaria vaccine into its routine immunization program. In Ghana, Kenya, and Malawi, the vaccine was associated with a 13 percent reduction in mortality among children eligible for vaccination, with roughly one in eight deaths averted.

But keeping those gains will require more than the vaccine itself. Health workers still have to reach children, trace those who miss doses, and get vaccines safely to communities. That work is now under pressure.

The suspension of United States Agency for International Development (USAID) programs left Ghana facing an estimated $156 million funding gap across affected programs, including a projected $78.2 million shortfall in health. The health funding supported programs including malaria prevention, maternal and child health, nutrition, family planning, and HIV services.

The disruption has also raised concerns about the systems that keep routine immunization running. A study examining donor withdrawal in northern Ghana found that 75 percent of the districts surveyed reported vaccine delays or irregular supplies. The study also found constraints affecting cold-chain equipment, delivery kits, and transport fuel.

Nana Owusu Ensaw, municipal director of health for Akuapim North, said Ghana should use the funding shock to rethink how it pays for healthcare. "The $78 million health funding gap after USAID program closures is significant, but it is also a chance to rethink healthcare financing in Ghana. The Ghana Medical Trust Fund, or MahamaCares, is already expanding access to specialized care," Ensaw said.

John Yabani, medical director of Banahene Specialist Hospital, said private providers were also prepared to play a larger role. "Ghana's healthcare sector is at a pivotal moment. We have already been investing in medical tourism and positioning ourselves to attract patients from across West Africa and the diaspora. The private sector is ready to step in and complement government efforts," he said.

But private investment cannot immediately replace the public health infrastructure needed to deliver routine vaccinations, particularly in remote communities. Not everyone sees the loss of donor funding only as a setback. A government official who spoke to Al Jazeera on condition of anonymity said he had long been uncomfortable with African countries relying on Western governments to finance basic healthcare.

George Kwame Egeh, cofounder and director of operations at the Humserve Africa Foundation, said his organization had long advocated greater use of local funding. "We have always used internally generated funding from colleagues and corporate Ghana to support all health interventions. We believe that civil society organizations can step in and fill the gap that the USAID cuts are creating," Egeh said.

For immunization programs, however, replacing donor money is not simply a matter of finding another funding source. Health workers still have to travel to remote communities, trace children who miss doses, maintain cold-chain equipment, and organize outreach services. In the Oti Region, where many communities are rural, hard to reach, and close to Ghana's borders, the concern is particularly acute.

A 2025 study of routine immunization in Ghana's Eastern and Oti regions found basic antigen coverage in Oti of 85.3 percent, while coverage for the national schedule was 62.1 percent. Mark Appiah, chairman of the Oti Regional Health Committee, told Al Jazeera he was concerned that financing pressures could erode those gains.

"Funding pressures could affect outreach, defaulter tracing, transportation, supervision, and immunization campaigns, all of which are essential to maintaining these gains. A child should not lose protection against a preventable disease because the health system is experiencing a financing problem," he said. Appiah called for domestic resource mobilization and targeted support for hard-to-reach communities.

In northern Ghana, Rahinatu, a mother whose child has benefited from routine immunization, said the funding gap had created real challenges for her community. "But I am optimistic the government will figure a homegrown solution as soon as possible to get things back on track for us," she said.

Ghana is in an accelerated transition from Gavi, the Vaccine Alliance, support and is expected to take full responsibility for financing its immunization program from 2030. At the same time, Gavi is facing its own funding pressures. Ghana has begun looking for ways to do that. The government has removed the cap on funding from the National Health Insurance Scheme, while it is also backing efforts to develop local vaccine manufacturing capacity.

As health ministers and senior officials from the WHO African Region's 47 member states meet in Addis Ababa for the 76th session of the WHO Regional Committee for Africa, Ghana's experience points to a difficult question facing many countries: how quickly can governments build greater financial independence without allowing the health services that children rely on today to weaken? Appiah's message was simple: "No child in Oti Region should be denied life-saving immunization because of where that child lives or because of a temporary financing gap."

Source: www.aljazeera.com