Leaders across Africa have said US President Donald Trump’s decision to abruptly end billions of dollars of aid to the continent is a wake up call for their countries to be more self-reliant.

So far they haven’t risen to the challenge.

In South Africa, the annual budget came and went last week with no provision to replace the more than $400-million in American money spent on HIV/AIDS programmes that were cancelled following Trump’s gutting of the US Agency for International Development. Nigeria added an additional $200-million in health-care spending in an attempt to make up for the $800-million in US funding it lost — amounting to less than a dollar per citizen.

“I want to thank Mr. Trump actually, I think he’s slapped us not on one cheek but on both cheeks, we should have been hammered a long time ago,” Zambian President Hakainde Hichilema, who’s country was getting $600-million in aid a year from the US, said in a speech. The southern African government hasn’t so far detailed how it will fill the gap.

Kenya’s former President Uhuru Kenyatta, Ghana’s new leader, John Mahama and ex-Malawi President Joyce Banda all echoed Hichilema. But like Kenyatta, the politicians ran their countries and held senior government positions for decades but did little to wean them off foreign aid.

“It would be really good to see people, instead of just talking, saying what is their long term plan” to replace aid, said Nic Cheeseman, a professor of democracy at the University of Birmingham. “What we haven’t seen so far from leaders is anything that remotely resembles a strategy,” he added, noting that many countries have done little to finance their own health care and other needs over the last two decades.

In Kenya, which has just lost an estimated $800-million in International Monetary Fund assistance because it failed to meet its obligations, a health ministry spokesperson said the government will now pay for the health programmes the US funded, without providing details.

Nigeria is “actively working to strengthen its health system by leveraging domestic resources” following the US withdrawal, health minister, Muhammad Ali Pate, said in a statement. He gave no indication of what steps are being taken. A spokesperson for Ghana’s health ministry said it’s waiting for an increased allocation from the government.

“As government we are working very hard to mitigate the impact of the withdrawal, which came without notice,” Foster Mohale, a spokesperson for South Africa’s health department said. The department is waiting for the budget, which is still being debated in parliament, to be approved and will then try and fill some, but not all, of the gap.

Meanwhile, autocratic governments including Rwanda and Mali’s military junta have celebrated the US cuts. “Whoever gives you aid controls your life,” Rwandan President Paul Kagame, whose country has long been one of Africa’s biggest per-capita aid recipients, said in an interview with a right-wing US influencer earlier this month.

The withdrawal of US assistance has seen tens of thousands of health care workers lose their jobs across the continent, while many of the 17-million Africans — two-thirds of the global total — infected with HIV globally can’t access life-saving medication.

“Some of the apparent paralysis may be that there just aren’t readily available resources to mobilise,” said Linda-Gail Bekker, chief executive officer of the Desmond Tutu Health Foundation, said in an interview. She led research that forecasts 601 000 additional deaths from HIV/AIDS in South Africa alone over the next decade unless government fills the gap

In 2023 Sub-Saharan Africa received $16-billion in aid from the US — including $4-billion for combating HIV and $7-billion for disaster relief and food assistance, according to Moody’s Ratings.

But filling the void left by the US departure is a big ask for the strained finances of many governments — many African countries spend more on servicing debt than health. The continent has more than $1.2-trillion in external debt, with the debt-to-gross domestic product ratio rising by about two-fifths since 2008, according to the African Export-Import Bank.

At a time when wealthy European nations are slashing their own assistance budgets, African countries may have little choice but to find ways of funding programmes — and large parts of their health-care systems — that have for years been financed with aid.

“Aid dependence has its own contradictions and limitations. And I think it’s a moment to confront that,” said Binaifer Nowrojee, president of the Open Society Foundations. “Where are African governments in terms of their own responsibilities to their citizens and what are they going to do to address this gap now?”