{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:56:48Z","timestamp":1790607408358,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The enactment of the One Big Beautiful Bill Act (OBBBA) in July 2025 represents a fundamental shift in United States global health financing, with significant implications for African public health systems. For more than three decades, US development assistance for health particularly through initiatives such as the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative, and maternal and child health programs\u2014has been central to disease control and health system strengthening across sub\u2010Saharan Africa. OBBBA institutionalizes reduced funding baselines under an \u201cAmerica First Global Health Strategy,\u201d constraining bilateral assistance and limiting flexible mechanisms that previously supported surveillance, laboratory systems, workforce development, and pandemic preparedness. This perspective examines the anticipated consequences of OBBBA for African public health through three interconnected lenses: disease\u2010specific impacts on HIV\/AIDS, tuberculosis, malaria, and maternal and child health; systemic effects on health systems, including workforce sustainability, supply chains, surveillance, and research infrastructure; and broader economic and geopolitical implications for health sovereignty and partnership dynamics. Drawing on existing empirical evidence, modeling studies, and historical analogues of funding disruptions, we argue that abrupt reductions in US global health financing risk reversing hard\u2010won gains in disease control, exacerbating health system fragility, and increasing vulnerability to emerging infectious threats. At the same time, the policy shift may accelerate diversification of partnerships and prompt renewed debates on domestic resource mobilization and African health sovereignty. We conclude that coordinated responses by African governments, regional bodies, international institutions, and development partners are urgently required to mitigate risks, protect treatment continuity, and sustain progress toward global health security and the Sustainable Development Goals.<\/jats:p>","DOI":"10.1002\/puh2.70309","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T18:35:47Z","timestamp":1784745347000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impacts of the One Big Beautiful Bill Act on African Public Health Systems"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1671-9584","authenticated-orcid":false,"given":"Majani","family":"Edward","sequence":"first","affiliation":[{"name":"Research and Training Unit, Department of Research and Innovation MacWish College of Health and Allied Sciences  Mwanza Tanzania"},{"name":"Centre for Reforms, Innovation, Health Policies and Implementation Research  Dodoma Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jusu","family":"Musa","sequence":"additional","affiliation":[{"name":"National Public Health Agency Ministry of Health  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mlemile","family":"Stephen","sequence":"additional","affiliation":[{"name":"Research and Training Unit, Department of Research and Innovation MacWish College of Health and Allied Sciences  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam Soko","family":"Bundu","sequence":"additional","affiliation":[{"name":"National Public Health Agency Ministry of Health  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Nakasita","family":"Alex","sequence":"additional","affiliation":[{"name":"Department of Public Health St. Francis University College of Health and Allied Sciences  Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5049-8299","authenticated-orcid":false,"given":"Ameh Wisdom","family":"Owoicho","sequence":"additional","affiliation":[{"name":"Federal University of Technology  Minna Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naima","family":"Mbwana","sequence":"additional","affiliation":[{"name":"Research and Training Unit, Department of Research and Innovation MacWish College of Health and Allied Sciences  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Global Health and the Future Role of the United States","author":"National Academies of Sciences, Engineering, and Medicine Health and Medicine Division; Board on Global Health; Committee on Global Health and the Future of the United States","year":"2017"},{"key":"e_1_2_12_3_1","first-page":"1","article-title":"Financing for HIV, AIDS, TB and Malaria in Uganda: An Equity Analysis","volume":"75","author":"Zikusooka C. 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