Ongoing reports and analysis

In September, the U.S. State Department issued the “America First Global Health Strategy.” The document denounces the long-established practice of using foreign aid to fund U.S.-based nongovernmental organizations (NGOs) to deliver health services in low-income countries, arguing that this practice is wasteful and promotes these countries’ dependency on aid. Surprisingly, the strategy calls for a pivot to directly funding poor countries’ governments, many of which have long been accused of corruption and ineffectiveness. In December, U.S. Secretary of State Marco Rubio signed the first agreement under the new strategy—a deal with Kenya to combat infectious diseases.

Many aid experts and foreign governments have advocated for some version of this shift. The old model of funneling aid through NGOs and private contractors saved hundreds of millions of lives and helped untold others prosper, but by bypassing national governments, it undermined their efforts to build up their own public health systems and wean themselves off aid. In 2024, only of the U.S. Agency for International Development’s (USAID’s) multibillion-dollar budget went directly to foreign governments, while nearly 90 percent went to large U.S. and international contractors and NGOs.

In September, the U.S. State Department issued the “America First Global Health Strategy.” The document denounces the long-established practice of using foreign aid to fund U.S.-based nongovernmental organizations (NGOs) to deliver health services in low-income countries, arguing that this practice is wasteful and promotes these countries’ dependency on aid. Surprisingly, the strategy calls for a pivot to directly funding poor countries’ governments, many of which have long been accused of corruption and ineffectiveness. In December, U.S. Secretary of State Marco Rubio signed the first agreement under the new strategy—a deal with Kenya to combat infectious diseases.

Many aid experts and foreign governments have advocated for some version of this shift. The old model of funneling aid through NGOs and private contractors saved hundreds of millions of lives and helped untold others prosper, but by bypassing national governments, it undermined their efforts to build up their own public health systems and wean themselves off aid. In 2024, only of the U.S. Agency for International Development’s (USAID’s) multibillion-dollar budget went directly to foreign governments, while nearly 90 percent went to large U.S. and international contractors and NGOs.

If the State Department were to redirect just a portion of foreign aid funding, it would represent billions of dollars to help these countries strengthen their health care systems themselves. The agreement with Kenya includes an unprecedented $1.6 billion in direct U.S. aid over five years. Aid to foreign governments of this magnitude has not existed in recent decades—except to national security priorities such as Egypt, Israel, Jordan, and Ukraine.

The shift to direct aid is in line with reforms that we pushed for as career staff at USAID under both Democratic and Republican........

© Foreign Policy