The Trump administration is implementing significant changes to how and where the U.S. government distributes global health aid, departing from decades of established practice. This new strategy will bypass non-governmental organizations (NGOs) and prioritize support for the Western Hemisphere and Asia Pacific regions, a notable shift from previous focuses on Africa, U.S. officials revealed on Thursday.
Secretary of State Marco Rubio articulated that this fresh approach is designed to eliminate “a culture of dependency among recipient countries,” as outlined in a document detailing the changes.
Over the coming months, the State Department plans to forge new bilateral agreements directly with recipient nations, effectively removing NGOs from their traditional role in health aid delivery. For many years, U.S. officials relied on NGOs due to their perceived technical expertise in managing and distributing health assistance across numerous countries.
This revised strategy also marks a significant pivot away from a long-standing emphasis on Africa, where many countries have historically relied on U.S. government support for H.I.V. prevention and treatment programs.
The move comes after Mr. Rubio’s dismantling earlier this year of the United States Agency for International Development (U.S.A.I.D.), an organization established by the Kennedy administration in 1961 with a congressional mandate to deliver health and other forms of international assistance.
For decades, U.S.A.I.D., the State Department, and other federal entities collaborated with both partner governments and NGOs, both domestic and international, to deliver aid effectively.
However, numerous health experts contend that the dissolution of U.S.A.I.D. and the substantial cuts to foreign assistance initiated after President Trump assumed office in January have jeopardized the well-being of millions globally, particularly across Africa and Asia.
Mr. Rubio’s new framework is detailed in a document published by the State Department on Thursday, titled “America First Global Health Strategy.” In its introduction, Mr. Rubio passionately advocates for changes to the conventional methods of foreign aid distribution.
“Our health foreign assistance programs in particular have become inefficient and wasteful, too often creating parallel health care delivery systems and a culture of dependency among recipient countries,” he stated. “Many of the NGOs who support these programs have committed many times to helping transition the work to local governments, but little progress has been made.”
The executive summary of the document further claims that many congressional-funded non-governmental groups, especially those involved in technical assistance and program management, possess “perverse incentives to self-perpetuate rather than work towards turning functions over to local governments.”
The State Department aims to finalize negotiations with countries on these new aid delivery mechanisms by the end of the year, with implementation set to begin by April.
During a briefing with State Department reporters on Thursday, a Trump administration official explained that the document merely provides a foundational framework. Formal negotiations are expected to commence next week with international counterparts during the annual United Nations General Assembly in New York.
The official clarified that the State Department, now overseeing U.S.A.I.D.’s remaining foreign assistance programs, will continue to provide H.I.V. prevention and treatment aid to African nations. However, the U.S. government plans to shift its focus for many non-H.I.V. diseases and health initiatives towards direct governmental partnerships, including efforts against tuberculosis in the Asia Pacific region and maternal and child health programs.
The official was one of three on the call who requested anonymity, a common practice in Washington for such background briefings.
Global health experts and African officials alike have voiced strong criticism regarding the Trump administration’s weakening of PEPFAR, a life-saving program launched by President George W. Bush to combat H.I.V. This initiative has saved millions of lives, primarily in African nations, and has historically garnered bipartisan support.
As reported by The New York Times in July, State Department officials have drafted plans to phase out PEPFAR in the coming years. At the time, a State Department spokeswoman indicated that these planning documents were not yet finalized.
The Trump administration official emphasized that the new health aid framework is not designed to enact immediate budget cuts. However, the document released Thursday clearly states that as partner governments assume greater responsibilities in health care delivery and management, U.S. assistance will be reduced accordingly.