The Trump administration is shaking up its global health aid strategy, moving away from long-standing practices. U.S. officials announced Thursday that the government would now bypass non-governmental organizations (NGOs) and shift its primary focus from Africa to the Western Hemisphere and Asia Pacific regions. According to Secretary of State Marco Rubio, this new direction is designed to eliminate “a culture of dependency” that has, in his view, plagued recipient nations.
Over the next few months, the State Department intends to establish direct bilateral agreements with countries for health aid delivery, effectively cutting out the non-governmental organizations that have, for decades, played a crucial role in managing and distributing this assistance. This radical shift also marks a departure from decades of concentrated efforts in Africa, where numerous countries have depended heavily on U.S. government support for HIV prevention and treatment initiatives.
This new policy comes on the heels of Mr. Rubio’s earlier dismantling of the United States Agency for International Development (USAID) this year. USAID, established by the Kennedy administration in 1961, was mandated by Congress to provide global health and other forms of assistance. For decades, USAID, the State Department, and various other U.S. federal government entities collaborated with both foreign governments and non-governmental organizations, both domestic and international, to distribute aid effectively.
However, numerous health experts warn that the dissolution of USAID and significant reductions in foreign assistance since President Trump took office in January have put the lives and well-being of millions, especially in Africa and Asia, at severe risk. Mr. Rubio’s updated vision is detailed in the ‘America First Global Health Strategy,’ a document released by the State Department on Thursday. In its opening remarks, Mr. Rubio advocates for a fundamental rethinking of traditional foreign assistance delivery.
He stated, ‘Our health foreign assistance programs have, in particular, become inefficient and wasteful, frequently creating redundant healthcare systems and fostering a culture of dependency among receiving nations. While many NGOs supporting these programs have repeatedly pledged to transition responsibilities to local governments, tangible progress has been minimal.’ The executive summary further claims that many Congressional-funded non-governmental groups, particularly those focused on technical assistance and program management, possess ‘perverse incentives to self-perpetuate rather than work towards turning functions over to local governments.’
The strategy outlines that the State Department aims to finalize negotiations with partner nations on these new aid delivery methods by year-end, with implementation commencing by April. During a briefing for State Department reporters on Thursday, an anonymous Trump administration official confirmed that this document serves as a foundational framework. State Department representatives are expected to initiate negotiations with their international counterparts during the upcoming annual United Nations General Assembly in New York.
The official clarified that the State Department, now overseeing former USAID foreign assistance programs, would maintain HIV prevention and treatment aid to African nations. However, the U.S. government plans to emphasize direct partnerships with other governments for non-HIV related health concerns, such as tuberculosis in Asia Pacific and maternal and child health. This official, along with two others present on the call, spoke on condition of anonymity, a common practice for background briefings in Washington.
The Trump administration’s perceived weakening of PEPFAR (President’s Emergency Plan for AIDS Relief) has drawn sharp criticism from many global health experts and African officials. PEPFAR, initiated by President George W. Bush, has been credited with saving millions of lives, predominantly in African countries, and has historically received bipartisan acclaim. In July, The New York Times reported that State Department officials had drafted plans to discontinue the PEPFAR program in the near future, though a spokeswoman stated at the time that these plans were not yet final. The Trump administration official emphasized that while the new health aid framework isn’t designed for immediate budget reductions, the document itself indicates that U.S. assistance will decrease as partner governments assume more responsibilities for healthcare delivery and management.