The Trump administration is set to fundamentally change how and where the U.S. government delivers health aid worldwide. This move breaks from decades of established practice by bypassing non-governmental organizations (NGOs) and focusing efforts on the Western Hemisphere and Asia Pacific, rather than Africa, U.S. officials revealed on Thursday.
Secretary of State Marco Rubio’s new initiative aims to dismantle what he calls ‘a culture of dependency among recipient countries,’ as outlined in a recently released policy document.
In the coming months, the State Department plans to forge new bilateral agreements with nations, directly managing health aid delivery and thereby removing NGOs from their long-standing role in coordinating and distributing assistance in many parts of the world.
This strategic pivot also marks a departure from a decades-long focus on Africa, a continent where numerous countries have historically relied heavily on U.S. government support for critical health initiatives, including HIV prevention and treatment programs.
This change follows Mr. Rubio’s earlier actions this year to dismantle the United States Agency for International Development (U.S.A.I.D.). Established by the Kennedy administration in 1961, U.S.A.I.D. was mandated by Congress to provide health and other forms of international assistance globally.
For years, U.S.A.I.D., the State Department, and other federal entities collaborated extensively with both foreign governments and non-governmental organizations, both domestic and international, to ensure aid reached those in need.
However, many health experts are now voicing concerns. They argue that the weakening of U.S.A.I.D. and significant cuts to foreign assistance since President Trump took office have jeopardized the lives and well-being of millions, particularly across Africa and Asia.
Mr. Rubio’s new framework is detailed in a State Department document titled ‘America First Global Health Strategy,’ released Thursday. In its opening pages, the Secretary advocates for a departure from traditional foreign aid methods.
He wrote, ‘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. 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 further asserts that many NGOs receiving congressional funding, especially for technical assistance and program management, ‘have perverse incentives to self-perpetuate rather than work towards turning functions over to local governments.’
The document states that the State Department intends to finalize negotiations for these new health aid delivery models with partner nations by the end of this year, with implementation slated to begin by April.
During a briefing with State Department reporters on Thursday, a Trump administration official, speaking anonymously, clarified that the document provides a framework. He added that State Department officials would initiate negotiations with their international counterparts on the sidelines of the upcoming annual United Nations General Assembly in New York.
The official confirmed that the State Department, now overseeing residual U.S.A.I.D. foreign assistance programs, would continue supporting HIV prevention and treatment in African nations. However, he emphasized that the U.S. government plans to shift its focus for many non-HIV diseases and health initiatives towards direct partnerships with foreign governments, including combating tuberculosis in the Asia Pacific region and promoting maternal and child health.
This official was one of three on the call who insisted on anonymity, a common practice for such background briefings in Washington.
The Trump administration’s efforts to curtail PEPFAR—the President’s Emergency Plan for AIDS Relief—have drawn widespread criticism from global health experts and African officials. This program, launched by President George W. Bush to combat HIV, has saved millions of lives, primarily in African countries, and has historically garnered bipartisan support.
The New York Times previously reported in July that State Department officials had drafted plans to discontinue PEPFAR in the coming years. At the time, a State Department spokeswoman stated that these planning documents had not been finalized.
The anonymous Trump administration official stressed that the new health aid framework is not designed for immediate budget cuts. However, the document released Thursday indicates that as partner governments assume more responsibilities in healthcare delivery and management, U.S. assistance will gradually be reduced.