The Trump administration is set to drastically alter how and where the United States provides global health assistance, overturning decades of established practice. This new strategy, announced by U.S. officials on Thursday, involves circumventing non-governmental organizations (NGOs) and redirecting focus primarily to the Western Hemisphere and Asia Pacific, a significant departure from the traditional emphasis on Africa.
Secretary of State Marco Rubio, the architect of this new approach, stated in a foundational document that the goal is to dismantle what he calls ‘a culture of dependency among recipient countries’.
Over the next few months, the State Department will embark on negotiating fresh bilateral agreements directly with nations, effectively removing NGOs from the aid delivery process. Historically, U.S. officials relied on these non-governmental groups for their specialized technical knowledge, entrusting them with the management and distribution of health aid across numerous countries.
This policy shift also marks a sharp deviation from decades of concentrated effort in Africa, a continent where many nations have heavily depended on U.S. government support for critical H.I.V. prevention and treatment initiatives.
This move comes on the heels of Secretary Rubio’s decision earlier this year to dismantle the United States Agency for International Development (USAID), an institution established by the Kennedy administration in 1961 with a congressional mandate to provide global health aid and various other forms of assistance.
For decades, USAID, the State Department, and other federal entities collaborated extensively with both foreign governments and non-governmental organizations, both domestic and international, to ensure the efficient delivery of aid.
Numerous health experts contend that the dissolution of USAID and severe reductions in foreign assistance, initiated following President Trump’s inauguration in January, have placed the lives and well-being of millions worldwide — especially in Africa and Asia — at grave risk.
Rubio’s revised strategy is detailed in a document unveiled by the State Department on Thursday, titled ‘America First Global Health Strategy.’ In its introductory remarks, Rubio advocated for a fundamental reevaluation of conventional foreign assistance methods.
He criticized existing health foreign assistance programs as ‘inefficient and wasteful,’ alleging that they frequently establish ‘parallel health care delivery systems and a culture of dependency among recipient countries.’ Rubio further noted that many NGOs supporting these initiatives, despite repeated pledges to transition responsibilities to local governments, have shown minimal progress.
The executive summary of the strategy asserts that numerous non-governmental groups, often funded by Congress for technical aid and program administration, possess ‘perverse incentives to self-perpetuate rather than work towards turning functions over to local governments.’
According to the document, the State Department aims to conclude negotiations with various nations on these new aid delivery mechanisms by the end of the year, with implementation slated to commence by April.
During a briefing with State Department reporters on Thursday, a Trump administration official, speaking anonymously, clarified that the document merely offers a framework. Officials are expected to initiate negotiations with international counterparts at the upcoming annual United Nations General Assembly in New York.
The official confirmed that the State Department, now overseeing the remaining foreign assistance programs from the dismantled USAID, will maintain H.I.V. prevention and treatment aid for African nations. However, the U.S. government intends to prioritize direct partnerships with other governments for various non-H.I.V. health areas, such as combating tuberculosis in the Asia Pacific region and improving maternal and child health.
This official was among three sources who provided information during the press call, all requesting anonymity — a common practice for sensitive background briefings in Washington.
The Trump administration has faced widespread criticism from global health experts and African leaders for severely weakening PEPFAR, a vital program launched by President George W. Bush to combat H.I.V. This initiative has been credited with saving millions of lives, predominantly in African countries, and has historically garnered bipartisan acclaim.
In July, The New York Times reported that State Department officials had drafted plans to discontinue PEPFAR in the near future, although a spokeswoman at the time stated that these plans were not yet finalized.
The unnamed Trump administration official clarified that the new health aid framework does not target immediate budget reductions. However, the document indicates that as partner governments assume greater responsibility for health care delivery and management, U.S. assistance will gradually be reduced.