U.S. to Cut Out Nongovernmental Groups in Refocusing Health Aid
Secretary of State Marco Rubio said the United States would negotiate agreements to deliver aid in new ways and would focus on the Western Hemisphere and Asia Pacific.
U.S. to Cut Out Nongovernmental Groups in Refocusing Health Aid
Secretary of State Marco Rubio said the United States would negotiate agreements to deliver aid in new ways and would focus on the Western Hemisphere and Asia Pacific.
Reporting from Washington
The Trump administration is changing how and where the U.S. government delivers health aid around the world, breaking decades of practice to bypass nongovernmental organizations and prioritize the Western Hemisphere and Asia Pacific regions over Africa, U.S. officials said Thursday.
Secretary of State Marco Rubio’s new approach aims to end “a culture of dependency among recipient countries,” he said in a document announcing the change.
In the coming months, the State Department plans to negotiate new bilateral agreements with countries to deliver health aid in ways that cut out nongovernmental organizations. For decades, U.S. officials assessed that those groups had more technical expertise than partner governments, so they helped manage and deliver health aid in many nations.
The new strategy also veers away from decades of focus on Africa, where many nations rely on the United States government to help with H.I.V. prevention and treatment.
It follows Mr. Rubio’s dismantlement this year of the United States Agency for International Development, which was created by the Kennedy administration in 1961 and put under congressional mandate to deliver health aid and other forms of assistance around the globe.
That agency and the State Department, as well as other parts of the U.S. federal government, had worked for decades with both partner governments and nongovernmental organizations in the United States and other countries to deliver aid.
Many health experts say the dismantlement of U.S.A.I.D. and drastic cuts to foreign assistance that began after President Trump took office in January have endangered the lives and the health of millions of people overseas, particularly in Africa and Asia.
The new approach by Mr. Rubio is laid out in a document the State Department released on Thursday called “America First Global Health Strategy.” On the opening page, Mr. Rubio argued for changes to the traditional way of dispensing foreign assistance.
“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 wrote. “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 says that many nongovernmental groups that receive funding approved by Congress, 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 says the State Department will work to complete negotiations with nations on new ways of delivering health aid by the end of this year and begin putting them into place by April.
A Trump administration official briefing mostly State Department reporters on Thursday said that the document provided a framework, and that State Department officials would start negotiations with counterparts from various countries on the sidelines of the annual United Nations General Assembly in New York next week.
The official said the State Department, which took over the remnants of U.S.A.I.D.’s foreign assistance programs, would continue to provide H.I.V. prevention and treatment aid to African nations. But he said there were many non-H.I.V. diseases and health areas on which the U.S. government planned to focus through direct partnerships with other governments, including tuberculosis in the Asia Pacific region and maternal and child health.
The official was one of three on the call with reporters. All three insisted on speaking on the condition of anonymity, which is typical of such background briefings in Washington.
Many global health experts and African officials have criticized the Trump administration’s crippling of PEPFAR, a program started by President George W. Bush to curtail H.I.V. and which has saved millions of lives, primarily in African nations. The program has won praise from Republican and Democratic officials over the decades.
State Department officials have drawn up plans to end the program in the coming years, The New York Times reported in July. A State Department spokeswoman said at the time that the planning document had not been finalized.
The Trump administration official said the new health aid framework is not aimed at making immediate budget cuts. The document released Thursday says that as partner governments take over more duties in the delivery and management of health care, the U.S. government will be cutting assistance.
Edward Wong reports on global affairs, U.S. foreign policy and the State Department for The Times.