Changes in U.S. Global Health Strategy
In the aftermath of the Trump administration, concerns have been voiced about the state of America’s global health initiatives. Critics argue that the U.S. Agency for International Development (USAID) has seen its programs diminished. However, a significant shift occurred without much fanfare—the America First Global Health Strategy was introduced, effectively transferring authority from USAID to the State Department.
This new strategy is meant to fundamentally alter the distribution of billions in foreign aid. It’s backed by a group of former officials now offering advice from the private sector, including ex-USAID administrator Mark Greene, along with former Congress members Ted Yoho and Chris Stewart. Although their role isn’t to implement the program, they advocate for more stringent accountability measures and performance indicators to ensure the framework’s longevity.
At the core of the America First Global Health Strategy is a move away from traditional models that relied heavily on grants and NGOs. Instead, it aims for country-specific agreements that tie funding to measurable results, thereby holding foreign governments more accountable over time. The intention is to enhance oversight of spending, although many fine details still need clarification, particularly regarding how to set and apply performance benchmarks.
Thus far, this strategy has involved a few bilateral health agreements, established on a country-to-country basis. For example, in December 2025, a five-year health cooperation agreement was signed with Kenya, focusing on pressing issues like HIV/AIDS, malaria, and tuberculosis. Notably, U.S. funding is now linked to ongoing progress and greater financial input from the Kenyan government. Other similar agreements are in the pipeline, with discussions occurring with nations like Nigeria and Cameroon.
Historically, Congress has allocated substantial funding to the Global Health Fund, granting USAID considerable leeway in program execution. This framework offered lawmakers some oversight, yet they had minimal influence over specific funding actions. Yoho remarked that this discretionary power has led to a drift from the initial mission of aid efforts.
“The core mission has weakened,” he noted, criticizing the agency for becoming too intertwined with political and ideological agendas.
The new approach, however, ties global health assistance closely to national security, bilateral relationships, and economic interests—although since it hasn’t been codified into law, these priorities may be altered by future administrations. Yoho cautioned that without legislative backing, the current priorities could vanish if a Democratic administration takes over.
Former Rep. Chris Stewart emphasized that even legislators who support health spending often lack insight into program operations post-funding.
Stewart shared that during his discussions with foreign leaders, they expressed a desire not just for assistance but for partnerships that build their capabilities. This sentiment, he claims, is crucial for future relations.
Supporters of the strategy argue that it doesn’t necessitate the abandonment of global health investment. They cite existing successful initiatives like PEPFAR, which focuses on HIV/AIDS prevention, as examples of effective aid that also strengthens U.S. alliances abroad. Stewart and Greene highlighted the importance of child health and nutrition as ongoing priorities, with Yoho pointing to low-cost interventions that are both effective and widely supported.
Green, a former USAID administrator, mentioned a key focus of the strategy is to promote what he calls a “journey to self-reliance.” The aim is to help countries transition from being aid recipients to becoming partners and ultimately donors themselves.
This shift to country-by-country agreements is intended to ensure that funding promotes local capacity and assumes shared responsibility. The emphasis is on combining government resources with private sector innovations. Green mentioned partnerships with companies like Zipline, which leverages drone technology for medical deliveries, as an example of blending public health goals with American ingenuity.
Nonetheless, Green recognized that many dimensions of this strategy are still developing. Although the plan seeks to connect funding with performance metrics, precise criteria and enforcement methods remain in progress.
For advocates of the new method, increasing accountability might help assuage skepticism around foreign aid generally. Yoho reflected on his own shift in perspective regarding aid.
“I once sought to eliminate foreign aid,” he admitted. “But I learned just how essential it can be.”
The success of the America First Global Health Strategy in fulfilling its objectives or revealing new challenges may depend significantly on the degree of Congressional authority formalization and the administration’s commitment to enforcing accountability standards.
