What replaced USAID? Inside the Trump administration’s global health overhaul
Accountability can't be optional.
For months after the Trump administration dismantled the U.S. Agency for International Development, critics warned that America’s global health programs were being gutted. What drew far less attention was what replaced it.
In December 2025, the White House quietly rolled out the America First Global Health Strategy, shifting control of U.S. global health aid from USAID to the State Department and fundamentally rewriting how billions of dollars in foreign assistance are distributed.
The transition has been shaped in part by a small group of former officials now advising the White House from the private sector, including former USAID administrator Mark Green and former lawmakers Ted Yoho and Chris Stewart. They are not running the programs, but they have been involved in pressing for clearer accountability standards, tighter performance metrics and congressional guardrails they say are necessary if the new framework is going to last beyond a single administration.
At the core of the strategy is a sharp break from how U.S. health aid traditionally has worked. The America First Global Health Strategy replaces USAID’s grant-heavy, nongovernmental organization-driven model with country-by-country agreements that tie funding to performance benchmarks and push foreign governments to assume greater responsibility over time. The framework promises tighter control over spending, but many of its enforcement details — including how benchmarks will be set and applied — are still being developed.
So far, the strategy has been implemented through a limited number of bilateral health agreements negotiated country by country. In December 2025, the United States signed a five-year health cooperation agreement with Kenya, covering areas such as HIV/AIDS, malaria and tuberculosis, with U.S. funding tied to continued performance and increased co-investment by the Kenyan government. Similar memorandums of understanding have since been signed or are under negotiation with countries including Nigeria and Cameroon, according to State Department disclosures.
Congress has long appropriated global health funding at a high level, giving USAID broad discretion over how programs were designed and implemented — a structure that left lawmakers with oversight but little involvement in individual funding decisions. Yoho said that discretion allowed the agency to drift over time.
"It lost the purity of purpose of what it was designed to do," Yoho said. "They lost their mark and they became political and ideological."
The new strategy, by contrast, explicitly frames global health …
Accountability can't be optional.
For months after the Trump administration dismantled the U.S. Agency for International Development, critics warned that America’s global health programs were being gutted. What drew far less attention was what replaced it.
In December 2025, the White House quietly rolled out the America First Global Health Strategy, shifting control of U.S. global health aid from USAID to the State Department and fundamentally rewriting how billions of dollars in foreign assistance are distributed.
The transition has been shaped in part by a small group of former officials now advising the White House from the private sector, including former USAID administrator Mark Green and former lawmakers Ted Yoho and Chris Stewart. They are not running the programs, but they have been involved in pressing for clearer accountability standards, tighter performance metrics and congressional guardrails they say are necessary if the new framework is going to last beyond a single administration.
At the core of the strategy is a sharp break from how U.S. health aid traditionally has worked. The America First Global Health Strategy replaces USAID’s grant-heavy, nongovernmental organization-driven model with country-by-country agreements that tie funding to performance benchmarks and push foreign governments to assume greater responsibility over time. The framework promises tighter control over spending, but many of its enforcement details — including how benchmarks will be set and applied — are still being developed.
So far, the strategy has been implemented through a limited number of bilateral health agreements negotiated country by country. In December 2025, the United States signed a five-year health cooperation agreement with Kenya, covering areas such as HIV/AIDS, malaria and tuberculosis, with U.S. funding tied to continued performance and increased co-investment by the Kenyan government. Similar memorandums of understanding have since been signed or are under negotiation with countries including Nigeria and Cameroon, according to State Department disclosures.
Congress has long appropriated global health funding at a high level, giving USAID broad discretion over how programs were designed and implemented — a structure that left lawmakers with oversight but little involvement in individual funding decisions. Yoho said that discretion allowed the agency to drift over time.
"It lost the purity of purpose of what it was designed to do," Yoho said. "They lost their mark and they became political and ideological."
The new strategy, by contrast, explicitly frames global health …
What replaced USAID? Inside the Trump administration’s global health overhaul
Accountability can't be optional.
For months after the Trump administration dismantled the U.S. Agency for International Development, critics warned that America’s global health programs were being gutted. What drew far less attention was what replaced it.
In December 2025, the White House quietly rolled out the America First Global Health Strategy, shifting control of U.S. global health aid from USAID to the State Department and fundamentally rewriting how billions of dollars in foreign assistance are distributed.
The transition has been shaped in part by a small group of former officials now advising the White House from the private sector, including former USAID administrator Mark Green and former lawmakers Ted Yoho and Chris Stewart. They are not running the programs, but they have been involved in pressing for clearer accountability standards, tighter performance metrics and congressional guardrails they say are necessary if the new framework is going to last beyond a single administration.
At the core of the strategy is a sharp break from how U.S. health aid traditionally has worked. The America First Global Health Strategy replaces USAID’s grant-heavy, nongovernmental organization-driven model with country-by-country agreements that tie funding to performance benchmarks and push foreign governments to assume greater responsibility over time. The framework promises tighter control over spending, but many of its enforcement details — including how benchmarks will be set and applied — are still being developed.
So far, the strategy has been implemented through a limited number of bilateral health agreements negotiated country by country. In December 2025, the United States signed a five-year health cooperation agreement with Kenya, covering areas such as HIV/AIDS, malaria and tuberculosis, with U.S. funding tied to continued performance and increased co-investment by the Kenyan government. Similar memorandums of understanding have since been signed or are under negotiation with countries including Nigeria and Cameroon, according to State Department disclosures.
Congress has long appropriated global health funding at a high level, giving USAID broad discretion over how programs were designed and implemented — a structure that left lawmakers with oversight but little involvement in individual funding decisions. Yoho said that discretion allowed the agency to drift over time.
"It lost the purity of purpose of what it was designed to do," Yoho said. "They lost their mark and they became political and ideological."
The new strategy, by contrast, explicitly frames global health …
0 Comments
0 Shares
46 Views
0 Reviews
