The Trump administration is reportedly now dramatically reshaping America’s foreign aid system, moving away from the decades-old USAID model and toward a streamlined approach that sends U.S. assistance directly to partner governments rather than funneling it through layers of high-priced NGOs.
The shift is part of the administration’s America First Global Health Strategy, which officials say eliminates waste, cuts out “beltway bandits,” and ensures American tax dollars produce measurable results.
So far, the administration has signed six memoranda of understanding (MOUs) with Kenya, Rwanda, Liberia, Uganda, Lesotho and Eswatini — totaling more than $4 billion in direct U.S. investment.
Those countries have pledged an additional $1.6 billion of their own funding. Mozambique and Ethiopia are expected to join next week, and administration officials say they aim to finalize a dozen agreements before year’s end.
A senior State Department official said that the old system “was unsustainable, enriched beltway bandits, and was designed to perpetuate itself rather than help countries become self-reliant.” Under Trump’s new strategy, the official said, foreign aid is no longer a subsidy for NGOs with massive overhead but a targeted investment in countries that commit to long-term improvements in public health and self-governance.
The most recent agreement — a five-year MOU with Eswatini — stands out. The small southern African nation, where more than 23 percent of adults aged 15–49 live with HIV, will focus its agreement on boosting public health data, improving disease surveillance, and advancing HIV prevention and treatment. Over the five-year period, Eswatini will increase its domestic health spending by $37 million alongside a $242 million U.S. contribution.
Secretary of State Marco Rubio explained the rationale behind the overhaul, noting that the previous NGO-driven model too often swallowed taxpayer dollars before they ever reached the intended beneficiaries. “We would go to a country and say we are going to help you with health care needs and then we would drive over to northern Virginia somewhere and find an NGO… and give them all the money,” Rubio said. “By the time it got down to it, the host country had very little influence… and only a percentage of the overall money ever actually reached the patients.”
Rubio said he hopes to sign 50 such agreements worldwide, emphasizing that U.S. aid should help nations become independent — not serve as a pipeline enriching nonprofit executives.
The administration’s skepticism of the NGO model is not without basis. Many major U.S.-funded health NGOs employ executives earning salaries rivaling Fortune 500 corporations. In 2024, the president of Research Triangle Institute made $1.4 million, while two vice presidents earned more than $850,000 each. At the Jhpiego Corporation, an executive earned over $1.08 million. Other NGO leaders routinely make between $500,000 and $700,000 a year — all while their organizations receive substantial federal funding.
For Trump officials, those numbers prove their point: the old system was feeding bureaucracies, not patients.
The America First Global Health Strategy marks one of the most sweeping attempts yet to realign U.S. foreign aid with American interests. By cutting out NGO middlemen and insisting partner nations invest their own money, the administration argues it is helping build real capacity abroad — and finally giving U.S. taxpayers a return on their investment.
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