Trump likes to do things his own way. And he doesn’t care what people have to say about it.
Now the White House threw out the playbook with a bold move that’s turning heads.
Trump Administration Advances America First Global Health Strategy
The Trump administration is actively implementing its America First Global Health Strategy, shifting away from the traditional USAID framework to deliver billions in health aid through direct bilateral agreements with African nations.
To date, the U.S. has signed six memoranda of understanding (MOUs) with Kenya, Rwanda, Liberia, Uganda, Lesotho, and Eswatini, committing over $4 billion in direct U.S. investment, matched by more than $1.6 billion from the partner countries. This approach bypasses intermediaries, aiming to ensure greater efficiency and accountability.
A senior State Department official described the previous USAID model as unsustainable, noting it “enriched beltway bandits” and tended to perpetuate dependency rather than foster self-reliance.
“Now, under the Trump administration, we are committed to ensuring that every tax dollar spent overseas delivers real results by ensuring aid gets directly to its intended recipients and creating a structure that helps partner countries move toward self-reliance,” the official told The Daily Wire.
Mozambique and Ethiopia are slated to sign similar agreements soon, with the administration targeting a dozen by year’s end.
Direct Aid in Action: Focus on Eswatini and Broader Goals
The latest five-year MOU with Eswatini, signed on Friday, targets enhancements in public health data systems, disease surveillance technology, and HIV prevention and treatment. In a nation where 23.4% of adults aged 15–49 are living with HIV, Eswatini has committed to increasing domestic health spending by $37 million alongside the $242 million agreement.
Secretary of State Marco Rubio, in announcing the initiative, highlighted inefficiencies in the prior system, where funds were routed through NGOs, absorbing significant portions in overhead while reducing host-country influence.
“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, one of these organizations, and give them all the money and tell them to go to this country and do their health care program for them,” 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 expressed ambition to expand to 50 such agreements, stating: “If we’re trying to help countries, help the country. Don’t help the NGO to go in and find a new line of business.”
Addressing Waste in the Previous System
Executive compensation at major taxpayer-funded health NGOs has drawn scrutiny, with figures including over $1.4 million for the president of Research Triangle Institute in 2024, alongside vice presidents earning more than $850,000 each; over $1.08 million at Jhpiego Corporation; $598,348 at Management Sciences for Health; $545,290 at Family Health International; and $506,371 at Pact Inc. In 2023, salaries reached $577,275 at the Elizabeth Glaser Pediatric AIDS Foundation and $703,405 at PATH.
This new direct model seeks to maximize the impact of American taxpayer dollars on the ground while promoting sustainability and national ownership in partner countries.
