The State Department’s new America First Global Health Strategy and reorganization of foreign assistance “fundamentally change the structure and goals of U.S. foreign aid in a way that marginalizes children,” writes an advocate for international children’s issues and global health. The shift moves foreign assistance toward a focus on serving the U.S.’s “national security” interests. The Trump administration has sought to justify the changes by claiming that the foreign aid system is “inefficient and wasteful.”
LEILA NIMATALLAH; [email protected]
Nimatallah is the Vice President of Advocacy and Mobilization at First Focus on Children.
Nimatallah told the Institute for Public Accuracy: “We have long documented the fact that U.S. foreign assistance does not prioritize children in the way it should, given that children make up about 30 to 50 percent of the population of low-income countries. But I am now really concerned. We have calculated that [foreign aid] to children has been reduced to about 6 percent.
“The U.S. is forgetting children, despite the fact that they are the most vulnerable. Children are not small adults. They have particular stages of development that require particular investments and support. It’s been well documented that without those supports, children either won’t grow up (die before their fifth birthday) or grow up with stunted brains and stunted bodies. The Lancet estimated that worldwide, 250 million children would grow up with stunted brains and bodies in 2016––and that was before Covid and the huge losses in U.S. investment. PEPFAR’s support for kids is gone. Maternal and child health programs have been decimated. Even food assistance programs, which are supported by the U.S. public and Congress, have been decimated.
“Sadly, we are having to relearn the lessons of the past 60 years all over again. We know low cost, highly impactful interventions: investing in clean water and sanitation; supporting breastfeeding for the first six months of life; proper nutrition and micronutrient supplementation; protecting kids from diarrheal disease and pneumonia; vaccination. We’re taking all that away. It’s crushing… Americans are profoundly generous and giving people, and we have proven that over six decades. The average American would not be happy knowing that a child abroad was going to die from dirty water. The federal government is not making decisions in line with what the American people want.”
Instead, “the America First Global Health Strategy gives support to other countries not based on what they need but based on how much they can give back to the U.S. It also oversimplifies and mischaracterizes what has been happening in global health, demonizing the global health strategy that has created the fantastic results we have achieved in the past––like reducing deaths of children under five. The new strategy places blame on NGOs for fraud, abuse, and waste and conflates non-profit NGOs and government contractors, which are very different. NGOs give grants, are mission driven, and are implemented by local community members. The role of for-profit contractors, meanwhile, should be minimal. This new strategy blames NGOs for USAID’s ‘problematic’ overhead costs. I take issue with the fact that it is problematic. That overhead is part of the USAID structure, because Congress requires very specific oversight and reporting requirements.”
The America First Global Health Strategy pursues government to government operations in lieu of funding nonprofit NGOs. But Nimatallah writes that “pursuing government to government operations assumes that every nation has a functioning government… In places with war and chaos, NGOs are often the only lifeline for the suffering. When funding is channeled exclusively through the central government, services for people in crisis-affected countries or hard-to-reach areas are likely to be neglected.”
She added: “It takes a huge amount of work to reach the most marginalized communities in the most rural areas of the world. Many recipient country governments simply can’t reach those communities. There are also no monitoring systems in place to ensure that the money going to recipient country governments will actually get to children in need.”