The United States government has announced that future foreign aid will be channelled primarily through direct agreements with national governments, rather than routed through nongovernmental organisations and other intermediaries.
The change, embedded in the administration’s America First Global Health Strategy, marks a stark departure from decades-long practice and comes alongside the practical winding down of the United States Agency for International Development (USAID).
Under the new model, Washington will negotiate multiyear bilateral compacts with recipient countries, requiring co-investment from those governments and performance benchmarks tied to U.S. priorities. These agreements are designed to shift aid delivery away from grants and contracts administered by NGOs, towards direct government-to-government engagement that U.S. officials say will enhance accountability, reduce waste and align assistance more closely with American strategic interests.
Secretary of State Marco Rubio, laying out the rationale for the pivot, said that “We must keep what is good about our health foreign assistance programmes while rapidly fixing what is broken,” framing the approach as one that retains U.S. generosity but “directly benefits the American people and directly promotes our national interest.”
The announcement follows the formal dissolution of USAID, with its remaining functions absorbed into the State Department after a period of review and widespread programme cuts. Rubio justified the organisational overhaul by arguing that the agency had “strayed from its original mission” and that a new framework was necessary to empower partner governments to grow sustainably.
This strategy is already in action. In recent weeks, the United States signed a bilateral health pact with Kenya worth more than $1.6 billion, under which the Kenyan government agreed to significantly increase its own health spending alongside U.S. funds. U.S. officials said the agreement exemplifies a shift away from traditional NGO-led assistance towards compacts designed to build local capacity.
At the same time, in Abidjan the United States committed $480 million directly to the Ivory Coast’s health sector under the administration’s global health plan, with Ambassador Jessica Davis Ba noting that the initiative reflects “a shift from traditional aid models to a focus on trade, innovation, and mutual prosperity.”
Critics, including many development experts and humanitarian advocates, question whether bypassing experienced implementing partners could weaken service delivery in fragile states and undermine the very goals aid seeks to achieve. They warn that the dramatic overhaul could reduce the reach of assistance, particularly where government capacity is limited. Observers also note that the context of these reforms includes deep cuts to U.S. foreign aid budgets and the scaling back of long-standing programmes.
The practical effects of this policy will unfold over 2026, as additional bilateral agreements are concluded and implementation begins in earnest. The shift represents not only a new operational model but also a broader redefinition of U.S. engagement in global development.
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