USAID's Health Challenge: Improving US Foreign Assistance

Roger Bate | 01 Jan 2024
Journal of the Royal Society of Medicine
On 19 January 2006, United States Secretary of State Condoleezza Rice announced fundamental changes to US foreign aid assistance. In an effort to promote effectiveness, the current United States Agency for International Development (USAID) Administrator, Randall Tobias, would now also serve as the first Director of Foreign Assistance. The position assumes a status level of Deputy Secretary of State, with the organization's activities and management more closely aligned with the State Department. This bold move reverses the Foreign Assistance Act of 1961, which established USAID as a separate entity. As an independent federal agency, USAID's original mandate at the height of the Cold War was twofold: to further America's foreign policy interests by expanding democracy and opening markets to American goods while improving the lives of the citizens in the developing world. Development was always a 'principal objective of the foreign policy of the United States,' as section 101 of the Foreign Assistance Act 1961 states, but played second fiddle to more obvious foreign policy concerns. USAID is still charged with prioritizing western values in foreign policy as well as meeting humanitarian need. Secretary Rice declared that policies are being reoriented to 'build and sustain democratic, well-governed states that will respond to the needs of their people and conduct themselves responsibly in the international system.' Yet USAID's mission in health has often been obscured. Access to basic health care in poor countries, a robust proxy for development, remains unacceptably low, and USAID had little to show for its efforts. HIV/AIDS, diarrhoeal diseases, tuberculosis and malaria are the deadliest diseases on the planet, claiming at least 6 million lives each year. These infectious diseases are preventable and treatable with increasingly cheap measures. In spite of the near tripling of US foreign assistance from US$10 billion in 2000 to US$27.5 billion in 2005, it is not a trivial matter to assess how much was actually spent on combating disease or on health in general.

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