The Trump administration is doing what Washington almost never does: admitting a broken system is broken—and fixing it. In a major shift away from the old USAID model, the State Department is rolling out a new America First Global Health Strategy that sends billions in aid directly to African nations, instead of routing it through the ever-hungry NGO bureaucracy.
So far, the U.S. has signed six memoranda of understanding with Kenya, Rwanda, Liberia, Uganda, Lesotho, and Eswatini, totaling more than $4 billion in direct U.S. investment. Those countries are matching the effort with over $1.6 billion of their own funding. Mozambique and Ethiopia are expected to sign similar agreements next week, with a goal of a dozen agreements by the end of the year.
According to a senior State Department official, the previous USAID system wasn’t just inefficient—it was designed to sustain itself. The official said it “enriched beltway bandits” and failed to help countries become self-reliant. In other words, it worked great for consultants in Northern Virginia, not so much for people actually needing care.
Under the Trump administration’s new approach, aid goes straight to the intended recipients, with a structure that encourages partner countries to take ownership of their own systems. The idea is simple: if taxpayers are footing the bill, the money should actually reach patients, not disappear into administrative overhead.
A five-year agreement signed Friday with Eswatini highlights the shift. The $242 million MOU focuses on improving public health data systems, modernizing disease surveillance, and strengthening HIV prevention and treatment. In a country where 23.4% of adults aged 15–49 live with HIV, Eswatini has committed to increasing its own health spending by $37 million over the life of the agreement. Accountability—imagine that.
Secretary of State Marco Rubio spelled out the problem with the old model last week. The U.S., he explained, would promise health care assistance to a country, then turn around and hand the money to a U.S.- or foreign-based NGO, leaving the host country with little control and patients receiving only a fraction of the funding. Rubio made it clear: if the goal is to help countries, help the countries—not create new business lines for NGOs.
That criticism isn’t theoretical. Executives at taxpayer-funded health NGOs routinely earn eye-popping salaries. In 2024 alone, the president of Research Triangle Institute made more than $1.4 million, while top executives at other organizations earned between $500,000 and $1 million. Apparently, “global health” has been very good to some people—just not always the ones it was supposed to serve.
Rubio has said he hopes to sign up to 50 such agreements, expanding the model even further. It’s a clear break from the past and a clear statement of priorities: real results, real accountability, and respect for American taxpayers.
By cutting out the middlemen and empowering partner nations, the Trump administration is proving that America First doesn’t mean America alone—it means smarter leadership, real partnership, and aid that actually works. That’s a win for taxpayers, for partner countries, and for the people who finally see help reach where it’s needed most.
