NEW YORK (AP) — The State Department on Thursday announced it will refocus its foreign health assistance strategy around multiyear bilateral deals with recipient countries, making aid dependent on negotiations that officials say will help reduce waste and advance American priorities.
“We must keep what is good about our health foreign assistance programs while rapidly fixing what is broken,” Secretary of State Marco Rubio said in a letter about the new strategy. “We will continue to be the world's health leader and the most generous nation in the world, but we will do so in a way that directly benefits the American people and directly promotes our national interest.”
The new approach aligns with President Donald Trump’s pattern of dealing with other nations transactionally, using direct talks with foreign governments to promote his agenda abroad. It builds on his sharp turn from traditional U.S. foreign assistance, which supporters say helped U.S. interests by stabilizing other countries and economies and building alliances.
It also fits with Trump's concerns that foreign aid in previous administrations had diverged from America's values. His administration has dismantled the U.S. Agency for International Development, or USAID, and cut billions in congressionally approved foreign aid money. A foreign aid freeze earlier this year temporarily paused funding for programs including the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, which has been credited with saving more than 26 million lives.
The new plan will give countries more “skin in the game” over the health assistance they receive and incentivize governments to work toward ultimately no longer needing U.S. aid, according to a senior administration official who spoke on condition of anonymity to brief reporters before the strategy was made public.
An overview of the plan released by the State Department said global health programs “have become inefficient and wasteful.” The administration says it will focus future foreign health aid dollars on drugs, diagnostic kits and other front line needs while transitioning other things it once funded, such as program management and technical assistance, to governments in recipient countries.
The department said specific budget changes will be determined through negotiations with individual countries. That will begin in the coming months with the goal of having new agreements in place by the spring of 2026. The department pledged that all front-line costs, including for workers who administer health care to patients, will be covered under the new deals.
The administration will keep supporting areas struggling with HIV, including in parts of Africa, but direct more funding toward partners in the Western Hemisphere and the Asia-Pacific, said the senior administration official and a second U.S. official, who spoke under the same condition of anonymity. Funding will shift away from nongovernmental organizations that the administration views as handling their money irresponsibly, the officials said.
The department's strategy document hails the successes of PEPFAR while arguing it is inefficient and spends too much of its budget on overhead costs that may be duplicative.
The strategy also lists surveillance of diseases around the world as an important goal and pledges to increase U.S. government staff in areas more at risk of outbreaks.
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