Streamlining Procurement and Localizing the Partner Base.

USAID is a grantmaking and contracting agency that disburses billions of dollars of federal funding in developing countries through implementing partners, such as U.N. agen- cies, international NGOs, for-profit companies, and local nongovernmental entities. In rare instances, such as in Jordan and Ukraine, the agency provides direct budget support to finance the operations of host-country governments. USAID far more often counts on expensive and ineffective large contracts and grants to carry out its programs. It justifies these practices based on speed and a lower administrative burden on its institutional capacity.

Partnering and procurement reform was a pillar of the Trump Administration’s effort to secure better development results, cut costs, and advance the Journey to Self-Reliance strategy of exiting countries from aid. In December 2018, USAID launched its first Acquisition and Assistance Strategy to streamline procurement processes; introduce innovation into its programming; and diversify its partner base away from large, expensive, and partisan implementers. The strategy counted on local NGOs, including faith-based entities already on the ground, to provide the agency with less costly and more effective alternatives to the aid giants. The strategy also prioritized global partnerships with the private sector—corporations, investors, diasporas, and private philanthropies—the source of real capital invest- ment, innovation, and efficiencies that can maximize the impact of taxpayer dollars. Under the Biden Administration, despite rhetoric to the contrary, the aid industrial complex has recaptured the agency and stifled further reforms.

The next conservative Administration should immediately implement language on key policy topics as standard provisions in all grants, cooperative agreements, and contracts. These provisions should include language on implementing the Policy on Protecting Life in Foreign Assistance, imposing conditions on funding to multilateral organizations, and increasing accountability and transparency. To ensure that USAID exercises its existing authorities to streamline procure- ment processes, the next conservative Administration should name a political appointee as the agency’s Senior Procurement Executive and Director of the agen- cy’s Office of Assistance and Acquisitions (OAA) in the Bureau of Management (M). The head of M/OAA is one of the most important positions at USAID, as the office is ground zero for controlling the disbursement of U.S. foreign aid. The White House should empower the Administrator and his or her designees to make determina- tions concerning the scale and scope of awards and increase the transparency and accountability of subawards, which can escape public scrutiny and promote pro- gressive policies during conservative Administrations. USAID should use existing authority to use program funds to expand its roster of contracting and agreement officers to accelerate the delivery of funds for disaster responses to a more diverse collection of implementers.

Accomplishing the next conservative Administration’s policy goals at USAID will require that political appointees have knowledge of, responsibility for, and visibility into the design and awarding of grants, contracts, and cooperative agreements. The Administration should restore the Senior Official Accountabil- ity Review (SOAR) or create a similar process to ensure that proposed programs above a certain dollar threshold in Total Estimated Cost/Total Estimated Amount receive a close review by policymakers in each bureau and office and, for large awards, in the agency’s front office.

“Localization” is a buzzword within the aid community but correctly assumes that more funding through local organizations produces better aid outcomes. Shift- ing from giant U.S.-based implementers has proved difficult to achieve, however, given intense internal bureaucratic resistance; opposition from the aid industrial complex; and foot-dragging from progressives, who view local NGOs—especially faith-based NGOs prominent in Africa and Latin America—as obstacles to promot- ing abortion, gender radicalism, climate extremism, and other woke ideas.

The President’s Emergency Plan for AIDS Relief (PEPFAR) has shown that localization at scale is possible within a short time span. Over the four years of the Trump Administration, the multibillion-dollar program increased the amount of funding disbursed to local entities from about 25 percent to nearly 70 percent with positive overall results. This model should be replicated across all of USAID. In addition, the next conservative Administration should expand use of the New Partnership Initiative (NPI) to every bureau and office; reset the requirements for USAID’s overseas missions to craft and execute NPI action plans; and assign each

mission a minimum percentage of its portfolio that must go to new, underutilized, and local partners. Crucial to the strategy will be increasing the use of open com- petition that lowers barriers to entry and fixed-amount awards that carry less of a compliance burden along with eliminating cost-plus reimbursement contracts that favor large companies. Before advancing a new program, the agency should be required to assess existing local activities to avoid undercutting or duplicating them. At every opportunity, USAID should build on existing local initiatives.

Global Health

The United States is the world’s largest funder of global health initiatives. For more than 60 years, the American people have offered health assis- tance to the world and saved millions of lives. The USAID Bureau for Global Health (GH), the second largest within USAID, oversees a multibillion-dollar operation to support maternal and child health; voluntary family planning; PEPFAR and the President’s Malaria Initiative (PMI) (both started under President George W. Bush); and other initiatives against other infectious and neglected tropical diseases. Effective use of funds is essential to maximize care for the world’s neediest people. Countries with strong health institutions and sound public health practices responded quickly to and recovered more rapidly from the COVID-19 pandemic. This demonstrates the importance of “localization,” by which USAID helps gov- ernments and the private sector in developing countries to strengthen their own ability to address needed training, services, accountability, and organiza- tional capacity.

Unfortunately, many USAID-funded global health activities remain rooted in patterns that began decades ago and measure improvements in terms of inputs— money spent—instead of outcomes achieved. From the 1950s to 1970s, the major recognized threats to human health were infectious diseases such as polio and smallpox, and USAID funded programs “in” a country, not “with” a country. Mater- nal and child health, food, water, and sanitation programs were often intermittent. USAID consistently financed population control, contraception, and abortion as essential to “development.” Most programs focused on one disease or condition but had little integration with other global health activities. Chronic diseases were ignored.

Consequently, the next conservative Administration should focus on updating the Global Health Bureau’s portfolio, emphasizing a comprehensive approach to supporting women, children, and families; building host-country institutional capacity; increasing awards to local and faith-based partners (expanding what occurred during the Trump Administration with the NPI); and improving USAID’s ability to coordinate with local partners. Updating Funding Priorities. The Bureau should identify and eliminate out- dated and ineffective concepts and focus on funding innovation. A rigorous review is necessary to ensure that current programs and funding streams avoid wasting taxpayer dollars and prioritize what is needed now and what works.

Focusing on Holistic Health Care and Support for Women, Children, and Families.

The continued high rate of maternal and infant mortality is a persistent global tragedy. Contrary to current publicity, this problem is not solved by abortion. Families genuinely cherish children. The next leadership at USAID must focus attention on women and children’s health (including unborn children) as well as health risks across life spans, including childhood infections, cervical cancer, adolescent risks, and family stability, by utilizing a coordinated approach. The Bureau should implement a “Request for Application for Resilient Families” that harvests collaborative funds from siloed programs and makes individuals and the family, not diseases or conditions, the true focus of intervention.

Increasing USAID Collaboration with Faith-Based Organizations.

FBOs historically have been much more successful in outreach to remote and vulnerable populations, based on trust built through decades of service. The value of collab- orating with FBOs was demonstrated in the October 2020 Evidence Summit on Religious Engagement. In sub-Saharan Africa, FBOs often provide more than 80 percent of health care, especially to the extremely poor. In contrast, the Global Health Bureau historically has provided 85 percent of its funding to large U.S. NGOs with significant overhead costs, as a result of which only 20 percent–30 percent of funding reaches people in need.15

Leveraging the Strength and Experience of Presidential Initiatives.

Millions of people are alive today because of the American people’s investment in PEPFAR and PMI. The training, laboratory, clinical intervention, health educa- tion, data collection, and organizational platforms of these programs became the bedrock for responding to the COVID pandemic. It is time for these programs to become part of an integrated, strong, and sustainable network of health care and public health in developing countries. A smooth transition to national ownership and funding, however, will require better coordination of USAID’s own stovepiped programs with PEPFAR and PMI.