Strengthening The Collection And Use Of Data

Good decisions are based on accurate data. For decades, global health programs have relied mostly on statis- tical modeling (rather than actual data) or survey data (the weakest type of data). Poor data quality undermines both the evaluation and improvement of desired outcomes achieved by our global health programs. The Trump Administration implemented critical updates of PEPFAR’s systems for the collection and reporting of data to increase transparency and hold funded partners and overseas missions accountable. The next conservative Administration should apply these reforms to all of USAID’s global health programs.

Strengthening Private-Sector Engagement. The Bureau’s Center for Inno- vation and Impact (CII) should be empowered to expand networks of private and faith-based health organizations that can develop projects using develop- ment-impact bonds, capital funds, and innovative technologies, including with the

Millennium Challenge Corporation and the new U.S. International Development Finance Corporation. More flexible and agile CII funding will spur innovation within the Bureau and help to enhance countries’ self-reliance in the provision of health care.

Improving Bureau Hiring, Staffing, and Recruitment Practices.

The Global Health Bureau should address its own management challenges by modifying the high ratio of contractors to direct hires, holding career leadership accountable for effective management, and building more flexibility in emergency responses. Bureau personnel suffer from “mission drift,” burnout, and a lack of vision. New directives, social agendas, and extra layers of review have obscured core activities and caused talent to leave the agency. Conservative leadership must return the focus to development and improved workforce morale and focus on global out- comes and the efficient use of taxpayer dollars.

Holding the U.N., the World Health Organization (WHO), and Other Mul- tilateral Organizations Accountable. Leadership should designate a political appointee to help coordinate cross-agency efforts to hold the U.S. government’s multilateral partners (U.N. and WHO agencies and other international organiza- tions) to a higher level of financial and programmatic accountability, including assurances that language promoting abortion will be removed from U.N. docu- ments, policy statements, and technical literature. The United States must have more prominent representation in international technical committees and regu- lation-setting organizations to ensure the proper execution of American resources, the preservation of our values, the protection of innovation, and the vitality of our biomedical sector.

Global Humanitarian Assistance. The U.S. government is the world’s largest humanitarian actor, annually disbursing billions of dollars in lifesaving assistance— food, water, shelter, emergency health care, and related protection support—to tens of millions of vulnerable people. Funded by the U.S. Congress through the International Disaster Assistance (IDA) account, USAID pays for nearly half of the budget of the Nobel Prize–winning U.N. World Food Programme (WFP) as well as dozens of simultaneous operations that range from responses to hurricanes in Central America to tackling outbreaks of Ebola in Central Africa and caring for millions of people displaced by ongoing conflicts.

USAID’s emergency responses once were focused primarily on natural cata- clysms such as hurricanes, floods, and earthquakes. Today, the agency spends more than 80 percent of its humanitarian budget on chronic man-made crises. Most of these “emergency responses” began years ago and absorb billions of dollars annu- ally with no end in sight. Every year sees financial demands grow in response to new conflicts, most recently Ukraine. The budget of the Bureau for Humanitarian Assistance (BHA) has doubled compared to just a few years ago, and BHA can no longer manage its funds responsibly.

A politically powerful foreign aid industry that benefits financially from extending and expanding these large-scale programs for years, even decades, ensures little scrutiny of these ever-increasing appropriations. The massive growth in “emergency” aid distorts humanitarian responses, wors- ens corruption in the countries we support, and exacerbates the misery of those we intend to help. The permanence of this assistance, particularly in countries where we have little to no in-country presence and must rely on U.N. agencies to self-monitor, has morphed into a co-governance scheme in which the U.S. govern- ment effectively finances the social services obligations of corrupt regimes that threaten the United States. These governments can then redirect scarce budget resources away from costly health and education toward financing their wars, sup- porting terrorism, repressing their citizens, and enriching themselves. Examples of this abuse are spread throughout the world.

Yemen, once the breadbasket of the Arabian Peninsula, is now dependent on billions of dollars of aid as formerly productive Yemeni farmers cannot compete against “free food” while irrigation systems remain in disrepair, leaving the country to suffer from water shortages during long summer droughts and flooding during its rainy season. Iran-backed Houthi rebels divert substantial amounts of aid to support their war efforts. In Afghanistan, the aid infrastructure built over 20 years of American military presence that three Presidents wanted to end collapsed with the failure of U.S.-trained Afghan forces to repel the Taliban’s 2021 advances. Yet the country has received nearly $1 billion more in U.S. humanitarian aid since the Taliban’s takeover and absent a U.S. embassy to ensure that it is not diverted to the Taliban and other terrorist groups.

In Burma, U.S. aid finances all of the food and medical care for hundreds of thousands of persecuted Rohingya that the military regime forces to live in open-air concentration camps.

In northern Iraq, hundreds of thousands of Yazidis—targeted for genocidal extermination by ISIS—remain in miserable camps unable to return home because of the Iraqi government’s refusal to clear out Iran-backed militias occupying their homeland.

Over the past decade, the U.S. government has expended $14 billion in aid to Syria where the bloody regime of Bashar al-Assad—a close ally of Iran and Russia—skims nearly half of foreign aid through inflated official exchange rates, the diversion of food baskets to its military units, and procurement arrangements with compromised local contractors. In effect, humanitarian aid is sustaining war economies, creating financial incentives for warring parties to continue fighting, discouraging governments from reforming, and propping up malign regimes.

Nefarious actors reap billions of dollars in profits from diversions of our human- itarian assistance, but so do international organizations. The WFP charges 36 percent in overhead while Oxfam International’s overhead has reached 70 percent in Yemen, reflecting the high costs of foreign staff, security, and logistics. With pow- erful lobbies in Washington, D.C., and in leadership positions throughout USAID and the Department of State, the aid industry adroitly exploits Congress’s dispo- sition to increase funding year on year to assist those in dire need but provides no evidence to justify the mounting budget requests.

In 2020, USAID’s leadership fused formerly bifurcated food and nonfood emergency relief operations into a single Bureau for Humanitarian Assistance to improve the management of the agency’s largest portfolio, but this reform was not sufficient to address the problem. The next Administration should resize and repurpose USAID’s humanitarian aid portfolio to restore its original purpose of providing emergency short-term relief, prepare vulnerable communities for tran- sition, and do no harm in the following ways:

Work with Congress to make deep cuts in the IDA budget by ending programs that do more harm than good in places controlled by malign actors, such as in Yemen, Syria, and Afghanistan, where our aid is consumed by fraud, diversion, and partner overhead costs. Require USAID and the State Department to devise country-based exit strategies that term-limit the duration of humanitarian responses and transition funding from emergency to development projects. This will require robust diplomacy to press host governments to integrate displaced persons in lieu of keeping them in expensive and dehumanizing camps financed by the international community.

Transition from large awards to expensive, inefficient, and corrupt U.N. agencies, global NGOs, and contractors to local, especially faith-based, entities that are already operating on the ground. This approach provides a far less expensive and more effective alternative for aid delivery. Local partners more ably navigate corrupt environments and are more likely to steer vulnerable populations away from dependence on aid toward self-sufficiency. Require that BHA avail itself of existing IDA authorities that it fails to use, including to dispense with the cost-reimbursement model that disqualifies — 268 —Agency for International Development undercapitalized local NGOs; accept other donor vetting of local partners; streamline the award-approval process; and expand the use of fixed-amount awards to rein in cost overruns.

Direct USAID’s Bureau for Management to hire more procurement officers for BHA to strengthen the Bureau’s award management capacity and reduce the incentives to issue large awards to aid industry giants. Allow BHA to manage the process of hiring Personal Services Contractors. Require BHA’s partners to adopt stricter vetting procedures to prevent aid from being diverted to terrorists. Increase efforts to obtain greater contributions, not just pledges, for humanitarian operations from other donors and make this a condition for receiving additional U.S. aid.

Leveraging Foreign Aid to Unleash the Power of America’s Private Sector. During the 1960s, when USAID was launched, 80 percent of financial flows from the United States to the developing world was in the form of U.S. government assistance. Today, that figure is under 10 percent, overtaken by private investment, remittances, and private charities, all demonstrating the power of America’s pri- vate sector to promote wealth-generating economic development in poor countries. Leaders in the developing world routinely press U.S. officials about their preference for “trade and investment, not aid.”

Instead, the Biden Administration is leveraging private-sector financing to promote its climate and other progressive agendas worldwide. The next conser- vative Administration must return USAID to a foreign aid model that leverages its resources to promote private-sector solutions to the world’s true development problems and end the need for future foreign aid. Private capital investment in these markets is the greatest enabler of job creation and sustainable economic growth throughout the developing world.

A key tool of American soft-power leadership is the U.S. Development Finance Corporation (DFC). Launched in December 2019, DFC sought to unleash the power of America’s private sector to advance our interests by providing emerging markets with blended financing opportunities to help end wretched poverty, create new markets for U.S.-made products, strengthen bilateral partnerships in strategic parts of the world, and offset China’s predatory loans and investments. The Trump Administration launched a USAID–DFC Working Group to maximize development outcomes and review individual investment projects through a counter-China lens and ensure a cohesive interagency development response.

As development agencies, USAID and DFC must do a better job of aligning their respective activities and closely integrate both structurally and operation- ally. The easiest way to foster this alignment is to “dual hat” the role of DFC’s chief development officer so that he or she serves simultaneously in both institu- tions. Like all U.S. federal bodies, DFC should be restored to its original intent of deploying its commercial risk-reducing financial services instead of its current misuse as another global vehicle to promote economy-killing climate programs, meet irrelevant diversity objectives, and overfocus on low-impact or misguided gender-based activities.

Branding. A deeply embedded culture within the foreign aid bureaucracy views public recognition of U.S. assistance as secondary to a larger philanthropic mission and is embarrassed by the American flag. Citing vaguely defined secu- rity concerns, USAID’s implementers—U.N. agencies, international NGOs, and contractors—often fail to credit the American people for the billions of dollars in assistance they provide the rest of the world even as they engage in self-promoting public relations to raise other donor funds. This approach has negative foreign policy implications as China relentlessly promotes its own self-serving efforts to gain influence and resources. Worst of all, malign actors sometimes appropriate credit for unbranded U.S. assistance: Houthi terrorists, for example, claim to pro- vide for the people under their occupation with anonymous U.S. humanitarian aid. The United States is in a struggle for influence with China, Russia, and other competitors, and American generosity must not go unacknowledged.

The next conservative Administration should build on the Trump Administration’s brand- ing policy, which revamped ADS Chapter 320, to force the aid bureaucracy to fully credit the American people for the aid they are providing. The Senior Advisor for Brand Management in the Bureau for Legislative and Public Affairs (LPA) (dis- cussed infra) should be a political appointee who is responsible for maximizing the visibility of U.S. assistance by enforcing branding policy on every grant, coopera- tive agreement, and contract. The LPA should liaise with counterparts at the U.S. Agency for Global Media (USAGM) to ensure local media pickup of these activities.