The past few weeks have made quite clear that US-led foreign assistance will forever look different. The primary mechanism of that assistance, the US Agency for International Development (USAID), has merged within the State Department. Thousands of previously full-time employees are now without work. Around 80% of USAID’s programs no longer exist.
But a Democratic administration could reverse President Donald Trump’s dismantling of USAID, which the president predicated on executive authority. This fact raises the question: When the Trump administration inevitably leaves office, how should a future administration rebuild USAID?
This is a practical question. Those who believe in the importance of American foreign assistance will need a tangible plan to rebuild and reconceive the agency. Any incoming administration will find itself struggling to undo the damage done without a clear blueprint in hand.
But it is also a philosophical question, as the destruction of the traditional American-led international development sector opens up a broader conversation about what shall take its place.
In four years, most existing American implementing partners will have shuttered or downsized. The overall pool of international donor funding will have shrunk substantially. National and local governments will likely have decoupled many of their systems from US regulations and/or funding streams.
In this new landscape, those who work in or care about international development must think deeply about what foreign aid is for — about the objectives and values that should direct its course. A simple return to the status quo will neither meet the challenge of the moment nor seize the opportunity for a generational leap ahead.
Accordingly, when the time comes, those looking to rebuild the foreign assistance sector should embrace the opportunity to reinvent USAID, preparing it for the new challenges of a post-populist 21st century.
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One model for the reinvention of USAID is the US President’s Emergency Plan for AIDS Relief, better known as PEPFAR. The world’s most significant HIV/AIDS prevention and treatment program, PEPFAR has long received strong bipartisan support and is responsible for saving more than 25 million lives throughout its 21 years of existence.
PEPFAR’s success cannot simply be duplicated across other development areas. After all, the program’s design was to solve a specific health crisis. Still, given that PEPFAR is the most successful and popular foreign aid program implemented by the United States since the Marshall Plan, it is the most logical starting point for a framework to rebuild USAID.
PEPFAR has always been a unique mechanism within the larger infrastructure of US foreign assistance, operating almost as its own agency with its own metrics and problem-solving approaches. If we can recognize PEPFAR’s achievements as exceptional (and they are), we should consider how we might more broadly replicate these achievements.
PEPFAR offers three principal takeaways for those looking to rebuild USAID and foreign assistance more broadly: focus on more tightly defined problems; place a greater emphasis on collecting and sharing annual program data; and do more to engage the American people.
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One of PEPFAR’s organizational strengths is its focus and specificity. While operating through thousands of grants and award mechanisms, all of them exist for a single reason. Moreover, with time, health professionals’ understanding of how to provide AIDS relief has become very clear: offer preventative care, especially to people at risk; test early and often; link people to treatment; and keep them on treatment. PEPFAR has always embraced an institutional culture of “we know the problem, and we know the solution.”
Contrast this with an agency that is trying to solve a million problems that often interact with one another and face competing stakeholders and funding sources. Solving “poverty” is important and laudable, but what aspects of poverty should the government prioritize?
Defenders of USAID-as-it-was may reply that this is precisely the point — problems are complex, and to tackle poverty you need a program for wage growth and a program for housing and a program for nutrition and a program for education.
But this becomes both unrealistic and counterproductive. The everything-everywhere-all-at-once approach makes oversight more difficult and can lead to groupthink, inefficiency, and duplicated efforts. And it often results in years-long investments that lack any clear long-term targets or transition schemes, making it more likely that foreign governments and institutions become dependent on the money. (A lot of good research has been done on aid dependency as one of factors holding back developing countries. Take, for example, the case of Lebanon.)
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Instead, USAID should be more problem-oriented, with greater mission focus and program specificity. Of course, choosing which problems to prioritize when facing multiple crises is a daunting task, especially when problems interact. Plus, there is a lot of genuine disagreement among development experts about which investments or programs are most effective.
Taking a page out of PEPFAR’s book, though, USAID’s defenders will have to rebuild the agency with a list of clear priorities in hand. And to give new USAID programs the best possible chance, they should depart with the maxim: “we know the problem, we know the solution.”
Another thing PEPFAR gets right is its emphasis on data. Partly because it is built around a well-defined problem and set of solutions, PEPFAR monitors progress using a set of indicators specifically tailored for the purpose, and a culture of data use and regular performance monitoring imbue its efforts.
This data-driven strategy not only makes it easier to enforce accountability and make tactical adjustments on the ground — it also feeds into PEPFAR’s ongoing effort to justify itself to Congress. Before the reauthorization battles of 2023-2024, PEPFAR’s advocates were prepared to remind legislators that it was doing good work, always with the numbers to prove it.
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USAID has had an evidence-based approach to aid for over a decade, but responsibilities for collating and transmitting evidence have been fragmented, with subpar interaction between the HQ and mission levels.
Developing indicators tailored to specific problems, informed by workers on the ground, may provide an opportunity to improve top-down accountability, with universally agreed-upon definitions of success steering program evaluations and funding decisions.
Integrating more clearly defined metrics also has the advantage of making it easier to win political battles. As Emily Bass wrote in a 2024 series of articles on PEPFAR reauthorization, “history suggests that using PEPFAR-like approaches to improve the information available [to the US government] could … garner more resources, even from a divided and distracted Congress.”
To be clear, not everything is easily quantifiable, and some might reasonably worry that a greater emphasis on data could reduce foreign assistance to a bean-counting exercise. But the alternative is politically untenable and likely counterproductive over the long run.
Those seeking to rebuild USAID must learn from this, and rethink USAID’s public posture as soon as possible.
Arguably, the most important pillar in rebuilding USAID is rebuilding its relationship with the American people. If the catastrophic culling of USAID has taught its defenders anything, it is that the agency did not have enough allies at home.
PEPFAR’s success in this area is harder to replicate, as it emerged at a very specific time and won bipartisan acclaim in part because a conservative president launched it. The experts who crafted it also had deep ties with activists from the well-established domestic HIV/AIDS campaigns that had made headlines in America for decades.
Moreover, as the recent reauthorization battle demonstrates, even a program as hallowed as PEPFAR can be vulnerable to bad-faith scrutiny, conspiracy theories, and political opportunism.
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The program’s unique genesis and its relatively durable support, however, offer clues for rebuilding USAID’s future public engagement arm, emphasizing the importance of strident White House support and the power of tackling issues abroad that many Americans have dealt with or suffered from directly.
USAID has organized many congressional delegation visits, and its Bureau for Legislative and Public Affairs played a pivotal role engaging with the public. Yet, in hindsight, its engagement efforts rarely escaped the beltway. For example, the fact that USAID bought grain and other agricultural products directly from US farmers is only now a national story, with op-eds highlighting the loss to US farmers in the Illinois Times and the Topeka Capital-Journal, among others.
US presidents before Trump rarely treated USAID as a vital national interest or incorporated the agency’s work within a broader political vision. Indeed, after withdrawing troops from Afghanistan in 2011, even Obama argued that “it’s time to start nation-building here at home.” While not a comment on USAID per se, such statements betray a growing skepticism that has left USAID’s raison d’être in doubt.
PEPFAR had a clear story to tell from the beginning, and the good it did was always cast in comprehensible terms. Those seeking to rebuild USAID must learn from this, and rethink USAID’s public posture as soon as possible. They should work with US-based activists and tap into existing campaigns and nonprofit efforts, building on and learning from broad coalitions like the AIDS activists of an earlier age.
They also need to do more to prioritize loud success stories like the Kansas farmers as a matter of course, rather than a matter of survival.
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It’s no accident that as the most successful aid program of the last 60 years, PEPFAR came about through an act of whole-cloth invention. Yes, it needed to be tweaked and honed over the years to reach its full potential, but the program was deliberately designed to be different from almost all other global health programming that came before or after.
For decades, a majority of Americans have thought that the government spends too much on foreign aid, and foreign aid will realistically never be a top priority for a significant majority of voters. But there is a latent altruism that runs through the American people, and rebuilding USAID in the right way can transform the agency into an institution passively approved of by a critical mass of voters.
To do this, a resurrected USAID must have more focused programmatic goals, a greater emphasis on data-driven monitoring, and a deeper commitment to public engagement. Then, perhaps, all the disruption and destruction would not have been in vain.
