Why America’s New Global Health Strategy Should Inspire the World
For years, U.S. global health dollars have been the lifeline of programs across low- and middle-income countries. They paid for antiretrovirals, mosquito nets, training workshops, and entire fleets of consultants. But in September, Washington unveiled a new “America First Global Health Strategy”, a new playbook where aid is no longer a blank check but an investment portfolio, with every dollar expected to earn a return in data, results, and, ultimately, American interests.
In this strategy, money is no longer released on the basis of goodwill or broad program categories. Instead, funds are tied to strict performance benchmarks, measurable outputs, and hard data focusing only on 4 core areas: Polio, Tuberculosis, HIV/AIDS and Malaria. The U.S. is sending a clear message: capacity-building workshops and endless trainings won’t cut it anymore. Neither will glossy conferences, symbolic pilots, or supply chains riddled with inefficiencies. Aid is becoming transactional and only those who can show results, from functional health information systems to digital monitoring, will stay in the game.
Source: America First Global Health Strategy (2025)
Part of this shift comes from frustration. According to the strategy, less than 40% of U.S. health aid actually reaches frontline medicines and healthcare workers. The other 60% is absorbed by technical assistance, program management, and overheads. Washington has also grown impatient with the excesses of large implementing partners like Abt Associates and RTI International allocating million-dollar salaries for their CEOs while local clinics run short of drugs. And then there’s outright leakage: donor-funded mosquito nets and antimalaria showing up for sale in black markets. Things like this and the problem of duplication of efforts are the abuses the new accountability push is meant to stop.
Source: America First Global Health Strategy (2025)
From my perspective in Nigeria, I’ve seen how duplication drains resources. Multiple NGOs descend on the same community, each with its own donor and reporting structure, often running parallel clinics that serve the same hundred patients. Integration is almost impossible when programs are vertical and siloed. So the U.S. insistence on efficiency could, in theory, force a reckoning that has been long overdue.
At its core, this is America prioritizing America as it invests in epidemiology and surveillance — not just abroad, but also to protect America at home. And honestly? That’s not surprising. These are U.S. taxpayer dollars. In Secretary Rubio’s words: “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”. Any family putting its own needs first will naturally frustrate its extended relatives. Globally, the implication is the same: less generosity for the “national cake" leaves many countries scrambling to fill the gap.
But it also comes with risks. When aid is treated like an investment portfolio, less glamorous priorities get sidelined. Maternal health, health education, and system-wide integration don’t easily produce short-term numbers. As someone training to be a doctor, I know how vital these “soft” areas are. If expectant mothers don’t get quality care, if young people aren’t educated on prevention, if health systems remain fragmented, then even the most advanced disease surveillance system will struggle to hold the line.
The strategy also devotes striking attention to Beijing. It casts American health diplomacy as a transparent grant-based alternative to China’s loan-driven Belt and Road model. That framing raised questions for me. Why should a health strategy carry so much geopolitical weight? For many African countries, Chinese-built hospitals and roads may feel more tangible than U.S. grants tied up in layers of performance reports. In truth, both powers are exporting their own models and both leave recipient countries navigating complex trade-offs.
“When Washington eventually steps back, those who have prepared will be the ones still standing.”
Another major shift is how money will taper off. Instead of abrupt cut-offs, the U.S. promises a gradual exit: 100% funding today, sliding down year by year until programs are expected to stand on their own. On paper, this looks fairer. But the writing is on the wall, countries must build their own resilience.
What does this mean for young people in health? Honestly, it’s a wake-up call. Data analysts, epidemiologists, and health informatics professionals will be in demand like never before. I’ve already seen peers sharpening their skills in these areas, positioning themselves to ride the wave of this shift. But beyond career opportunities, the bigger challenge is whether countries like mine can use this moment to strengthen systems instead of clinging to external aid.
The America First strategy is both a warning and an opportunity. It promises accountability, efficiency, and data-driven progress but it also risks deepening the gap between what gets measured and what truly matters for people’s lives. For countries like mine, the path forward is clear: ramp up domestic financing, strengthen local pharmaceutical manufacturing, and invest in engaging health education implementation so fewer people need treatment in the first place. Because when Washington eventually steps back, those who have prepared will be the ones still standing.
Reference
U.S. Department of State. (2025, September). America First Global Health Strategy. Washington, D.C. Retrieved from
https://www.state.gov/wp-content/uploads/2025/09/America-First-Global-Health-Strategy-Report.pdf
