My time working for USAID
In summer 2023, I wrote a story for the United States Agency for International Development (USAID) about their work in the Gaza Strip and West Bank. Young adults who lived in these regions had received training through USAID about sanitation and hygiene, and they traveled from home to home to educate families, including children, about handwashing, waterborne illnesses, and menstrual hygiene. Even prior to the conflict with Israel, few homes had clean running water, people lived in very tight quarters, and illnesses such as dysentery were common. This project not only helped reduce the spread of illness but also provided skilled work to people in a place with high unemployment. Alas, the story never ran. Each USAID article needed multiple levels of review, and the reviews were not completed before the October 7 attack by Hamas on Israel.
This is one small example of the work done by USAID to keep people alive across the planet, most frequently women and children. I recently wrapped up three years working as a writer and editor for a government contractor, and most of my work was for USAID. I’ve thought a lot about that work in the past two weeks as I have watched the destruction of that organization, and with it, the destruction of livelihoods both here and abroad.
News organizations are reporting that more than 10,000 people worked for USAID worldwide, but that number doesn’t come close to capturing the number of people who will lose their jobs. In my home state of North Carolina, organizations doing global health work employed more than 117,000 people in 2022. Most of those organizations, including many of the largest employers in the state, received funding from USAID. In addition, companies producing health supplies and infrastructure equipment, from prenatal vitamins to sewage pipes, will be affected.
You may be questioning why our country is funding such a huge global apparatus. In 2023, we spent $40 billion on health and development projects across the world, which is less than 1% of the United States budget. To compare, we spent $816 billion on the Department of Defense that year. (If you want to see the USAID budget data, you will need to dig through this U.S. Department of State report because the USAID website is now empty.)
Why do journalists compare these two budgets?
Well, global health and development funding is a form of soft diplomacy. We have a lot of evidence at this point that ensuring access to health care, food, and education helps people thrive, and thriving people are more likely to have jobs and be able to support their families. In short, having basic needs met creates stability. This reduces the formation of militant and terrorist organizations.
Also, the world is interconnected, and preventing the spread of illness benefits all of us. COVID-19. Enough said.
What of this talk of “lunatic radicals”?
People working in global development skew progressive as do many people working in fields related to the poor and marginalized. A lot of global health efforts are aimed at people who cannot afford to access care or are afraid to access care. This includes people who use drugs and members of the LGBTQ community. These groups do not live separately from society. They share meals with, have sex with, and give birth to other humans, and thus, they pass illnesses to others who are in no way involved with behavior that some may find objectionable. Public health doesn’t allow room for exclusion, as the HIV epidemic demonstrated. Also worth noting: Many religious organizations are involved in global health work.
But global development is an outgrowth of colonialism. Isn’t this a case of white saviorism?
During my MPH program, I signed up for a humanitarian health course purely out of curiosity and was surprised to find that the bulk of the coursework involved critiquing our current system. I believe the professor wanted a bunch of dewy-eyed optimists to think critically about the repercussions of swooping into a foreign country and determining what should happen to people whose lives we did not understand. How would we address language barriers? Did we understand cultural norms so that we wouldn’t offend or endanger people? How would we reach a point where countries — often recovering from war or natural disaster — could provide these essentials to their people without U.S. help?
Once I entered the global health world, we frequently discussed these concerns. A large part of the work done by my organization was in capacity building, which is providing technical education to workers. For example, health workers would be taught how to recognize signs of hemorrhage and sepsis in a postpartum mom, both major causes of maternal mortality, and provide the correct treatment. Some health workers would also be taught how to run trainings so they could pass on their knowledge when new staff came aboard.
USAID was working to transfer greater responsibility to host countries by requiring that U.S. contractors partner with organizations in the home country and that those organizations lead each project. This transition was rocky.
USAID requires a huge amount of reporting about how money is being spent (which is where my job came in), and small organizations unaccustomed to this level of bureaucracy struggled to fulfill these requirements. Was it reasonable to request that non-English speakers file their reports in English? Perhaps not. Did this reporting system take time away from actively helping people? Probably. The effort to change the system was happening, if not fast enough, but each young person who entered the field increased the pressure to fix things. The young have a way of holding us to higher standards.
In this same vein, USAID did a lot of advocacy, encouraging governments to increase their health budgets, provide basic health care to their people, and develop long-term plans to improve their health care systems.
Couldn’t this be handled more efficiently by the private sector?
The Gates Foundation is the shining example of what a nonprofit organization can accomplish. Its budget for 2024 was $8.6 billion. I do not know employees working there so cannot speak to the efficiency of that organization compared to the U.S. government, but I would imagine it has fewer reporting requirements given that it is not accountable to U.S. taxpayers. I know of other billionaires who could fund such an enterprise, but they are busy breaking things.
And finally
I never expected to work in global health, let alone write an essay explaining it. I walked out of that humanitarian health course extremely skeptical of the system — and I’m still skeptical — but I’m also mature enough to recognize that all human systems are flawed. We amend them as we go.
If they survive, we amend them as we go.