WASHINGTON — The policies and budgets debated and decided in the halls Congress and within the walls of the White House in the first year of Donald Trump’s presidency are already having an impact on mothers, farmers, and children around the world.
As the U.S. government continues to operate under temporary funding bills, some organizations are feeling cuts already, or seeing the impact of a system moving slowly amid great uncertainty. From mothers in Kenya, to farmers in Malawi and Tajikistan, it seems that the most immediate impacts are being felt in health and in agriculture, where policy shifts have accompanied the budget uncertainty.
The impacts, while immediate for some now, are expected to multiply in the year ahead, and if the current pattern of delaying contracts or only doing short-term, almost stop-gap programming continues, many experts believe long-term development gains are at risk.
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Devex spoke with a number of government officials, leaders of nongovernmental organizations, and U.S. Agency for International Development contractors about how the budget recommendations and policies coming through Washington are impacting people in developing countries. The picture they paint is one filled with apprehension, disruption, and the potential to reverse or limit gains and effectiveness.
Delays and inefficiency
While many of the proposed funding cuts haven’t come through, continued budget and policy uncertainty has resulted in canceled or reduced contracts and delayed programs, which is limiting effectiveness on the ground, according to conversations with USAID implementers and a letter from Interaction, an alliance of U.S.-based NGOs. Interaction, on behalf of its members, recently wrote a letter to USAID’s acting assistant administrator for the Bureau for Management to express concern about cancellations or reductions in USAID programs around the world due to budget uncertainty.
“The ability to deliver life-saving and life-altering assistance is paramount to our community and USAID’s curtailing of programs, that include support for food and nutrition assistance, the education of young children, the treatment of contagious diseases, democracy and good governance, among other areas, comes at a time of outstanding need,” the letter states.
Interaction has tracked more than two dozen examples of USAID withholding hundreds of millions of dollars that had been appropriated as part of the fiscal year 2016 and fiscal year 2017 budgets. The letter highlights several examples, including a nutrition project in Africa that has been delayed more than a year, and a program in Asia that can’t procure commodities, which may disrupt the food pipeline early in fiscal year 2018.
Nine democracy, human rights, and governance programs at USAID or the State Department were canceled or delayed, often without explanation despite funding having been previously allocated.
“It is our hope that USAID is able to address these issues expeditiously so that critical programming can continue,” the letter reads. “While we understand USAID is immersed in the redesign of U.S. foreign assistance, the agency must preserve current programming at proper funding levels as it realigns itself for the future.”
A senior staff member at a USAID contractor described “terrible, tremendous delays in procurements, the release of RFPS,” in an interview with Devex. She asked not to be identified in order to speak freely. The delays seem to vary by mission, with some, such as Kenya and Serbia, pushing things through to get things contracted ahead of future cuts and others, such as Nigeria delaying contracts for more than a year, she said.
The U.S. government made some changes to Feed the Future, the flagship food security program, reducing the number of countries where it would be active, in a process that still seems unclear to some who are implementing the program. Feed the Future countries would follow a strategy set through the program, and now, in some cases, those that were dropped from the program are not confined by that strategy and are defining country needs differently, the contractor said.
Tajikistan, for example, was dropped from Feed the Future and in October the mission put out an export-oriented agribusiness competitiveness activity, which was outside the Feed the Future technical area, she said. Feed the Future funds came directly from D.C. and didn’t have to be part of mission budgets, which freed up missions to use the funding for other things and rely on the Feed the Future funds to cover agriculture-related programs.
“Missions now are able to design a project that’s a little more of a holistic fit for the portfolio, or the country, but there is no dedicated stream of funding. They have to find it in mission funding,” she said.
The changes and budget uncertainty is also disrupting projects. A Feed the Future project in Malawi, for example, got less than half of the funding it should have for year two of the five-year project. Essentially, that funding will fund operations but what the project can do in its second year is “dramatically reduced,” she said. That is detrimental, not only because it means inactivity for likely at least one planting season and the most vulnerable farmers won’t get support, but also because they will lose trust in the community and the program will be less effective, the contractor said.
When programs are sent into a holding pattern, they lose momentum and even if there is a future influx of funding, it takes money to restart the project and is not as effective.
Reproductive and maternal health
Perhaps the most immediate impacts of Trump administration policy are being felt as the result of the expanded “global gag rule,” or Mexico City Policy, which prohibits foreign NGOs that receive U.S. aid for global health programming to provide any abortion-related services, including referrals or counseling.
“Policies like the global gag rule will really undermine health systems,” he said. “It will be a spiral effect that takes us backwards in time, takes us back years of great work in global health.”— Jonathan Rucks, advocacy director, PAI
The result has been that organizations providing reproductive health care and other services have had their U.S. funding cut, or they’ve been forced to turn down U.S. funding to continue educating women about all of their options.
Bernard Olayo, the founder of Center for Public Health and Development in Kenya, has already seen organizations and health clinics lay off staff, and there is already more pressure on public facilities and public resources to try to meet those needs, he said. While Olayo’s work hasn’t been impacted directly by the global gag rule, many of the organizations he works with are facing major cuts in funding for critical health programs, which they “expect will directly impact the lives of many women and children.”
In addition to the organizations that will have their funding cut, USAID missions stopped or delayed much of their family planning and broader global health funding, said Jonathan Rucks, the advocacy director for PAI, a global organization working on reproductive health.
“Policies like the global gag rule will really undermine health systems,” he said. “It will be a spiral effect that takes us backwards in time, takes us back years of great work in global health.”
In Mozambique and Madagascar, programs that are working to help hard-to-reach women and girls will come to an end because there are no partners yet to take them on, Rucks said. In some cases PAI is working to see if other organizations in the area could ensure that the women and girls continue to have access to health care, he added. Rucks said that while the early impacts are evident today, when the policy is fully implemented next year, they will be even greater.
The funding cuts and budget uncertainty have also sent a bad signal about U.S. leadership in global health and to country governments where U.S. funding has been used as leverage to get them to invest in health care needs, including reproductive health, Rucks said. U.S. funding for global health programs is critical, and outstrips what other countries put in, Olayo said. Even if countries try to fill the gap with domestic resources or support from other funders, that will take time.
“The biggest worry for most people is that many that should have received services will not be able to receive them,” Olayo said.
In some cases the expected cuts have spurred governments to think about how they might bridge a gap or shortfall. Uganda, for example, expects a “major shortfall” in family planning commodities in the next two years and the government is in discussions with other partners to try to meet the need, Olayo said. Still, there are concerns that there will be disruption and shortages in reproductive health commodities.
Spurring a push for domestic resource mobilization
The effort to get countries to improve their own systems and better fund services for their citizens is not a new one, but the U.S. funding cuts seem to be actively forcing some governments to think more seriously about how they will do so in the wake of aid shortfalls.
“Everybody wants governments to take on ownership of these programs but it really is a long-term plan. It can’t happen between one fiscal year and another. It’s not like flipping a light switch.”— Jonathan Rucks, advocacy director, PAI
The U.S. is the largest global health donor, and many countries are dependent on U.S. funds to run national health programs and tackle key diseases including HIV, tuberculosis, and malaria.
“It’s an opportunity for countries to start thinking about how they can start co-funding, even if donor money supports some critical care services,” Olayo said. In Kenya, for example, the government now has a plan to use its own resources to fund reproductive health programs, he said, and more middle-income countries should be looking for ways to pay for more of health costs.
But while growing or middle-income countries may be able to cover more of the costs, the poorest countries will likely continue to suffer, Olayo said.
“Everybody wants governments to take on ownership of these programs but it really is a long-term plan. It can’t happen between one fiscal year and another. It’s not like flipping a light switch,” Rucks said. For countries, such as Ethiopia, where nearly half the health budget is donor-funded, cuts could disrupt entire health systems, Rucks said.
But generally the era of relying so heavily on U.S. funding for critical global health needs may be coming to an end and countries are more focused on how they can meet existing policies or strategies once U.S. funding is cut, said Ngozi Erondu, an assistant professor at London School of Hygiene and Tropical Medicine and co-founder of the Global Bridge Group, LLC, a global health consultancy, who works with policymakers in 14 sub-Saharan African countries on health systems and malaria.
“I definitely think that it is a good thing that local governments are thinking about how they can uphold their own systems. It’s something the global community has been talking about a long time,” Erondu said. But she warned there is confusion about how to do so and a concern that the health systems of some countries would be left in shambles after a U.S. withdrawal.
There are certainly some cases where countries just couldn’t come up with the funds to keep programs running that are supported by U.S. dollars, but in others, it might help leaders become more accountable, a Nigerian government official, who asked not to be named in order to speak freely, told Devex.
In some cases, aid money makes countries less accountable to its people, but when aid budgets are cut and care is lost, citizens begin to question the government, he said. These cuts could be an opportunity to get governments to commit more resources, some that have been subsumed by fraud, to programs, he said.
“These governments, now starved of money, need be able solve societal problems, provide solutions — that’s a good thing,” the official said.
In Nigeria, for example, the government will need to procure HIV medications because the U.S. has withdrawn assistance, as well as some TB drugs, which are very expensive, the official said. While it has committed to doing so, he doesn’t know if the government will in fact be able to procure what it said it will procure.
“There is a lot of apprehension and tension in ministries,” the official said. “I just hope politicians come through and provide these things. If not, people will be in trouble.”
If countries fall short — because they just don’t have the funds or don’t have the purchasing power — they will look to other partners to help bridge the gaps and build alliances with, he said.
Influence and allies
One impact that’s perhaps a bit more difficult to define is the decline of American influence in developing countries. A number of development professionals and grassroots NGO leaders told Devex that perceptions of the U.S. are changing. In some cases, that means that local communities see Trump’s tweets and are reluctant to support American businesses trying to enter their communities. In other cases, it’s leading to a sense that the U.S. may not be the leader it once was, and countries may not be as readily influenced by policy recommendations, especially as they turn to other countries to meet shortfalls left by the U.S. retreat.
One potential sign that U.S. influence is already diminishing came Thursday, when the U.N. General Assembly voted overwhelmingly to denounce the U.S. decision to recognize Jerusalem as Israel’s capital, despite threats by President Trump to cut aid to countries that voted against the U.S. decision.
“For a long time the power of the U.S. was not just felt within the developing world, in places like Kenya, through the military and other things, but through the charitable arm of the U.S. government,” Olayo said.
People are hearing the America First rhetoric and it is reducing U.S. influence, he said. “People don’t feel that the U.S. cares. That feeling that they care or will support the countries in need is reducing,” he said.
Aid is a foreign policy tool, and governments will listen to countries that provide aid, and cooperate with them on security and economic issues, the Nigerian government official told Devex. When the U.S. cuts aid, it loses the leverage that it has with leaders to support their causes, he said.
Among the leaders, often doctors and those working in health ministries, who Erondu speaks to, there has been a “solemn acceptance” of the situation, but also a shift in perception of the U.S. A “realization that the U.S. is not as powerful, or bulletproof as they thought” because in some ways the U.S. under Trump’s leadership is more like them, Erondu said. It’s too early to tell if actual influence has changed, but there is less confidence now that the U.S. will do what it says it will do, she said.
PAI is also concerned that governments won’t take the advocacy community seriously as a result of the back and forth about funding in the U.S. government, Rucks said.
“Part of our ability to have strong conversations and influence with governments is the fact that we’re bringing something to the table,” he said. Without being able to bring technical expertise and funding to support change, it makes it harder to advocate for governments to act, Rucks added.
As the U.S. withdraws, countries will look elsewhere for support and will form new alliances, several people told Devex. That may mean working more with the U.K. or European aid agencies, but it will also mean looking east to Japan, and certainly to China.
Read more Devex coverage on the future of U.S. aid.