The Trump administration’s proposed financial year 2018 budget has rightly and roundly been criticized for, among other things, dramatic reductions to the accounts that fund America’s role in the world, including development assistance or foreign aid.
Congressional opposition makes it likely that much of what Trump proposes will not become law. Still, the proposed aid cuts are jarring. Millions will suffer and many will die who otherwise could have been saved.
Members of Congress, aid practitioners and those who implement programs funded by the foreign aid accounts know two things about our investments abroad.
First, United States foreign aid has achieved amazing results in lifting millions out of poverty, creating stable and prosperous democracies and trading partners, and saving millions of lives that otherwise would have been lost to preventable or treatable disease. In terms of global health investments alone, child mortality rates around the world are less than half what they were 25 years ago, and all are trending down toward the levels that exist in Organisation for Economic Co-operation and Development countries like the U.S. More kids alive? Good by any standard, and among the reasons why foreign aid has been an area of great bipartisan consensus in recent years.
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Second, no one believes that U.S. budget challenges, to the extent they weigh on our economy or our democracy, will be solved through cuts to the tiny foreign assistance budget. Everything the U.S. spends on the State Department, the U.S. Agency for International Development, foreign assistance, multilateral development banks, the United Nations system, the Peace Corps — all of it amounts to barely 1 percent of the federal budget.
There is no “foreign aid dividend,” and there never has been.
But these realities are not penetrating the Trump administration’s misguided thinking. And even if these realities took hold — the value of these investments, and their amazing impact far beyond the share of the budget they represent — we would still be facing the policy changes that are imposed when power changes hands in the White House, with debilitating effect on aid efficiency and people's lives.
This is a wake-up call for us to reduce our reliance on a capricious provider of the resources we need to deliver solid development results.—
Trump’s expanded “Global Gag Rule,” or Mexico City Policy, will hobble reproductive health programs worldwide, weaken global health pillars such as the President’s Emergency Program for AIDS Relief, and ultimately lead to more women dying needlessly.
Even when foreign aid is robustly funded, policy shifts can spell big problems for recipients and millions living in resource poor settings.
But maybe we are missing the point, and the opportunity, that Trump’s penny-wise-and-pound-foolish financial year 2018 budget proposal represents.
This is a wake-up call for us to reduce our reliance on a capricious provider of the resources we need to deliver solid development results.
Instead of relying so heavily on aid, we need to focus on addressing and fixing market failures in developing countries, designing programs for better cost recovery and financial sustainability from the start, unlocking national government health budgets and delivering basic health care at an affordable price.
Are there other viable alternatives to reliance on USAID global health funding? It turns out, there are.
There is an unprecedented interest among impact investors, social investors, private philanthropists, and corporate shared value initiatives.
We can choose to see this as a strategic challenge: Can we reimagine health care and put the consumer more in charge of her own health, while reducing the reliance on aid? We think innovation in diagnostics and therapeutics, and rising incomes in many parts of the developing world, make this a possibility and soon, a practicality.
We can bring health care directly, and cheaply, to her doorstep in many cases and allow her to make the right choices for her and her family, regardless of political agendas.
Improving health markets and thoughtfully reducing the need for government donor subsidy actually puts accessible health for those living in developing countries on more stable footing. And the needy are no longer negatively impacted by policy vagaries and budgetary fantasies of this or any future U.S. administration.
Remaining aid can be reserved for the poorest and most distressed who will continue to require subsidy and public financing in order to be served. Whether that comes from governments such as the U.S. government, or from host government infrastructures including national health insurance schemes and public sector social systems, is a topic of ongoing and vibrant discussion. But regardless of this trend, putting more health directly in the hands of the health consumer, and working toward a future where she is able to afford more of it herself, is a good development outcome.
Trump’s budget may be just the wake-up call the development community needs. Charting a path away from reliance on donor subsidy for our work is a healthy move. The sooner Washington’s shifting winds and ideology temples are irrelevant to her, the better her life might actually be.