The aid collapse is a stress test for locally built health tech

The collapse of the U.S. Agency for International Development has exposed something the global health community has quietly known for years but rarely said out loud: Most digital health infrastructure in low- and middle-income countries was never really owned by those countries. It was rented.

When the Trump administration cut 83% of USAID programming in early 2025, the disruption was not just financial. An internal USAID memo reported that cessation of maternal and child health programming would affect services for 16.8 million pregnant women annually and eliminate postnatal care for 11.3 million newborns. Bangladesh alone stood to lose access to critical maternal health care for roughly 600,000 women and children. These numbers tell a story about funding cuts. They also tell a story about system design.

The standard model in global digital health has followed a predictable logic: a bilateral donor or United Nations agency funds a platform, an international NGO or consultancy builds it, and a local ministry of health deploys it. When the funding stops, the platform stops. The country is left with neither the institutional knowledge to maintain it nor the commercial logic to sustain it. The platform was a project, not infrastructure.