USAID Bureau for Global Health criticized by government watchdog

Workforce challenges and management issues are hindering the ability of the U.S. Agency for International Development’s Bureau for Global Health — one of the most important entities within the agency — to deliver on its mission, according to a U.S. government watchdog. In a report dated in June and shared with Senate Foreign Relations Committee Chair Robert Menendez, a Democrat from New Jersey, the Government Accountability Office, or GAO, outlined a series of failings. The report follows previous criticism, reported by Devex, over an attempt by the agency to move staff to a different contracting firm, which sparked a bitter fight over benefits, equity, and transparency. Some contractors at the bureau were so frustrated by their treatment at the agency that they organized a “sick-out” to protest the move. Workforce issues have so bedeviled USAID over the last few years that Administrator Samantha Power has openly talked of a “staffing crisis” at the agency, with some senior officials acknowledging that the current staffing structure is not “fit for purpose.” In emailed comments to Devex, a USAID spokesperson said the agency “takes oversight and accountability for our management and operations seriously and appreciates the opportunity to address the findings which will continue to strengthen the USAID Global Health Bureau.” Workforce issues In its 72-page report, GAO said the bureau’s workforce, the majority of whom are contractors, are not permitted to do the job demanded of a government agency, such as oversight of the bureau’s contracts and grants for its more than a $1 billion budget. “The majority of the Bureau’s staff are non-direct hires who, according to USAID, do not meet the definition of federal employees who are able to perform inherently governmental functions,” the report said. A USAID spokesperson told Devex that in an attempt to consolidate the agency’s “cost of doing business,” Congress created an operational expense account where the agency draws funding to hire full-time staff. The spokesperson said that staffing needs had surpassed the budget geared toward hiring. The bureau has used funds geared toward programs to hire institutional support contractors, or ISCs, who comprise 60% of the bureau's workforce, according to the spokesperson. The agency acknowledged that these contractors are limited by federal law in what they can do at the agency, including certain functions related to performance monitoring of USAID’s contracts and grants. The agency was engaging with Congress for a solution to this conundrum so USAID can use program funds to hire staff, the spokesperson added. In the meantime, the agency was using a new authority granted to it in fiscal year 2023 for times of crisis to use program funds to hire direct employees. Some of the bureau’s work of preventing and responding to health emergencies falls within this new authority. The agency plans to recruit up to 70 new direct hires using this authority, the spokesperson told Devex. GAO also found that there are instances where the staff workforce are unevenly distributed relative to the needs of the bureau’s priorities. For example, the agency assigned 134 people to deliver work on HIV and AIDs worth $189 million, but 82 people to work on maternal and child health worth almost $500 million. USAID said that workforce needs are not determined by “the total funding allocated and managed directly by [the bureau] but takes into consideration programmatic needs and resources worldwide.” Overall, the bureau has struggled just to hire people, the report said. There were 75 vacancies for roles that were budgeted for over the last three years, between 2020 and 2022. In response, the agency spokesperson said the bureau had made progress and continues to keep the vacancy rate at under 10%. Challenges with diversity The report said the bureau also is wrestling with how to promote a diverse workforce, a stated goal of USAID. The bureau’s staff said there were “challenges'' with diversity and inclusion. Referencing an internal report, GAO said “some staff noted that the Bureau has a healthy dialogue on DEIA issues, while others noted bullying, disrespectful behavior, and micro-aggressions,” referring to diversity, equity, inclusion, and accessibility. While there were attempts to improve on these issues at team and office levels, the staff called for a more systemic approach. The hiring of a senior advisor to work on diversity and inclusion was an example of how the bureau was addressing the challenges related to diversity. There is also an agency-wide DEIA action plan with specific targets, but those targets are yet to be approved as of May of this year. USAID didn’t respond specifically as to why the targets had not been approved. Awkward leadership structure The workforce issues go all the way to the top of the bureau’s leadership, GAO found, with the mixture of political appointees and civil service officials creating an awkward structure atop the bureau. Political appointees come with little USAID experience and their unfamiliarity leads to new ways of doing things that change every few years, instead of leveraging the existing structures, bureau officials told GAO. USAID said that the bureau’s leadership structure was “consistent with other parts of USAID and the federal government.” In its own internal analysis, the agency also found problems in the workplace culture. “Negative leadership behaviors have persisted in the Bureau without a system to hold leaders accountable, according to Bureau officials,” GAO said. There are efforts underway to address these issues but a culture shift takes time, GAO acknowledged. It’s time for the bureau to have a clear plan to address the workforce issues, GAO said. “Without a workforce plan, the Bureau will have limited ability to accurately project future staffing needs,” the report said. “The Bureau may also be unable to determine the optimal mix of the types and numbers of positions in senior leadership to ensure it operates as efficiently as possible.” In addition, the bureau has “gaps” in the way it assesses each of its strategic priorities, GAO said. Also, the way it collects data in programs has created a situation where its reports to Congress exclude key information. “For example, the Bureau’s reports to Congress on maternal and child health do not contain results for 18 countries that received a total of more than $200 million in maternal and child health funding between fiscal years 2019 and 2021,” GAO said. The USAID spokesperson insisted that it does have indicators to assess its work. They pointed out that the agency’s report on maternal and child health only included results for countries on the work on preventing deaths. The reports were “not intended to reflect the entirety” of the maternal and child health portfolio. “However, going forward we will be sure to include full country results reporting in our reports,” the spokesperson told Devex. The GAO offered six recommendations for USAID Administrator Samatha Power to address these issues, including: a workforce plan, clear metrics to judge internal performance, and efforts by bureau leadership to address cultural challenges. As of now, GAO said USAID had agreed with its recommendations, and all six recommendations are “open”. “When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information,” GAO said. USAID told Devex that “work is already underway” to implement each of GAO’s recommendations. The agency has a deadline of Jan. 5, 2024, to provide “a Statement of Action Taken and Planned to Congress,” the spokesperson said.