USAID local contractors for women and children's health

The U.S. Agency for International Development’s new acquisition and assistance strategy emphasizes increased spending with new, underutilized, or local entities and locally established partners. Its goals are to diversify the agency’s partner base from a “relatively small circle of large organizations” and catalyze partner countries’ “journey to self-reliance” by working more directly with groups on the ground. This new strategy is provoking reevaluations by many current and prospective USAID partners. Current U.S.-based partners may view it as a threat or possibly as a competitive differentiator for those with stronger networks of local subcontractors. Those without these networks will likely start building them — the new strategy will track subawards to local entities and encourage prime awardees to incorporate local capacity development into their plans. On the other hand, it will open the market to more local development entities. While USAID has made direct awards to local organizations in the past, this new direction could create a more level playing field in countries where USAID operates. Whether a veteran implementer from Washington or a new grassroots NGO from South Africa, any organization stands to benefit from taking an inventory of the local organizations working with USAID in its sectors and geographies of focus. This will help organizations understand the local competition and size up potential local partners. Below is a cursory example of how this might be done using publicly available U.S. government spending data for USAID with a focus on reproductive, maternal, neonatal, child, and adolescent health — or RMNCAH — in India, Kenya, and Nigeria. These three lower-middle-income countries have experienced significant progress in reducing their maternal mortality rates and, as the data shows, have been leveraging local partners with the single largest public donor in global health: the U.S. government. Global health and HIV/AIDS programs account for over two-thirds ($20 billion) of the entire value of the Q3 2020 USAID business forecast including a forecasted 10-year family planning, maternal and child health, nutrition, and other health elements program with an estimated cost of $1.5 billion. USAID is the main implementing agency in reproductive, maternal, and child health, with $1.44 billion allocated in funding in fiscal year 2020. USAID RMNCAH partners in India According to a Devex analysis of agency spending data from USAspending.gov, USAID spent just over $52 million between the fiscal years of 2015 and 2019 on RMNCAH programming in India, of which just under $30 million went to local Indian partners. This is a conservative estimate, as the data is not tagged for sectors of work and rarely includes detailed project descriptions, making relevant spending items more difficult to identify. USAID spent $278 million in India in prime awards over these years, meaning that RMNCAH programming comprised about 20% of all spending, with just over half of that going to local organizations. Thus, though USAID spent less on RMNCAH in India than in Nigeria or Kenya, it spent proportionally more on the local organizations than in either of those other countries. Many relevant programs address all aspects of RMNCAH, such as Swasti’s work with USAID’s India mission under the Partnerships for Health program and IPE Global’s work scaling up RMNCAH solutions in select Indian states. PwC India’s presence on the list points to an interesting fact: Sometimes it is difficult to separate local organizations from local subsidiaries of global organizations. Also notable — though not included in the local awards data — is USAID’s funding of a development impact bond in maternal and neonatal health. This work manifests itself in the data as awards to the UBS Optimus Foundation, a Switzerland-based corporation foundation. USAID RMNCAH partners in Nigeria Over the same time period, USAID spent $179 million on RMNCAH programming in Nigeria, approximately 8% of total USAID spending in the country during that time. Of this, almost $54 million was spent with local Nigerian organizations, such as the Society for Family Health. Interestingly, this comprises 85% of USAID spending at a prime award level with local organizations, perhaps indicating that RMNCAH is one of the few sectors where local Nigerian groups compete with foreign organizations for prime awards. The top local partners were all local NGOs or nonprofits, with the exception of Marie Stopes International’s local Nigerian office. Nigeria appears to have a larger, more competitive market of local sub awardees. The most successful of these is the Achieving Health Nigeria Initiative, which started as a nonprofit affiliate of U.S.-based FHI 360 but has since grown to become an independent organization. The presence of the Association for Reproductive and Family Health on both the list of top five prime awardees and top five subawardees speaks to the fact that local Nigerian organizations are both partners and competitors for USAID RMNCAH funding in the country. Many RMNCAH-related programs in Nigeria relate to either HIV/AIDS or orphans and vulnerable children. Some projects even combine the two, as with the Local Partners for Orphans and Vulnerable Children Project, implemented by multiple local civil society organizations including Health Initiatives for Safety and Stability in Africa. USAID RMNCAH partners in Kenya Of the three countries analyzed, USAID spent the most in Kenya — across all sectors and in RMNCAH-related programming specifically. It spent $856 million on RMNCAH in Kenya between 2015 and 2019, of which 21% went to local partners. This means that this sector of activity represents approximately one-third of total USAID spending — at $2.7 billion — on Kenya programs in this time period. Some programs in Kenya focus on access to health care, such as Afya Timiza, implemented by the Amref Health Africa, or AMPATHPlus, implemented by the Moi Teaching and Referral Hospital. Despite not appearing on the top five lists here, GoldStar Kenya is another interesting local organization in that it — like the Achieving Health Nigeria Initiative — is a former affiliate of FHI 360 that helped implement other RMNCAH-access projects, such as the Afya Uzazi Nakuru-Baringo Program, as a prime awardee. It has also been a subawardee of FHI 360, suggesting that this strategy of “incubating” local affiliate organizations to act as future local partners may be a successful approach to engaging USAID’s new acquisition and assistance strategy. For access to in-depth analysis, insights, and funding opportunities from over 850+ sources — combined with Devex Pro news content — sign up to a Pro Funding subscription online today or get in touch to learn about our Pro Funding group options.