America First Global Health Strategy

Overview

The U.S. Department of State has released its America First Global Health Strategy, which outlines a comprehensive vision to make America safer, stronger, and more prosperous while saving millions of lives around the world and preventing infectious disease outbreaks from reaching American shores.  The strategy is built on three pillars.

• Safer – Strengthen global disease surveillance, respond quickly to outbreaks, and protect U.S. borders.
• Stronger – Use health assistance strategically through multi-year agreements to build resilient local systems, reduce dependency, and encourage co-investment.
• More Prosperous – Safeguard the U.S. economy by preventing outbreaks, while promoting American health innovation and products worldwide.

The strategy aims to save lives, build resilient health systems, and keep America safer, stronger, and more prosperous.

This strategy builds on the successes of past global health programs.  Over the last 25 years, the United States global health programs have:

• Prevented thousands of infectious disease outbreaks from reaching American shores.
• Saved over 26 million lives through the President’s Emergency Plan for AIDS Relief (PEPFAR) and millions of additional lives through other global health programs.
• Prevented 7.8 million babies from being born with HIV / AIDS.

However, it is highlighted that the global health programs have become inefficient and wasteful and created a culture of dependency among recipient countries.

• Today, less than 40% of health foreign assistance goes to frontline supplies and health care workers.
  • ~25% of funds are used to purchase commodities (e.g., diagnostics, drugs)
  • ~15% of funds are used to employ over 270,000 frontline healthcare workers (e.g., mostly nurses and community health workers)
• The remaining 60% of funds are spent on technical assistance, program management, and other forms of overhead costs.
• Over the past 25 years, US health programs have created a culture of dependency among many recipient countries.

Future direction

This strategy aims to strengthen bilateral relationships with key countries by entering multi-year bilateral agreements that advance American interests, save lives, and enable economic growth:

• The US global health foreign assistance program is not just aid – it is a strategic mechanism to further US bilateral interests around the world. Moving forward, we will utilize health foreign assistance to advance U.S. priorities and move countries toward resilient and durable local health systems. 
• The US Government will do this by entering multi-year bilateral agreements with recipient countries that lay out clear goals and action plans.
  • Frontline Commodities & Healthcare Workers: Bilateral agreements will ensure that 100% of funding for all frontline commodity purchases and all frontline healthcare workers is maintained.
  • Data Systems: Bilateral agreements will ensure there are data systems in place to monitor epidemiology data, service delivery data, and supply chain data.
  • Technical Assistance, Program Management and Overhead: Bilateral agreements will work to rapidly transition U.S. technical assistance from supporting individual clinical sites to supporting governments in taking over key functions. This will include more direct government-to-government assistance as well as leveraging the private sector and faith-based organizations. 
  • Co-Investment: Bilateral agreements will require recipient governments to co-invest in these efforts and include performance benchmarks that must be met in order to release future U.S. health foreign assistance funding.
• The US Government aims to complete bilateral agreements with recipient countries receiving the vast majority of U.S. health foreign assistance by December 31, 2025 with the goal of beginning to implement these new agreements by April 2026.

Official website