What does food security really have to do with global stability and everyday life?

In this episode, I’m joined by Marian Ostertag, a former USAID Foreign Service Officer who spent her career working on agriculture and food security. Marian explains why effective development work focuses on long-term systems — food, markets, and institutions — so countries can withstand shocks without constant emergency aid.

We talk about how food systems connect far beyond borders, why global supply chains are more fragile than we like to admit, and how agriculture quietly underpins everything from economic resilience to security. Along the way, Marian breaks down why pigs can be a matter of national security, why Paraguay keeps coming up, and what’s lost when long-term development work disappears.

This is a grounded, thoughtful conversation about prevention over reaction, systems over short-term fixes, and why food stability matters far more than most of us realize.

Making People Visible

This space exists to center voices from global development and public service.

Your support keeps Global Development Interrupted going and helps ensure these stories are told.

In this powerful conversation, Ramona Godbole, former Deputy Director of Policy Planning and Programs at USAID’s Global Health Bureau, takes us inside the chaotic dismantling of America’s global health infrastructure—and the critical memo that became her final act of public service.

Ramona led the development of USAID’s first-ever comprehensive global health policy, a document designed to sunset the need for foreign aid by building sustainable, equitable health systems worldwide. Just months after its release in January 2025, she watched as a new administration took a different approach: sunsetting the aid itself, prioritizing rapid withdrawal over long-term impact.

What does it mean when the goal shifts from ending disease to ending assistance? When payment systems freeze even for programs labeled “lifesaving”? When the data that tracks millions of lives suddenly goes dark?

Ramona shares what she witnessed during those first chaotic weeks, why she wrote the most important memo of her career, and what happened next. She explains the difference between development and humanitarian assistance—and why conflating them has consequences that ripple far beyond foreign policy. And she reveals where critical health data has gone, what the lack of transparency means for accountability, and why this moment sets a precedent that extends well beyond USAID.

This isn’t just a story about foreign aid. It’s about what happens when expertise is sidelined, when transparency vanishes, and when documenting the truth becomes an act of moral courage.

Below, you can read the USAID Global Health Policy that Ramona and her team developed—the strategic vision that was released in January 2025, just weeks before the agency’s dismantling began.

Policy for Global Health Development: Advancing Life Expectancy and Well-Being

TABLE OF CONTENT

EXECUTIVE SUMMARY

INTRODUCTION

BACKGROUND

VISION

PRINCIPLES

* Equitable, Inclusive, and Person-Centered

* Evidence-Based and Adaptable

* Locally Led Development and Country Ownership

* Collaboration and Diverse Partnerships

POLICY INTO PRACTICE

* The Primary Health Care Approach

* Strengthen Systems to Deliver Health Services

* Enable Resilient and Sustainable Health Ecosystems

* Advance Research and Innovation for Health

LEARNING

CONCLUSION

GLOSSARY (OF TERMS USED THROUGHOUT)

ANNEX: GLOBAL HEALTH SUB-SECTOR POLICIES, STRATEGIES, AND GUIDING DOCUMENTS

EXECUTIVE SUMMARY

In today’s world, the demand for a robust policy to guide USAID’s global health development work has never been more urgent. We are confronted by a landscape where emerging infectious diseases, persistent health disparities, and the sweeping consequences of climate change intersect. The COVID-19 pandemic starkly revealed these vulnerabilities, exposing significant gaps in health systems and access to services worldwide and emphasizing the necessity for a coordinated and strategic response. It underscored how intricately linked our health is to economic, environmental, and social factors, reinforcing the importance of strengthening resilience capacity—not just for the crises we anticipate, but for those we cannot predict.

Through decades of USAID work, it has become increasingly clear that global health outcomes are best achieved when we work across technical areas focusing on strategic, coordinated programming and strengthening cross-cutting systems. This policy provides a new and uniting vision to guide all USAID global health development programming and defines new pathways that connect every aspect of our work. This policy institutionalizes a commitment to intentionally work across all of our health programming toward equitably and sustainably advancing life expectancy and well-being.

For the first time, this policy lays out the crucial role of primary health care (PHC) in the Agency’s global health development work and how it is essential to achieving this cross-sectoral vision. This comprehensive, community-based approach helps make services supported through USAID global health programs accessible to all, including individuals from marginalized groups. With a PHC approach, health service delivery is based on a model of integrated and coordinated people-centered care, both within health facilities and in the community. Strengthening PHC is key to building health system resiliency for the future and is foundational to pandemic preparedness.

This new framing of USAID’s global health development work and operations are guided by four core principles:

* Equitable, Inclusive, and Person-Centered: We believe that all individuals deserve access to health services that respect and respond to their unique needs. This means addressing the barriers that prevent equitable, high-quality care; supporting health services that are both accessible and comprehensive; and putting people at the heart of everything that we do.

* Evidence-Based and Adaptable: We are committed to using data and evidence both to design our programming and to foster continuous learning and monitoring and evaluation. This approach allows for effective programming and nimble responses to overcome new challenges and seize emerging opportunities.

* Locally Led Development and Country Ownership: We recognize that sustainable health outcomes are best achieved when local governments and communities take the lead. By prioritizing local partnerships and emphasizing local ownership, local actors are able to strengthen health systems and services from within.

* Collaboration and Diverse Partnerships: We know that no single entity can tackle global health challenges alone. Our commitment to building partnerships across sectors and with a diverse range of stakeholders allows us to harness collective action, share knowledge, and increase our impact.

These principles underpin every aspect of USAID’s health development programming across three pathways through which we work to achieve our health goals, all of which are supported by the scaffolding of PHC:

* Strengthen Systems to Deliver Health Services: Strengthening health systems and improving service delivery are mutually reinforcing; effective health systems support better service delivery, and high-quality services enhance the performance and sustainability of health systems.

* Enable Resilient and Sustainable Health Ecosystems: Health is influenced by myriad factors as part of a broader health ecosystem, encompassing the social, economic, environmental, political, and legal elements affecting health. Building and strengthening health systems, including service delivery, that are resilient and adaptable to shocks and stresses—such as those from economic downturns, natural disasters, or pandemics—requires consideration of this health ecosystem and cross-sectoral work so that they remain sustainable over the long term.

* Advance Research and Innovation for Health: Innovation drives progress. We support the development of and incorporation of new technologies, data systems, diagnostic tools, approaches, treatments, and vaccines into our programs. By fostering research partnerships and promoting local innovations, we help scientific advancements benefit all communities, including people in the most vulnerable situations.

At USAID, we aim to continue to foster enduring improvements in global health. As we navigate an increasingly complex and evolving global health landscape, we must sustain the gains made while moving forward with an approach that is both adaptive and strategic and incorporates the most recent advances in innovation and research. This policy is not only a response to immediate needs but also an opportunity to build and strengthen systems that are sustainable and resilient to future shocks and stresses, while enabling the delivery of high-quality and equitable health services.

Further, global health development does not exist in a vacuum. Our work in health is part of a larger, multisectoral approach that spans education, food security, economic growth, environment, climate, humanitarian response, and democracy and governance. Progress in health leads to better development outcomes; and USAID’s development work, in turn, improves health.

Through this policy, we continue our investments in USAID’s flagship global health programs and unite all global health development priorities around our shared vision to partner with communities and countries to equitably and sustainably advance life expectancy and well-being.

INTRODUCTION

From its earliest days, USAID’s global health development efforts have focused on reducing the glaring gaps in survival between the richest and the poorest and improving global health security. In partnership with countries around the world—and alongside local actors, other U.S. government agencies, and multilateral organizations—USAID has committed to equitably increasing access to high-quality health care.

USAID’s work to save and improve lives takes many shapes: delivering lifesaving vaccines and promoting child health and development; increasing access to HIV/AIDS treatment and prevention options; helping individuals and couples exercise their right to decide whether and when to have children and how many children to have; supporting individuals to give birth safely; and working toward control and elimination of malaria, tuberculosis (TB), and many other neglected and emerging infectious diseases. USAID complements these efforts with bolstering local health systems not just to achieve, but to sustain, progress. And, by demonstrating a steadfast commitment to respecting, protecting, and fulfilling the right to health, USAID has committed to improving health outcomes equitably.

USAID’s health programming not only addresses immediate health needs but also contributes to the Agency’s broader development, national security, and diplomacy goals—reinforcing U.S. leadership in creating a healthier, safer world. As the world’s largest bilateral donor for health, USAID is uniquely positioned to use a development diplomacy approach to bring together our collective expertise, convening power, influence, and programs to tackle the health challenges of today and tomorrow while simultaneously addressing interconnected development issues.

With this Policy for Global Health Development, the first in more than a decade, USAID reaffirms its commitment to a strategic and integrated approach that will drive future progress in advancing life expectancy and well-being across our health development programs. This policy calls for continued strategic investments in USAID’s flagship global health programs, which not only work to achieve specific health outcomes but can also be designed to advance integrated health systems. This policy also strives to align our programming to collectively focus on strengthening a primary health care (PHC) approach, which combines multi-sectoral policy and action, community empowerment, and integrated health services. This person-centered approach focuses on proactive care—health promotion, disease prevention, diagnosis, and treatment—delivered equitably by multidisciplinary teams as close as possible to people’s everyday environments, reducing morbidity and mortality across the lifespan.

This policy will build on and support the Agency’s development vision for “progress beyond programs” outlined in USAID’s Policy Framework; which prioritizes reversing the decline in global life expectancy that occurred during the COVID-19 pandemic, bolstering global health security, and improving PHC. The policy also relies on, connects, and amplifies the many existing global health policies and strategies that guide our work within specific health priorities (see Annex) to provide a united vision for optimizing USAID’s significant global health impact.

BACKGROUND

Since 1961, USAID has partnered with countries around the world to improve health, mitigate disease, and increase global health security. Over the past five decades, global health outcomes have improved considerably as illustrated by a dramatic reduction in deaths from diarrheal illness; the eradication of smallpox; substantial strides in preventing and treating HIV, TB, and malaria; the development of new tools; and a remarkable increase in global lifespan. Investments in creating an expanded and more capable health workforce, strengthened health systems, and innovations to adapt to new and existing challenges have also been critical in contributing to this unprecedented progress.

Moving forward, USAID programs must sustain the gains made and continue to adapt to the evolving global health landscape, which includes new and emerging challenges. The COVID-19 pandemic stalled or reversed decades of public health progress; highlighted financial, structural, cultural, and attitudinal barriers to health; increased gender-based violence; and accelerated information manipulation related to health. Additionally, the rise of noncommunicable diseases, mental health conditions, and antimicrobial resistance further complicates the global health agenda. Increasing crises due to conflict and migration are straining health systems and heightening health threats. Climate change is also threatening progress, including changing the location, timing, and intensity of disease outbreaks; undermining nutrition; and causing heat-related illness and death. Biodiversity loss and environmental degradation further compound global health challenges, including disruptions to food and water security and increased risk of infectious diseases. USAID global health programs increasingly operate in complex environments and will need to continue to navigate the challenges of frequent and protracted emergencies. Further, the rise in democratic backsliding and global threats to human rights have profound implications for health. Many countries face rising sovereign debt and constrained health budgets, food insecurity, climate catastrophes, and other crises, which not only jeopardize health, but also pose a risk to global health security. The effect of these compounding crises is stark: after seven decades of uninterrupted progress, global life expectancy declined in 2020 and again in 2021.

Nevertheless, new opportunities are emerging. Many countries in which we work have growing economies, leading to rising incomes and reductions in poverty. This also creates opportunities to increase tax bases and grow health investments. While these populations continue to need support, it is crucial that assistance aligns with evolving contexts, underscoring USAID’s adaptability. The improvement of educational attainment, involvement of the world’s largest generation of young people, and the establishment of formal community health systems present additional opportunities. Further, the digital transformation of health systems—alongside increased digital connectivity and emerging technologies such as artificial intelligence—can increase access to health care services and address health disparities, although potential risks must also be acknowledged and mitigated.

In our global health work, there is also the opportunity for better health outcomes to have a pronounced impact on broader development goals (see Fig 1). Countries simply cannot achieve prosperity, peace, and stability if their people are not healthy enough or cannot live long enough to build it. By promoting health equity, access to health services, and robust health systems worldwide, USAID’s global health efforts help to stabilize communities, foster economic growth, and build resilient societies.

VISION

This policy articulates USAID’s vision to partner with communities and countries to equitably and sustainably advance global life expectancy and well-being. Increasing life expectancy by reducing deaths before age 50, and enhancing well-being by contributing to quality of life, are both influenced by access to health care, promotion of health, supportive social structures, and favorable economic and environmental conditions. Within global health development programming we contribute to well-being both directly—through support to physical and mental health—and indirectly—as healthy people and communities can contribute to and influence their world with a sense of meaning and purpose.

USAID’s fundamental approach to achieving accelerated, sustained, and equitable progress in global health development is centered on three interconnected pathways: strengthen systems to deliver health services; enable resilient and sustainable health ecosystems; and advance research and innovation for health. Across each pathway, a PHC approach is the critical scaffolding needed to reduce inequities in life expectancy and increase access to essential health services (see Fig 2).

PRINCIPLES

USAID’s global health work is guided by a set of underlying, core principles that articulate how we work to achieve our vision of advancing life expectancy and well-being. These principles should be integrated into all global health operations and supported activities.

Equitable, Inclusive, and Person-Centered

Equity within health helps provide opportunity to all people to achieve well-being. This includes individuals of any race, ethnicity, age; sexual orientation, gender identity and expression, and sex characteristics; individuals with disabilities; and individuals from any marginalized group.,,,, Increasing equity and inclusivity involves engaging diverse communities and supporting governance and accountability measures, such as social accountability, to incorporate the needs and perspectives of health service clients. It means building programming around the specific needs of the communities where USAID works and making it possible for local stakeholders to lead our shared efforts.

Health equity is the basis to achieving universal health coverage (UHC), as called for by the United Nations Sustainable Development Goals (SDGs). Consistent with Agency policy, USAID health programming prioritizes gender equality, inclusive development, and promotion of global human rights-based principles to protect, respect, and fulfill the rights of individuals to make decisions about their health as well as allow high-quality health interventions to reach all populations, especially marginalized groups. In alignment with a PHC approach, service delivery and systems interventions should be designed from the beginning to be person-centered, comprehensive, age and developmentally appropriate throughout the lifespan, and accessible to meet diverse needs. Programs should aim to understand and address social determinants of health that affect equitable health outcomes.

Evidence-Based and Adaptable

To advance USAID’s enduring effectiveness, grounding our work in evidence, data, and continuous learning is critical to shape effective global health activities. USAID remains committed to using evidence-based tools and frameworks to guide our investments and using knowledge and data—including data disaggregated by gender and age—to support a culture of adaptation. Additionally, leveraging digital transformations of health systems and employing new and existing analytical tools, such as artificial intelligence, climate information systems, improved early warning systems, and geospatial technologies, allows for improved targeting of programs and rapid adaptation to changing epidemiological and demographic patterns. Agency health programs should continue to incorporate data, evidence, and learning into all stages of the program cycle, from design and implementation, to monitoring and evaluating, to making adjustments or improvements based on outcomes. Creating time and space for pausing and reflecting on data and evidence is essential, allowing USAID to pivot when necessary and practice adaptive management.

Committing to adaptability also means investing in our enduring effectiveness through a focus on, and reforms to, our own organization. Expanding, diversifying, retaining, and empowering USAID’s workforce will equip the Agency with the people and skills to deliver on our vision, while reducing administrative and bureaucratic burdens will allow us to focus on the work that matters most. Modernizing our communication will help us share USAID’s tremendous global health achievements as well as counter information manipulation.

Locally Led Development and Country Ownership

USAID’s global health work recognizes local governments and communities as critical actors required to achieve effective, sustainable local health services and systems. We endeavor to follow their lead in developing country-specific health programs, in alignment with broader Agency policies., Local ownership of priorities, implementation, and resources is crucial to achieving global health and partner countries’ development objectives. Thus, USAID’s global health resources strive to be implemented as close to the communities that USAID serves as possible.

Locally led development involves collaborating with regional partners, investing in and supporting local manufacturing, and facilitating government-to-government (G2G) engagements where appropriate. Partner governments are a key local actor, performing critical roles in governance and service delivery, and G2G partnerships are essential to USAID’s broader work in bolstering local leadership’s efforts to promote democracy and fight corruption. By partnering directly with local entities—such as national and district governments, Indigenous Peoples’ customary governance systems, the local private sector, local faith communities, civil society, and other local organizations—USAID respects and elevates the knowledge and preferences of local populations. This approach is essential for strengthening local health systems and transferring decision-making power and resources to local actors. USAID remains committed to strengthening the capacity of local entities, enabling them to lead in planning, budgeting, and reporting on their own health systems. This includes fostering sustainability by supporting local health workforces to deliver care through improved planning, prioritization, and implementation of health programs.

Collaboration and Diverse Partnerships

Through the practice of development diplomacy, we are committed to fostering and establishing partnerships across diverse sectors, including with governments, multilateral partners, civil society, and the private sector, in addition to local communities. Cultivating such partnerships acts as a force multiplier, building consensus, reinforcing norms, and leveraging additional resources for effective and sustainable global health programming. USAID’s commitment to this principle also means advancing interagency efforts and U.S. government initiatives, including implementing lifesaving HIV programming under the President’s Emergency Plan for AIDS Relief (PEPFAR) and leading the U.S. President’s Malaria Initiative (PMI), which has driven progress in preventing malaria cases and saving lives globally. Strong collaborations and partnerships also allow for wider opportunities for knowledge and information generation, capture, sharing, and use. With the number of young people at its highest level ever globally, now is also the time to support their inclusion in key partnerships to harness their power and collective action most effectively. Finally, multisectoral approaches should be emphasized and expanded to drive stronger, collective impact in global health and other development sectors. When working through and with these partnerships, our programming can have an exponential impact on global health outcomes.

POLICY INTO PRACTICE

Across all program areas and to achieve the objectives of each of our funding streams, the Agency’s global health work is delivered via three intertwined pathways, with PHC as a key cross-cutting approach. These pathways, scaffolded on PHC, collectively guide our efforts to maintain, sustain, and advance progress toward improving life expectancy and well-being. The following recommendations are best practices to be considered across USAID’s global health development work, which refers to the Agency’s concerted health efforts and initiatives outside of humanitarian response. In all cases, USAID will continue to respect congressional directives on health programs.

The Primary Health Care Approach

Recommendation: USAID global health programs should, where possible, collectively and deliberately support country governments to advance a primary health care (PHC) approach as a key aspect of supporting delivery of essential services and broader public health and health systems strengthening efforts.

PHC is a comprehensive approach to health that combines multi-sectoral policy and action, community empowerment, and integrated health services. It is a whole-person-centered approach where proactive care—health promotion, disease prevention, diagnosis, and treatment—is delivered equitably by multidisciplinary teams as close as possible to people’s everyday environments, reducing morbidity and mortality across the lifespan. USAID’s foundational health initiatives—preventing maternal, newborn, and child mortality; improving nutrition; increasing access to voluntary family planning and reproductive health services; ensuring immunizations, and TB, HIV, and malaria prevention and treatment; and responding to disease outbreaks and health emergencies—are aligned with, contribute to, and benefit from a PHC approach. PHC plays a vital role in promoting resilient health systems that can adapt to the environmental and social determinants of health by investing in health worker training, health information systems, digital health, and supply chain resiliency, while supporting community preparedness. PHC also works to address health challenges related to climate change, such as mental health, displacement, and loss of livelihoods, while advocating for sustainable solutions such as renewable energy in health facilities. PHC can provide 90 percent of health services a person will need throughout their life and is a necessary path to achieving UHC, equitable life expectancy, and pandemic preparedness.

PHC is the key to restoring essential health services, building health system resiliency, and improving global survival rates. USAID remains committed to supporting the inclusion of a diverse array of local health actors including health workers, patients/clients, communities, and civil society in our health programming to strengthen their capacities. PHC is aligned with this policy’s principles and should be incorporated into all three pathways.

A PHC approach is critical to supporting countries to achieve their health-related goals. Health service delivery should be based on a model of integrated and coordinated people-centered care, both within health facilities and in the community. An effective model is multidisciplinary and team-based and delivers seamless, equitable patient care. PHC also requires strong and integrated health systems including the optimization of subnational and facility management of the health workforce, financing, and quality and improved integration and interoperability of supply chain and information systems. PHC is also the key to building health ecosystem resiliency and maintenance of essential service provision even during health and climate emergencies.

Strengthen Systems to Deliver Health Services

Recommendation: Where feasible, needed, and appropriate, USAID global health programs should continue to support immediate service delivery needs in ways that bolster partner-country health systems, and systems strengthening efforts should continue to be oriented to sustainably improve service delivery.

At the core of our efforts to advance life expectancy and well-being are USAID’s health development investments to support delivery of services and strengthen health systems to advance our health priorities. USAID’s work to support service delivery in partner countries addresses the immediate needs for improving health outcomes—such as providing mosquito nets, voluntary family planning and reproductive health services, and lifesaving medicines and vaccines—and promoting social and behavior change. These efforts are essential to enhancing the availability, accessibility, demand for, and utilization of health care services. They have been critical to achieving our progress to date and will continue to play a vital role in future progress.

In tandem, USAID strengthens health systems, which advance systemic and lasting improvements. Our efforts—including strengthening capacity at the local, regional, and national level; promoting sustainable financing and local private-sector engagement in health; bolstering resilient, low-emission supply chains; improving governance; building integrated health information systems; and fostering responsible digital transformation—all work to support health services that are high-quality, equitable, affordable, and responsive. The benefits of strong health systems, inclusive of a PHC approach, also extend beyond our immediate goal of improving service delivery, helping national governments address broader public health challenges, and strengthening capacity to prevent, detect, and respond to outbreaks.

Supporting the delivery of high-quality health services and strengthening health systems are interdependent, connected, and equally critical to promoting lasting change. The focus and balance of our efforts are informed by the specific context of each country. In countries with more established health systems, resources might be directed toward lingering service delivery challenges, pilots for new approaches, and systemic issues. Conversely, in countries with more fragile health systems or challenging environments, USAID resources may be most effectively used in supporting immediate health needs, while also striving to strengthen systems where possible. This tailored approach allows us to respond appropriately to each country’s unique circumstances so that we are optimizing our efforts to advance progress toward our vision of advancing life expectancy and well-being.

A critical component across all our health programs that simultaneously supports service delivery and strengthens systems is the management, expansion, and retention of a diverse health workforce, inclusive of critically important community health workers (CHWs). USAID’s efforts strengthen country capacity to effectively manage and finance health worker training and employment. A well-supported, professionalized health workforce, including CHWs, requires an enabling policy environment to facilitate adequate remuneration, rights, and protections; access to mental health support; and the training and education needed to provide inclusive, stigma-free, and high-quality care. This support, both directly from USAID and through local capacity strengthening, is essential for overcoming health care worker shortages, sustaining the gains achieved in health programs, and building resilience for the future.

USAID’s efforts to bolster locally led health services and systems, whether through our flagship health and disease-specific programs or cross-cutting systems strengthening efforts, are oriented to deliver lasting impact beyond the availability of donor funding and the specific focus of USAID programming. In alignment with the Agency’s commitment to advancing progress beyond programs, our health investments come together in an integrated way to yield wider benefits.

Enable Resilient and Sustainable Health Ecosystems

Recommendation: USAID’s global health programs should continue to collaborate with and leverage humanitarian and broader development efforts to achieve resilient and sustainable health ecosystems.

USAID recognizes that global health programming is intrinsically connected to a broader health ecosystem, comprising social, economic, environmental, political, and legal factors that affect health. USAID strives for our health investments to be both sustainable and resilient by building local systems that are able to maintain positive outcomes over time and strengthening the capacity of people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces acute and chronic vulnerability and facilitates equitable health outcomes.

Achieving resilient and sustainable ecosystems to support our health goals of advancing life expectancy and well-being requires a multi-pronged approach. To anticipate and respond to expected and unexpected shocks and stresses, USAID uses evidence and analysis to better understand risks, and practices adaptive management and shock-resistant health programming. In addition, USAID’s work to build health systems is complemented by a broader, holistic systems-thinking approach that positions health and health care access within a wider dynamic environment beyond the traditional boundaries of the health sector. This approach means addressing root causes and social determinants of health, such as access to education, poverty, human rights violations, discrimination, harmful social and gender norms and gender-based violence, and promoting good governance and supportive policies, as well as considering these factors in the design, implementation, monitoring, evaluation, and adaptation of USAID projects.

Coordination and collaboration across sectors is a cornerstone of achieving resilience and sustainability of our health programming. USAID has long maximized development assistance for health by aligning with efforts in sectors including water, sanitation, and hygiene (WASH); agriculture; and food security, all of which have been critical to achieve and sustain health outcomes. Across the Agency, USAID is working to address the considerable impacts of climate change on human health, as well as environmental health issues such as air pollution, extreme heat, health care waste management, and lead exposure and mitigation, which links our health initiatives with those in education, economic growth, and the environment.

Collaborative, multisectoral, and transdisciplinary approaches strengthen the capacity of local, regional, national, and global systems to absorb, adapt, and transform as necessary, supporting the availability of high-quality care to the communities we serve every day, not just during times of shocks and stresses. The One Health approach—which recognizes the interdependence of the health of humans, animals, and ecosystems—exemplifies the power of this type of approach, offering long-term holistic solutions to a wide range of cross-sectoral development and humanitarian challenges that are essential for human health as well as contribute to broader global health security.

Both conflict and complex emergencies have profound implications on health and can disrupt governments’ abilities to provide essential health services and build resilient health systems. These impacts further underscore the critical need for coordination between and across health and USAID’s broader development and humanitarian programs for resilience and sustainability. USAID health efforts require operating beyond global health, layering, sequencing, and integrating our health programming with other sectors across the Agency. Through a coordinated humanitarian, development, and peace (HDP) approach, USAID prepares, maintains, and adapts assistance before, during, and after crises—including water, shelter, health care, sanitation and hygiene, and critical nutrition services—to meet the needs of those in the most vulnerable situations and among hard-to-reach populations.

USAID’s work to build sustainability and resilience of the broader ecosystem, coupled with our efforts to strengthen local health systems and a strong foundation in PHC, supports health and development programs that work to reinforce one another. This promotes a virtuous cycle where improved health outcomes contribute to broader development goals, and progress in these areas, in turn, further enhances health outcomes.

Advance Research and Innovation for Health

Recommendation: USAID global health programs should continue to develop, adopt, and scale-up innovative health solutions for equitable access and accelerated impact.

Throughout the history of USAID global health programs, we have emphasized the value of advancing research and innovation, and incorporating evidence-based best practices, technologies, and medical countermeasures to accelerate global health outcomes. USAID support for global health research and development includes implementation and operations research to achieve breakthroughs in operational approaches to disease prevention, diagnosis, and treatment. This includes adopting emerging best practices related to lifesaving health behaviors through research-backed social and behavior change communication. By using evidence-based approaches and scientific rigor to improve health outcomes and scaling up interventions more rapidly to reach more people, we can make our programs increasingly effective.

USAID-funded research and development has led to many key successes, including more than 50 years of commitment to build databases for evidence-based decision-making through household surveys and data collection. We have also supported the development and adoption of more effective strategies to prevent and reduce maternal, child, and newborn mortality and malnutrition, such as oral rehydration salts; groundbreaking innovations in new and existing contraceptive methods; development and scale-up of the use of evidence-based High Impact Practices (HIPs) to improve voluntary family planning and reproductive health programming; support for introduction of lifesaving vaccines; antiretroviral drugs for the prevention of HIV infections; new drug formulations and vaccines for malaria; and new treatment regimens for drug-resistant TB. USAID support of national digital health strategies and architecture is also critical and enables integrated health service delivery. By ethically leveraging standards-based digital technologies and responsibly using advanced technologies such as artificial intelligence, USAID can aid partner countries in applying science and technology by developing innovative solutions and bringing evidence-backed innovations to scale.

Investments in implementation research have also led to lifesaving health and development behaviors, approaches, and interventions. These include development of optimal HIV prevention packages, strengthening of community health and primary health care implementation, and a better understanding and means of addressing factors affecting the provider-client interface during service provision. Evidence from implementation and operational research allows USAID to strengthen integrated and PHC programming in ways that are backed by data. Across all research supported—from medical countermeasures to program implementation—USAID endeavors to abide by the highest ethical practices and promote inclusivity of all marginalized populations, as participants, researchers, and beneficiaries.

USAID’s efforts also focus on expanding local stakeholders’ research capabilities, supporting the adoption and scale-up of local innovations, and emphasizing local ownership and leadership in research endeavors. USAID is committed to building equitable partnerships, including with marginalized groups, so research and scale-up efforts are respectful and mechanisms are in place to deliver equitable benefit-sharing. Building robust local infrastructure for health research is crucial for sustainable development. Empowering local researchers with a focus on inclusivity further contributes to sustainable global health advancements.

By accelerating the development and equitable scale-up of health technologies and tools to address critical unmet needs and emerging challenges, and by ensuring the widespread adoption and implementation of research-based, lifesaving health and development interventions, USAID’s efforts in research capability and innovation drive systematic improvements in health outcomes. Strengthening the research capabilities of local stakeholders, institutions, programs, and partnerships further enhances these outcomes in a manner that is systematic, equitable, inclusive, and sustainable, thereby contributing to broader resilience and sustainability of our health investments.

LEARNING

Learning is a fundamental aspect of USAID’s approach to global health and is integral to our mission of improving health outcomes worldwide, in line with Agency policy. Knowledge and learning are invaluable resources within USAID’s global health initiatives, serving as essential tools to inform program design, influence development efforts, and drive sustainable impact. Through both our principles and practices, USAID is committed to continuous learning to enhance program implementation and adaptation, ultimately driving progress toward advancing life expectancy and well-being. This includes fostering internal cohesion between USAID’s global and country teams around a shared commitment to embedding learning into its global health initiatives.

USAID engages in various learning activities within the global health sector aimed at enhancing effectiveness and sustainability. These activities include developing a unified global health results framework for the Agency, collecting and analyzing data, developing and implementing learning agendas for different health areas, sharing best practices and lessons learned, fostering collaboration among stakeholders, and using inclusive practices to offer accessibility for all stakeholders. We also facilitate knowledge-sharing through platforms such as conferences, workshops, online resources, repositories, and communities of practice, enabling Missions and other stakeholders to exchange insights and experiences. USAID’s aim is for learning to directly inform decision-making at all levels.

Despite these efforts, evidence gaps persist within USAID’s global health work, hindering the completion of a full circle of continuous learning. These gaps stem from challenges such as fragmented knowledge, limitations in collecting local knowledge, limited data accessibility, insufficient synthesis and dissemination mechanisms, and cultural norms that lead to inequalities in accessing health information and services. Additionally, the abundance of information and its complexity can be overwhelming, hindering the ability to filter relevant data, make informed decisions, drive meaningful action, and adapt or replicate best practices. Evidence and knowledge are often scattered across programs, sectors, and geographic regions or are not made available in timely and useful ways, impeding our ability to harness collective insights effectively. Furthermore, the lack of shared systematic processes across organizations, partners, and communities for documenting, capturing, and sharing knowledge and learning leads to missed opportunities for cross-cutting analysis and innovation.

USAID is committed to embedding learning into the core of our global health initiatives. To leverage knowledge effectively, we will enhance routine opportunities for reflection and learning, cultivating a culture of continuous improvement across the global health sector. This approach creates space for critical analysis, evaluation, and the adaptation and application of knowledge gained, ensuring lessons learned are used to inform future decision making and drive sustainable outcomes. By aligning with the Agency Learning Agenda, which includes a set of nine questions that cut across USAID’s policy priorities and respond to critical Agency evidence needs, we enable our programs to be informed by and contribute to the latest evidence and best practices. This will further emphasize equitable and inclusive learning processes, engaging a broad range of stakeholders, including marginalized groups and people in vulnerable situations, and facilitating joint learning with countries, regions, and local actors. Questions on how to build resilience to shocks and stresses, respond to climate change, and equitably incorporate local knowledge directly intersect with USAID’s global health priorities. USAID recognizes the potential value in integrating local knowledge and contextualizing it within global strategies, which can enhance culturally nuanced and effective interventions.

USAID is committed to promoting sharing and knowledge exchange among and for USAID Missions and our partners, which includes protecting and elevating the authority of local actors’ knowledge. This approach fosters opportunities for cross-fertilization of ideas, innovations, and best practices, thereby strengthening the collective capacity of the global health community and maximizing the impact of learning to drive tangible progress in global health.

CONCLUSION

The Policy for Global Health Development signifies a renewed commitment by USAID to advancing global life expectancy and well-being through a strategic approach. This includes strengthening systems and supporting services hand in hand, leveraging the full power of the humanitarian and broader development sectors to create an enabling health ecosystem, and accelerating progress by embracing innovation and research. In an increasingly complex global health landscape, this policy emphasizes adaptability, local leadership, evidence-based programming, and the importance of partnerships across sectors. This policy not only guides USAID’s current global health efforts but also sets a clear vision for the future to continue to achieve, sustain, and advance progress toward a healthier world.

GLOSSARY (OF TERMS USED THROUGHOUT)

Adaptive management: an intentional approach to making decisions and adjustments in response to new information and changes in context.

Global health security: the existence of strong and resilient public health systems that can prevent, detect, and respond to emerging infectious disease threats, wherever they occur in the world.

Health ecosystem: the broader context of various social, economic, environmental, political, and legal elements that affect health and well-being.

Health equity: the absence of unfair, avoidable, or remediable differences in health status among population groups defined socially, economically, demographically, or geographically.

Health resilience: the ability of people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces acute and chronic vulnerability and facilitates equitable health outcomes.

Local capacity strengthening: a strategic and intentional investment in the process of partnering with local actors—individuals, organizations, and networks—to improve the performance of a local system to produce locally valued and sustainable development outcomes.

Locally led development: the process in which local actors—encompassing individuals, communities, networks, organizations, private entities, and governments—set their own agendas, develop solutions, and bring the capacity, leadership, and resources to make those solutions a reality. USAID recognizes that local leadership and ownership are essential for fostering sustainable results across our development and humanitarian assistance work.

Marginalization: the process, whether in practice or in principle, in which individuals or communities with certain identities and/or experiences face difficulty or are denied access to social, economic, political, and/or cultural participation in their societies (e.g., exclusion from education, employment, health care, political participation, opportunity to practice cultural and linguistic traditions, express religious identity). Groups that face marginalization often experience discrimination in the application of laws, policies, and social and cultural norms and may be subject to persecution, harassment, and/or violence for historical, cultural, political, or other contextual reasons.

Marginalized groups: may include, but are certainly not limited to, women; youth; children in adversity and their families; older persons; persons with disabilities; LGBTQI+ people; displaced persons; migrants; Indigenous Peoples and communities; nondominant religious, racial, and ethnic groups; people of castes traditionally considered lower; people of lower socioeconomic status; and people with unmet mental health needs.

One Health: an integrated, unifying approach that aims to sustainably balance and

optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent. The approach mobilizes multiple sectors, disciplines, and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, and safe and nutritious food; taking action on climate change; and contributing to sustainable

development.

Primary health care: a comprehensive approach to health that combines multi-sectoral policy and action, community empowerment, and integrated health services. It is a whole-person-centered approach where proactive care—health promotion, disease prevention, diagnosis, treatment—is delivered equitably by multidisciplinary teams as close as possible to people’s everyday environments, reducing morbidity and mortality across the lifespan.

Social determinants of health: the social, cultural, political, economic, and environmental conditions in which people are born, grow up, live, work, and age, and their access to power, decision making, money, and resources that give rise to these conditions of daily life.

Systems thinking: a set of analytic approaches and associated tools that seek to understand how systems behave, interact with their environment, and influence each other. Common to all of these approaches is a conviction that particular actions and outcomes are best understood in terms of interactions between elements in the system.

Well-being: a positive state experienced by individuals and societies. Similar to health, it is a resource for daily life and is determined by social, economic, and environmental conditions. Well-being encompasses quality of life and the ability of people and societies to contribute to the world with a sense of meaning and purpose.

ANNEX: GLOBAL HEALTH SUB-SECTOR POLICIES, STRATEGIES, AND GUIDING DOCUMENTS

The Policy for Global Health Development is intended to bring together themes and amplify USAID health subsector policy and technical guidance as well as U.S. government (USG) health policies, strategies, and initiatives. More information on these complementary resources can be found below. In addition, the policy is informed by and aligned with other USAID policies (see Agency’s Policy Registry for more details), which have been referenced throughout.

USAID Policy Documents

High-Level USAID Technical Guidance

USG Initiatives, Policies, and Strategies

* USAID Multi-Sectoral Nutrition Strategy 2014-2025

* USAID Global TB Strategy, 2023-2030

* USAID Vision for Health System Strengthening 2030

* USAID Digital Health Position Paper 2024 - 2029

* Mental Health Position Paper

* USAID Global Health Research and Development Strategy 2023-2028

* Pathways to Progress for Sexual and Reproductive Health, 2024-2030

* Preventing Child and Maternal Deaths: A Framework for Action in a Changing World

* Approach to HIV and Optimized Programming

* Global Accelerator to End Tuberculosis/Implementation Approach

* Blueprint for Global Health Resilience

* Climate Change Impacts on Human Health and the Health Sector

* Primary Impact: Accelerating Progress in Global Health & Survival

* USAID Flagship Community Health Worker (CHW) Resource Package

* USAID Sector Environmental Guidelines for Healthcare Waste Management, 2019

* USAID Position Statement on One Health

* Global VAX

* U.S. Global Health Care Worker Initiative

* Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030

* U.S. President’s Malaria Initiative Strategy 2021-2026

* Global Polio Eradication Initiative

* U.S. Government Global Health Security Strategy 2024

* U.S. National Biodefense Strategy and Implementation Plan

* U.S. Government Global Water Strategy 2022 - 2027

* U.S. Government Strategy for Children to Thrive 2024 - 2029

JP, a third-generation Joseph Paul from “the other Dallas” (Pennsylvania), spent over a decade working on USAID projects across Africa and beyond—from Nigeria to Bangladesh, South Africa to Tanzania. From combating childhood malnutrition to strengthening civil society, he witnessed firsthand how American development work builds lasting partnerships worldwide.

Then came the midnight news alert that changed everything.

In this raw and insightful conversation, JP explains why he got into international development not just to help people, but as an exercise in American soft power—and why the sudden dismantling of USAID represents what he calls “a stupid self-own” for U.S. interests. He walks us through the real-world consequences: how Chinese ambassadors are knocking on doors where USAID just walked away, why the “From the American People” branding mattered so much, and what it means when an administration’s goal is to “traumatize” its own workforce.

This episode tackles the intersection of patriotism and service, the difference between venial and mortal sins in policy-making, and why staying resilient matters more than ever. Whether you’re familiar with international development or just learning why it matters, JP’s perspective offers a compelling look at what’s at stake when America abandons its soft power.

Making People Visible

This space exists to make room for more voices and perspectives from people who worked in global development, and to show why that work mattered in the United States and around the world.

Help us keep telling these stories.

Your support makes Global Development Interrupted possible.

In the Season Two premiere of Global Development Interrupted, host Leah Petit is joined by Chris Wurst, a former Foreign Service Officer with the U.S. Department of State and the creator and host of the podcast SoftPower/Ful Stories. Chris spent more than two decades working in public diplomacy and communications, where he helped bridge the gap between data and lived experience by telling the human stories behind American engagement abroad.

That perspective gave him a firsthand view of how the three Ds of diplomacy, development, and defense once worked together in practice. He reflects on moments when agencies brought distinct but complementary expertise to the table, including the response to the 2004 Indian Ocean tsunami and, during the response to the 2005 Pakistan earthquake, when U.S. agencies were working side by side on the ground. These experiences shaped his understanding of how coordination across institutions helped stabilize communities, save lives, and contribute to a safer world for everyone.

Today, that system looks very different. With USAID dismantled and the State Department significantly weakened, this conversation offers a clear-eyed look at what has been lost, why those institutions mattered, and what their absence means for both global stability and the United States. Chris and Leah explore why storytelling is essential in moments of disruption, how soft power operates beyond official policy, and why communication and public understanding are central to rebuilding trust and engagement.

Making People Visible

This space exists to make room for more voices and perspectives from people who worked in global development, and to show why that work mattered in the United States and around the world.

Help us keep telling these stories.

Your support makes Global Development Interrupted possible.

In our last episode, Ben Eveslage described what happened when U.S. global assistance suddenly stopped. Programs froze, but local partners kept showing up. Community organizations, peer educators, community volunteers, and community health workers were the ones who held things together when everything else fell away.

This episode with Mananza Koné, USAID Côte d’Ivoire’s first Localization Officer, helps explain why that was possible. Known as “Mama Localization,” she spent years strengthening the systems, trust, and leadership that helped local organizations in Côte d’Ivoire expand their programs and deepen their impact as they partnered with USAID. Her work shows what it looks like when investments are made not just in projects, but in people and the systems they carry.

When the funding ended, it was those community networks that kept care moving. The referral system, made up of volunteers and community health workers who made sure people got to the clinic, received medication, kept appointments, and stayed in care, continued on even with little to no pay or support. It is exactly the kind of community-driven structure localization was meant to reinforce and one that proved its strength when everything else fell apart.

Listening to Ben and Mananza together shows both sides of this moment. Ben saw the resilience of local partners in real time. Mananza helped build the foundation that made that resilience possible. Her message is clear. The talent, systems, and networks built over decades still exist. They are not a waste, and now is the time to listen to communities, invest in them, and invest in the systems that have proven to endure.

Thank you for listening and supporting these stories. If you’re able, becoming a paid subscriber helps sustain this work.

As we close out our focus on World AIDS Day, we talk with Ben Eveslage about a path that starts in suburban Michigan and extends across Ghana, Iraq, East Africa, and beyond, and the photography project he created to capture the people behind the HIV response.

Ben shares how coming of age online opened his world and connected him to people far outside the borders of the United States. That instinct to seek out real stories shaped his decade working on HIV programs supported by the U.S. Government, where he helped move outreach into digital spaces that offered safety, belonging, and accurate information to communities often pushed into the shadows.

We also talk about the moment that changed everything. After the 2025 stop-work order, the immediate halt of U.S.-funded global assistance, Ben watched appointments collapse in real time as clinics shut down, outreach ended, and staff lost their jobs. Rather than step back, he got on a plane.

This Substack is reader-supported. To receive new posts and support my work, consider becoming a paid subscriber.

What followed became Holding the Line, his storytelling and photography project documenting the frontline health workers and local organizations who continued serving their communities even after U.S. funding disappeared. Ben traveled through Ghana, Rwanda, Uganda, Kenya, Mauritius, Mozambique, and South Africa, sitting with people who had every reason to give up and yet kept going.

Through these stories, we talk about what it means to meet people where they are, how stigma can be more dangerous than disease, and why treatment alone cannot replace trust, dignity, or hope. Ben’s journey reminds us that global development is not defined by budgets or policy memos. It is defined by people, their resilience, their belief in one another, and their refusal to stop showing up.

About Holding the Line

Documentary photography from the frontline of the global response to HIV.Ben took time away from his formal role to travel across seven African countries to meet with local organizations and document their ongoing work. His photography captures the people who kept delivering HIV services after U.S. funding stopped.Explore the project and subscribe at holdingtheline.blog.

In last week’s episode, Eric Smith shared how USAID’s Office of Diversity, Equity, Inclusion, and Accessibility worked to build an agency where people felt seen, valued, and included. That conversation served as a reminder that inclusion is not just a workplace ideal—it’s a strategy for better outcomes.

This week, we carry that idea into the world of HIV.

I’m joined by Kent Klindera, who spent more than three decades working with sex workers, transgender communities, gay men, people who inject drugs, and others whose lives have always been deeply shaped by social exclusion. Kent makes one truth impossible to ignore: you cannot end HIV with treatment alone. People don’t live in laboratories—they live in families, in communities, inside legal systems that either protect them or push them underground.

Throughout our conversation, Kent unpacks what he witnessed as the first HIV Peace Corps volunteer in Thailand in 1988, and later across Uganda, South Africa, Botswana, and at USAID. He explains why criminalization fuels transmission, how stigma keeps people from returning for care, and what happens when drop-in centers and trusted relationships disappear overnight. He also shares the story of a young peer educator in rural Uganda. A moment that captures the weight people carry when the world around them refuses to make room for their whole selves.

This episode is a clear reminder that HIV work has always been about far more than medication. It’s about safety. It’s about dignity. It’s about belonging. And it’s about the systems and people that help someone stay connected to care when life becomes overwhelming.

If you’ve ever wondered what truly drives epidemic control, or why inclusive policies and community-led care matter as much as science, this conversation with Kent will shift the way you think about health.

Help These Stories Reach More People

Before USAID was dismantled, one small office was trying to bring the full breadth of America into public service. Eric Smith grew up in Massachusetts with Catholic values, conservative media, and a fascination with the Founding Fathers. That mix eventually led him to USAID, where he worked to expand who gets to serve and why it mattered.

Eric explains how his team partnered with universities across the Midwest and South, including Historically Black Colleges and Universities, Hispanic Serving Institutions, Tribal Colleges, and rural schools, creating new pathways for students who rarely saw themselves in global development. These partnerships were not only about representation. They also strengthened programs that connected U.S. students to real global challenges.

He reflects on what diversity and inclusion looked like overseas, how colonial histories shaped equity conversations with mission staff, and how initiatives like Feed the Future gave American agricultural students hands-on research experience abroad and brought valuable knowledge back to farms and universities at home.

Then came the forty-eight-hour notice that shut it all down.

🎧 Listen to Global Development Interrupted on Substack, Spotify, Apple Podcasts, and YouTube.

In 2014, Ebola reached U.S. shores—a wake-up call that pandemics anywhere can threaten communities everywhere. In response, the United States with other countries and international organizations launched the Global Health Security Agenda (GHSA), a global partnership to prevent, detect, and respond to emerging diseases before they spread.

In this episode, former USAID Senior Public Health Advisor Ashna Kibria reflects on how the U.S. strengthened outbreak preparedness systems around the world and what’s at stake now that USAID is gone. From building early warning networks to partnering with governments, researchers, and the private sector, Ashna helped design programs that connected public health, agriculture, and environmental systems to stop outbreaks before they started. She also led efforts to combat antimicrobial resistance (AMR), one of the world’s most urgent and overlooked health threats.

Today, those global partnerships continue but with reduced U.S. coordination and support. As new outbreaks emerge, the world is reminded that health security depends on shared responsibility, not isolation.

Listen to learn how USAID’s partnerships once formed a quiet frontline against pandemics—and what it means now that those defenses have shifted to others.

Subscribe to Global Development Interrupted for more stories about global health, diplomacy, and what happens when development is disrupted.

Dr. George Siberry, former Chief Medical Officer in USAID’s Office of HIV/AIDS, has spent his career at the heart of the global fight against HIV. A pediatrician by training, George began his journey translating for children with HIV in Baltimore and went on to help shape the President’s Emergency Plan for AIDS Relief (PEPFAR) approach to prevention, treatment, and care around the world. In this conversation, he reflects on the evolution of HIV and the programs created to fight it—from stigma and isolation to people-centered health—and what it takes to build systems that strengthen communities and improve health outcomes rather than treating diseases in isolation.

As USAID’s dismantling leaves critical partnerships fractured and PEPFAR’s future uncertain, George speaks candidly about grief, loss, and the work of rebuilding trust. He makes a powerful case for why America’s investments in global health were never just acts of charity—they were expressions of diplomacy, innovation, and shared humanity.

If this conversation resonated with you, take a moment to like, share, or comment. It helps more people find Global Development Interrupted and keeps these stories alive.