How Much Global Health Funding Goes Through USAID?

On January 20, President Trump issued an Executive Order calling for a re-evaluation and realignment of U.S. foreign aid that put a 90-day pause on new obligations and disbursements and initiated a full review of all foreign aid programs. This was followed by a stop-work order for existing efforts (with limited exception) already funded and underway, freezing most service delivery in countries around the world. With reports of the effective dissolution of USAID, the international development agency created more than six decades ago, there is uncertainty about the future of the aid it provides if it is incorporated into the State Department as President Trump calls to “CLOSE IT DOWN!”.

To shed light on the role of USAID in global health, this brief provides an analysis of the share of global health assistance obligated or implemented by USAID and other agencies on behalf of countries (or, “bilateral”) in FY 2023, using data from foreignassistance.gov. This includes funding that agencies either: 1) obligated for global health activities (e.g., USAID manages and provides funding to an implementing partner, such as a non-governmental organization, to directly carryout health programs); or 2) received from other agencies to directly implement specific programs (e.g., State Department directs funding to USAID to implement HIV/AIDS programs in countries). As this analysis shows, the majority of U.S. bilateral global health assistance is obligated or implemented by USAID, including for PEPFAR. (For more information on federal funding flows for global health, see 10 Things to Know About U.S. Funding for Global Health).

In FY 2023, USAID obligated/implemented 73% of all U.S. global health bilateral assistance. Of the $8.5 billion for bilateral global health efforts, across all program areas, USAID obligated/implemented $6.2 billion (73%) (see Figure 1). The next largest share was at the Department of Health and Human Services (HHS) ($1.9 billion or 22%), primarily the Centers for Disease Control and Prevention (CDC). Two percent ($141 million) was at State and 3% ($280 million) at all other agencies combined.

For PEPFAR, the U.S. global HIV/AIDS program, USAID obligated/implemented 60% of bilateral assistance. Of the $4.2 billion for bilateral HIV programs in FY 2023, $2.5 billion (60%) was obligated/implemented by USAID, followed by $1.6 billion (37%) at HHS, and 2% ($79 million) at State (see Figure 2). Just 1% ($25 million) was at other agencies.

USAID’s role is even greater in some sectors, including 100% in some cases. For maternal and child health, TB efforts, and global health security, USAID obligated 100% of all bilateral support in FY 2023 (see Figure 3). It obligated 99% of family planning and reproductive health and 96% for malaria efforts. PEPFAR, as noted above, is 60%, and nutrition programs are 59%.

There remains significant uncertainty surrounding the administration’s review of USAID and of U.S. foreign aid more generally, including which programs will be maintained, and how they will be carried out going forward. Given the current role of USAID in managing U.S. global health programs, through its thousands of staff around the world and its work with implementers on the ground, changing USAID, including by reducing or eliminating its capacity, would leave a gap that could affect service delivery and health outcomes, should it not be filled.