Development Assistance for Health, International Affairs, and National Security: Dangerous Implications of a Tidal Trend
USAID in Tigray, Ethiopia. Source: Public Domain
By Cara Fallon
Over half of the 1990-2014 Development Assistance for Health (DAH) came from six countries, with the United States government as the largest single donor.[1],[2] The new U.S. presidential administration introduced sweeping reductions, leaving the most vulnerable in developing countries at risk, specifically women, children, and families. The administration also removed health funding at a time when innovative advances in maternal and infant mortality reduction, vaccine-preventable diseases, and other successful public health interventions have achieved remarkable successes. These funding cuts now put millions of lives on multiple continents in jeopardy; they also remove a crucial tool for global health partnerships and security.
A major benefit of public health interventions is a commitment to cost-effective solutions that prioritize the most marginalized. These interventions save lives, strengthen economies, and produce good will and good policy. Although the Trump administration has criticized some public health programs as ineffective, numerous examples demonstrate their positive impact on health and security.
In 2023, for example, Niger announced a remarkable breakthrough in maternal mortality. Collaborating with a small NGO, the country reduced overall health system maternal mortality by 34.5% nationwide across almost 1.4 million births, reducing bleeding-deaths after childbirth in health facilities by over 50% in under two years and by 70% in six years.[3] Niger will now integrate an additional medication into the system to also prevent the second biggest maternal mortality cause: eclampsia deaths.
Financial benefits have been equally striking. Niger’s initiative costs a fraction of the averted cost to individuals, families, and the country from death and disability. Savings to the population (costs averted) have been estimated at $4.5 million USD annually, approximately 6-8 times its running cost. Yet, with a per capita GDP of approximately $643/year (as in Niger), resource-constrained countries cannot rigorously test and scale innovations in isolation. Collaboration is the solution. In this case, even a small NGO collaborating with the national government demonstrated a substantial impact on maternal death and disability.
The potential impact of this model extends far beyond Niger. Similar conditions exist among rural people of northern Nigeria, DRC, Chad, Mali, and Burkina Faso, 170 million combined. They share Niger’s challenges: limited healthcare infrastructure, high maternal mortality from bleeding, and significant numbers of home births. With approximately 6.8 million annual births and similar maternal bleeding death rates to pre-intervention Niger, successful adaptation of this model could prevent approximately 15,000 maternal deaths annually and prevent more children from growing up motherless.
Beyond maternal morbidity and mortality, childhood deaths due to vaccine-preventable diseases are a major global health concern, killing approximately 1.5 million people annually. More than 600,000 are children under the age of five.[4] Immunizations save lives, reduce cycles of disease, poverty, unemployment, and produce much-needed goodwill. They are among the most cost-effective interventions in development assistance. A study on 94 countries between 2011 and 2020 estimated net returns for achieving projected coverage of ten antigens at about 16 times the costs over the decade. With a full-income approach, quantifying the value of living longer and healthier lives, net returns reached 44 times the costs.[5] Funding reductions undermine these efforts, investments, and returns.
Not only are funding reductions strategically shortsighted, but they are also morally unsound. Development assistance is a vital part of international partnerships, strategic influence, and peacebuilding initiatives. For example, many people throughout Africa laud the PEPFAR program (The United States President’s Emergency Plan for AIDS Relief) for the millions of productive lives it has saved and continues to protect. For decades, it has been a U.S. contribution to Africa widely admired and appreciated—a moral and strategic success.
Global health programs that reduce mortality and improve basic health services also support prosperity and security. Improving maternal health care can remove some of the many reasons for migration to American and European shores in desperation. Health programs can be an investment in a positive rationale to refute terrorist recruiters who attract followers by pointing to the lack of host government attention to basic needs; they are a forward-looking investment in preserving healthy future consumers of U.S. goods, future inventors of tomorrow’s technologies, and future investors in the global economy. Global health funding is a strategic investment in national and international security.
Reorganizing USAID and other development assistance for health programs to improve efficiency is a welcome, potentially necessary change. However, reducing direct development and humanitarian assistance to the poorest of the poor, eliminating government partnerships with nimble, effective NGOs—whether international or local—and reducing funding for vaccine-preventable diseases is “throwing the baby out with the bathwater.” At best, it will reduce the United States’ influence, credibility, and genuine affection from and access to numerous countries worldwide. At worst, it will seed spite, isolation, and rejection. Appreciation and welcome are prerequisites for true security and economic prosperity at home and abroad—let us not cast them off carelessly.
About the author
Cara Fallon is a senior lecturer in global health and the director of undergraduate studies of the Global Health Studies Program at the Jackson School of Global Affairs. Her research analyzes the production of health disparities, the marginalization of the elderly and disabled from basic frameworks of health, and chronic disease in global health history. Cara Fallon holds a PhD in the history of science from Harvard University, an MPH from the Yale School of Public Health, and BA from Yale in history of science/history of medicine.
Endnotes
Dieleman, Joseph L., Casey Graves, Elizabeth Johnson, Tara Templin, Maxwell Birger, Hannah Hamavid, Michael Freeman, et al. “Sources and Focus of Health Development Assistance, 1990–2014.” JAMA 313, no. 23 (2015): 2359–2368.
Lawson, Marian Leonardo. Foreign Aid: International Donor Coordination of Development Assistance. Washington, DC: Congressional Research Service, 2013.
Seim, Anders R., Zeidou Alassoum, Ibrahim Souley, Rachel Bronzan, Aida Mounkaila, and Luai A. Ahmed. “The Effects of a Peripartum Strategy to Prevent and Treat Primary Postpartum Haemorrhage at Health Facilities in Niger: A Longitudinal, 72-Month Study.” Lancet Global Health 11, no. 2 (2023): e287–e295.
U.S. Agency for International Development (USAID). Immunization, 2017–2020. Accessed April 30, 2025. https://2017-2020.usaid.gov/global-health/health-areas/maternal-and-child-health/technical-areas/immunization#:~:text=Every%20year%2C%201.5%20million%20people,die%20from%20vaccine%2Dpreventable%20diseases.&text=Each%20year%2C%2019%20million%20infants,not%20reached%20with%20basic%20vaccinations.
Ozawa, Sachiko, Samantha Clark, Allison Portnoy, Simrun Grewal, Logan Brenzel, and Damian G. Walker. “Return on Investment from Childhood Immunization in Low- and Middle-Income Countries, 2011–20.” Health Affairs 35, no. 2 (February 2016): 199–207.
Disclaimer
The views expressed in this paper are solely those of the author and do not reflect the opinions of the editors or the journal.