USAID: Current support for global surgery and implications of reform
Introduction
The United States Agency for International Development (USAID) is a leader in international development and humanitarian efforts focused on improving health, alleviating poverty, and promoting democratic governance globally. The wide breadth of foreign assistance provided by USAID includes a serious commitment to global health and an accompanying emphasis on access to safe, timely, and affordable surgical care. USAID is the largest US governmental agency providing financial assistance to low- and middle-income countries in the surgical sector.1 This report provides an overview of USAID as an organization and its role in global health and global surgery, discusses implications of proposed reform on these initiatives, and details how USAID can best engage in global surgery for sustained impact.
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History
On November 3, 1961, John F. Kennedy signed the Foreign Assistance Act and issued an executive order establishing the USAID, a move that solidified US commitment to civilian foreign aid.2, 3 This was the start of the “decade of development” and the catalyst for a similar commitment to international development by the United Nations (UN). Over time, the mission of the USAID has evolved from an early emphasis on providing for basic human needs (food, health, education, etc), to promotion of free
Role in Global Health
One of largest categories of spending of the USAID is global health, which focuses on the following 3 strategic priorities: (1) ending preventable child and maternal deaths; (2) controlling the HIV/AIDS epidemic to create an AIDS-free generation; and (3) protecting communities from infectious diseases.11 Under the umbrella of these three goals, the USAID further organizes its global health sector into subsectors that include emerging pandemic threats, family planning, malaria, maternal and
Role in Global Surgery
Despite not having surgery specifically named as a priority, USAID programming in maternal and child health (emergency obstetric care, fistula repair, permanent sterilization), health system strengthening (service delivery, workforce, appropriate equipment, etc), and support for countless hospitals and medical schools is indisputably impacting surgical care around the world.
The Maternal and Child Survival Program (MCSP) was announced as a new USAID flagship program to aid in ending preventable
Reform
The USAID is moving into a new era. Beginning with a proposed merger of the State Department and the USAID accounts to create a joint Economic Support and Development fund, marked reforms of the USAID are on the horizon. Accompanying this reform would be a projected 41.7% overall decrease in spending of all direct development assistance and a 30.9% decrease in global health program assistance.40, 41 In line with the original goals of the USAID, the new administrator of USAID, Mark Green, states
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