『Inside USAID’s Dismantling: A Deputy Director’s Account of the Lifesaving Memo That Changed Everything』のカバーアート

Inside USAID’s Dismantling: A Deputy Director’s Account of the Lifesaving Memo That Changed Everything

Inside USAID’s Dismantling: A Deputy Director’s Account of the Lifesaving Memo That Changed Everything

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概要

 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-BeingTABLE OF CONTENTEXECUTIVE SUMMARYINTRODUCTIONBACKGROUNDVISIONPRINCIPLES* Equitable, Inclusive, and Person-Centered* Evidence-Based and Adaptable* Locally Led Development and Country Ownership* Collaboration and Diverse PartnershipsPOLICY INTO PRACTICE* The Primary Health Care Approach* Strengthen Systems to Deliver Health Services* Enable Resilient and Sustainable Health Ecosystems* Advance Research and Innovation for HealthLEARNINGCONCLUSIONGLOSSARY (OF TERMS USED THROUGHOUT)ANNEX: GLOBAL HEALTH SUB-SECTOR POLICIES, STRATEGIES, AND GUIDING DOCUMENTSEXECUTIVE SUMMARYIn 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 ...
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