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Published by The People, the Work, and What Was Lost When America Stepped Back
Global Development Interrupted creates space for voices, perspectives, and critical reflection on global development. By amplifying the experiences of people who have built their careers in public service and global work, it invites learning, dialogue, and reimagining of what global development is, was, and could be. globaldevinterrupted.substack.com
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What happens when environmental work that has taken decades to build suddenly disappears? For years, USAID supported efforts around the world to protect forests and wildlife, reduce pollution, strengthen local communities, and address the interconnected challenges of biodiversity loss, climate change, and environmental degradation. But when the agency’s programs were abruptly shut down, the loss went far beyond funding. In this episode, Leah speaks with former USAID environmental leaders Hadas Kushnir and Monica Bansal, who are now examining the impacts of the withdrawal of USAID’s environmental programs. They share what they heard from people around the world—and what those conversations revealed about the relationships, expertise, and long-term work that were lost. Their full findings will be published in a forthcoming report, Beyond the Funding Gap , out after Labor Day through their initiative, Momentum for the Environment. From man-eating lions and piranhas to landfill fires, plastic waste, and community conservation, this conversation explores what USAID’s environmental work actually looked like on the ground. It’s also a story of why environmental challenges in one part of the world can affect all of us. What did we lose when that work stopped? And what might it take to rebuild? If you want to support environmental work that’s still active on the ground, Hadas and Monica’s team has curated a pipeline of vetted, shovel-ready projects at www.oneearthpartners.com . You can also reach them directly at info@oneearthpartners.com to talk through what fits your interests. Guest: Hadas Kushnir and Monica Bansal, co-founders of Momentum for the Environment Initiative and former USAID environmental leaders Topics: USAID’s environmental and climate work, biodiversity loss, community-based conservation, the agency’s dismantling, localization, and the forthcoming Beyond the Funding Gap report Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
Can demography — the study of how populations grow, move, and change — offer a window into a country’s future? That’s what Leah talks about with Dr. Apoorva Jadhav, former USAID senior demographer and statistician, in this episode of Global Development Interrupted. Apoorva explains how USAID was rethinking the way it invested in development through the lens of demography — looking at population data and trends to understand where countries were headed and how to invest more strategically. That work came to an abrupt end when the agency was dismantled. The conversation gets into what’s at stake when the data infrastructure behind development begins to erode. USAID invested in the long-term systems, standards, and expertise that allowed the U.S. and other countries and organizations to make smarter investments and address real problems. Without that foundation, what happens to the quality of the data and the decisions built on it? Because behind every data point is a person — and, as Apoorva puts it, “there is a pulse.” Guest: Dr. Apoorva Jadhav, former Senior Demographer and Statistician, USAID Office of Population and Reproductive Health; author of Demography Matters on Substack Topics: Demographic and Health Surveys (DHS), family planning and reproductive health, maternal and child health, HIV and disability data, child marriage, global migration policy, the dismantling of USAID, the future of development data Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
Democracy is never finished. No country has gotten it perfect—not even here at home. In this episode of Global Development Interrupted , Leah talks with Amy Hamelin, a former USAID Democracy Officer who spent her career working across South Asia and sub-Saharan Africa. Drawing on her experiences in countries where democracy has been hard won and often tested, Amy shares what she learned about the people, communities, and institutions that keep it alive. Their conversation explores what democratic resilience looks like in practice: the importance of strong institutions, the role ordinary citizens play in sustaining democracy, and what we can learn from countries navigating democratic challenges—including lessons that matter here at home. Because democracy isn’t something we build once and then move on from. It is a work in progress, sustained by people who show up and institutions worth showing up for. This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Guest: Amy Hamelin, former USAID Foreign Service Officer Topics: Democracy, democratic resilience, institutions, civic participation, USAID, international development, South Asia, Kenya, South Sudan Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
For 16 years, Sara Sullivan helped USAID tell its story around the world. She never imagined she’d have to explain it to Americans. When the agency was dismantled in early 2025, she watched misinformation spread through the Republican and evangelical communities she grew up in. Rather than argue with strangers online, she started recording videos for the people she knew—sharing what she had seen firsthand across three continents and 16 years in global development. That’s how Average American was born. In this episode, Sara reflects on why USAID never built public understanding at home, the human cost of the stop-work order, and why she believes foreign assistance must tell its story differently if it ever returns. She also explains why she compares USAID to a government mission trip—and yes, she once starred in a Pakistani sitcom. Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
When Jen Erie published her memoir, she expected her global development colleagues to connect with it. She didn’t expect older white men to message her saying they saw their own lives in hers. Jen Erie grew up the daughter of Haitian immigrants in Queens, New York. She went on to spend more than a decade as a USAID Foreign Service Officer — leading health programs across the Philippines, South Africa, Tanzania, South Sudan, and Thailand. In this episode, Jen reflects on what that work actually looked like on the ground, the identity crisis that came with losing it, and what she discovered about herself — and others — when she finally told her story. The result was a book, and a realization: this conversation reaches far beyond global development. At its core, it’s about shared humanity — how much more we have in common than we think, and what it looks like to turn grief into something others can learn from. Want to learn more from Jen and pick up her book, The World Is My Bones ? Visit her at www.jennifererie.com Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
A scholarship program training the next generation of democratic leaders was named “Diversity and Inclusion” specifically to hide it from a military dictatorship. On day nine of the Trump presidency, that name got it canceled. Matt Pietz spent a decade in Myanmar for USAID working on democracy and education projects. His last project gave 450 of the country’s most promising young people four-year scholarships — because a dictatorship that had spent decades keeping its population uneducated knew exactly what an educated citizen could do. One semester in, the White House called and said cancel it. No questions, no review, no interest in where the money actually went. In this episode, Matt breaks down what the work really was, who it served, and why Myanmar’s instability is America’s problem too — where the absence of rule of law has produced the world’s top supplier of heroin and meth, a haven for online scam centers, and a power vacuum that China is filling fast. This is what democracy promotion looks like from the inside. And what it looks like when it’s dismantled from the outside. Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
Keisha Effiom sat at her dining room table in Rwanda, read the email about USAID’s final mission, and started writing. The result is a memoir — and this conversation. Keisha, former USAID Mission Director for Rwanda and Burundi, joins Global Development Interrupted to trace her journey from Howard University graduate to one of USAID’s top leaders and what she chose to do when it all came crashing down. She talks candidly about the human cost of USAID’s closure, why dismissing public servants with “just get over it” is not only wrong but cruel, and how she led her team through crisis without letting her heart go hard. She also shares the story behind her memoir, I Said My Peace With Peace: Inside USAID’s Final Days — a firsthand account of servant leadership when everything is falling apart. Whether you work in global development, care about U.S. foreign policy, or are leading people through uncertainty, this episode is for you. Want to learn more from Keisha and pick up her book, I Said My Piece with Peace ? Visit her at keishaeffiom.com Listen, Watch, Follow Listen & Watch on: Apple Podcasts | Spotify | Youtube Follow on: Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
Three former USAID officers. Three Maryland races. One mission: keep serving. In this episode of Global Development Interrupted, host Leah Petit sits down with Alicia Contreras-Donello, running for Maryland House of Delegates District 14; Allison Eriksen, running for Montgomery County Council District 3; and Tracy Starr, running for US House of Representatives District 5. Together they share their stories of humble beginnings, careers defined by public service, and the moment they decided that the best way to keep serving was to change the system from the inside. From economic development and renewable energy to food security and human rights, these women are bringing the skills that USAID built — and the communities that shaped them — directly to the ballot box. If you believe that government should be representative of the people it serves, this episode is for you. Maryland early voting runs June 11th through 18th. Primary Election Day is June 23rd. This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Interested in learning more about these candidates? Check them out below! Alicia Contreras-Donello - Maryland House of Delegates District 14 📸 Instagram/TikTok: @aliciaformaryland 👍 Facebook/LinkedIn: Alicia for Maryland 🌐 Website: aliciacontrerasdonello.com Allison Eriksen - Montgomery County Council District 3 📸 Instagram: @allisonformoco 🌐 Website: allisonformoco.com Tracy Starr - Maryland’s 5th District 📸 Instagram: @ tracyforcongress26 🌐 Website: friendsoftracy.com Stay connected with Global Development Interrupted Apple Podcasts | Spotify | Youtube Instagram: @globaldevinterrupted | Facebook : Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
A career spent investing in global education didn’t just build schools. It built futures. In this episode, former USAID Foreign Service Officer and Education Specialist Siena Fleischer shares what it takes to create opportunity through education: from teaching children to read, preparing youth for the workforce, and building global research partnerships. But this isn’t just about what worked. It’s about what’s now at risk. Siena was days away from boarding a plane to lead a flagship youth leadership program when everything stopped. With the dismantling of USAID, entire education systems are losing support. Siena explains what “learning loss” really means: not just missed school days, but lost generations, stalled economies, and fewer leaders equipped to shape the future. Education isn’t optional. It never was. And right now, it’s disappearing. Interested in learning more? Resources Siena Recommends * The Science of Reading * Balanced vs. Structured Literacy * Phonics vs. Whole Language * Dyslexia and The Reading Wars * Brookings Global Task Force on AI in Education * Educating Kids in the Age of AI 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. Stay connected with Global Development Interrupted Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
What do malaria rates, indigenous forests in Peru, and elephant tusk trafficking have in common? They’re all part of what USAID’s conservation work actually looked like. And what we’ve lost. Cynthia Gill spent 32 years building USAID’s conservation programming. Weeks watching it dismantled. And then the question: now what? The former Director for USAID's Center for Natural Environment joins Leah to talk about the shutdown, what was lost, and why she's just getting started through the Reimagining Global Conservation Initiative, a bipartisan playbook that reimagines how the US government contributes to global conservation, strengthening international stability and security while honoring nature as an American core value. To learn more about the Reimagining Global Conservation Initiative and join the coalition, visit their website and add your name to the mailing list . If you’d like to support the work, you can contribute here . To see a summary of the conservation and development legacy of USAID, see the Guardian’s coverage or read more deeply on Biographic . To reach Cynthia directly, email her at cynthia@focuscoaching.net . 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. Stay connected with Global Development Interrupted Instagram: @globaldevinterrupted | Facebook: Global Development Interrupted This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
What does it feel like to edit the word "equality" out of a US government document? To watch global development programs you believed in disappear overnight? Kelli Rogers knows. A global development journalist who moved from the newsroom to the State Department and back again, she's now leading the Aid Report at DevEx — documenting the real human cost of the foreign assistance cuts and the dismantling of USAID, one story at a time. We talk about what journalism looks like right now, the people behind the numbers, what gives her hope, and yes, even Bad Bunny. Listen to the Episode & Read the Aid Report: www.theaidreport.us 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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
She was a new mom, weeks postpartum, when she got fired. No warning. No plan. Just a career she’d spent 18 years building — gone. Kathleen Borgueta wasn’t supposed to become a founder. She was supposed to go back to work at USAID, where she’d overseen global health programs across 15 countries in East and Central Africa, managed COVID vaccine rollouts, and built cold chain infrastructure in Somalia. She had a plan for what kind of working mother she was going to be. Then the dismantling started. In this episode, Kathleen joins host Leah Petit to talk about what it really feels like to be fired, publicly called a villain, and left to rebuild your identity — while keeping a newborn alive. She also talks about what she built from the rubble: Pivoting Parents , a 1,200-member global community for laid-off parents refusing to disappear quietly. This is a conversation about agency — in foreign aid, in motherhood, and in deciding what you do when the thing you built your life around is taken from you. “There are a lot of days that hope feels false. But having a child and being invested in my community and invested in the global community forces me to have hope for the future.” Follow Kathleen: LinkedIn , Instagram , and www.pivotingparents.com 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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
He was in the room when it happened. Alex Natsios sat next to his father, Andrew Natsios — former USAID Administrator, war veteran, conservative Republican — for four and a half hours as members of Congress stood up one by one and repeated the same false claims about USAID. He watched them do it knowing they were false. He watched Fox News run graphics contradicting his father’s own words while he was still speaking. That’s when Alex stopped holding back. In this episode, Alex joins host Leah Petit to talk about what it felt like to witness the dismantling of USAID from the inside — sitting beside the man who helped build it. He shares how watching his father go “once more into the breach” at 75 years old pushed him to find his own way to fight back, and how the flood of misinformation led him to start Unsung Americans — a podcast dedicated to telling the real stories of aid workers on the ground. This is a conversation about truth-telling, legacy, and what it costs when a country decides to stop believing in its own work. “Our level of influence in the world was far more significant than even those of us who were very plugged in understood. And we’re all going to lose. America’s not gaining — we’re losing.” Find Unsung Americans on YouTube or Linktr.ee 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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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 workforc
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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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 . This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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 This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit globaldevinterrupted.substack.com/subscribe
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