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Did Trump accidentally do something woke for global health?

This could be the future of foreign aid. Or a total disaster.

A surprising quirk of the Trump administration is that every so often, it tries so hard to be anti-woke that it accidentally does something woke.

See, for example, the efforts of Secretary of State Marco Rubio, who oversaw USAID’s demise — directives that have contributed to the deaths of hundreds of thousands of people — and who stood at the White House beside the president of Kenya a few months ago, railing against what he called the “NGO industrial complex.”

Now, I don’t know who taught Rubio that progressive catchphrase, but I doubt that he got it from INCITE!, the radical feminist collective that popularized a variation of the term in an anthology that examined the role of nonprofits in undermining social progress. In the two decades that followed, the idea of a nonprofit or — as they’re often known in international contexts — NGO “industrial complex” grew into a snarky self-critique for much of that sector’s left-leaning young workforce. By the time Teen Vogue used the term in 2022, the phrase also hinted at an enduring related criticism of USAID’s tendency to primarily fund Western nonprofits rather than local governments and organizations in recipient countries.

USAID’s critics have long called for the agency to fund more local governments and groups, instead of relying on the “NGO industrial complex” to do its bidding.

The Trump administration has embraced this critique, negotiating dozens of global health deals that put aid in the hands of local governments, not foreign NGOs.

Ideally, this means more funding for local health systems, and foreign aid that’s more cost-effective and better attuned to local needs.

But this is global health MAGA-style after all, and skeptics fear the terms of the deals may be exploitative — and are already leading to deadly lapses in services.

In an unexpected twist, this term has found its way into the vocabulary of a very Republican secretary of state, now reflecting a preference for funding foreign governments over non-governmental organizations (NGOs). “If we’re trying to help countries, help the country,” Rubio said in his remarks in December announcing a new $1.6 billion bilateral aid deal between the US State Department and Kenya. “Don’t help the NGO to go in and find a new line of business.”

Whatever one thinks of Rubio, he has a point. As part of the “America First Global Health Strategy” announced last year, the Trump administration has embraced an approach to foreign aid that more left-leaning reformists have been talking about for years, a concept known as localization, or the idea that giving aid directly to local governments and organizations — not Western nonprofits — is the best and most cost-effective way to strengthen global aid overall and global health systems especially. In recent months, the US has negotiated dozens of deals between the State Department and African governments, which are set to collectively receive billions of dollars that they can spend as they see fit.

The logic might seem sound. But it hasn’t happened sooner because it’s also risky. It’s harder to audit a foreign government than a well-established, well-connected NGO. And millions of lives are on the line. The transition from the one approach to the other is also fraught: Dismantling USAID has disrupted access to vital medications and health services around the world, leading to mass suffering and loss of life. It is unclear if this new strategy will be able to fill those lapses in care, especially for the women and children most vulnerable to aid cuts.

But if there were ever a moment to blow up the entire old aid order, it’s arguably now, when there is very little left to lose. And it turns out some surprising figures in global health are cautiously optimistic about it.

“They’re basically making a bet that they can do it and get away with it, and if things go wrong, they’ll get a bit of a pass,” Rachel Bonnifield, director of the global health policy program at the Center for Global Development, said of the administration. “And that’s probably true, and it very well might be a good thing” for global health in the long run.

It comes at a critical juncture for global health and American foreign aid more broadly. “We all have to work hard to ensure that these disruptive moments are moments of real progress,” said Jirair Ratevosian, a senior adviser for health equity policy under the Biden administration and now a senior scholar at the Duke Global Health Institute. If all goes well, the strategy could “be a huge success for this administration,” he said, “something that I........

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