新框架将数十亿美元对外援助与绩效基准挂钩，并通过双边协议推动各国承担更大责任
作者：摩根·菲利普斯
福克斯新闻
发布时间：2026年2月4日 美国东部时间上午7:00
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在特朗普政府解散美国国际开发署（USAID）后的数月里，批评者警告称美国全球卫生项目正被大幅削减。鲜为人知的是，取而代之的是什么。
2025年12月，白宫悄然推出《美国优先全球卫生战略》，将美国全球卫生援助的控制权从USAID转移至国务院，并从根本上改写了数十亿美元对外援助的分配方式。
这一转变部分由一小群前官员推动，他们如今以私人部门顾问身份为白宫提供建议，其中包括前USAID署长马克·格林（Mark Green）以及前议员泰德·约霍（Ted Yoho）和克里斯·斯图尔特（Chris Stewart）。他们虽未直接管理项目，但一直推动制定更明确的问责标准、更严格的绩效指标和国会监督机制，称这些是新框架能在一届政府任期后持续的必要条件。
该战略的核心是与美国传统卫生援助模式的彻底决裂。《美国优先全球卫生战略》取代了USAID以赠款为主、非政府组织驱动的模式，转而采用逐国协议，将资金与绩效基准挂钩，并逐步推动外国政府承担更大责任。该框架承诺加强资金使用控制，但许多具体执行细节——包括基准设定和应用方式——仍在制定中。
美国国际开发署（USAID）本质上已被一个名为《美国优先全球卫生战略》的新项目取代。(Kevin Dietsch/Getty Images)
到目前为止，该战略通过逐国谈判的有限双边卫生协议实施。2025年12月，美国与肯尼亚签署了一项为期五年的卫生合作协议，涵盖艾滋病毒/艾滋病、疟疾和结核病等领域，美国资金与持续绩效及肯尼亚政府增加的共同投资挂钩。据国务院披露，美国随后与尼日利亚、喀麦隆等国签署或正在谈判类似的谅解备忘录。
国会长期以来一直以高水平拨付全球卫生资金，给予USAID在项目设计和实施方面的广泛自由裁量权——这种结构让议员们有监督权，但几乎不参与具体资金决策。约霍表示，这种自由裁量权导致机构随时间偏离了最初目标。
“它失去了原设计目的的纯粹性，”约霍说，”他们迷失了方向，变得政治化和意识形态化。”
相比之下，新战略明确将全球卫生援助围绕美国国家安全、双边关系和经济利益进行框架化。但由于尚未纳入法律，这些优先事项可能被未来政府重新定义或推翻。
特朗普全球卫生战略可能成为艾滋病防治的转折点
“如果没有被写入法律，援助的执行方式可能会随着政府更迭而消失，”约霍说，”如果我们转向民主党政府，现有的援助模式可能会被弃用。”
曾在负责外国援助资金的众议院情报委员会和拨款小组委员会任职的前众议员克里斯·斯图尔特表示，即使是批准全球卫生支出的议员，一旦资金离开华盛顿，也往往对项目运作知之甚少。
“即使作为拨款者——本应掌握资金审批权的人——我们也缺乏必要的监督，”斯图尔特说。
根据《美国优先全球卫生战略》，斯图尔特表示监督将从更早阶段开始，更明确的优先事项以及美国目标与受援国实际需求之间的更紧密对齐。在其访问中，斯图尔特称外国领导人多次表示，他们对开放式援助兴趣不大，更希望建立自身能力。
“我们不只是想要援助，”斯图尔特说，”我们想要贸易，想要建设自己的能力。”
斯图尔特表示，转向政府间协议旨在使资金使用更可追溯、更直接地归因于美国，同时仍需严格控制以防止浪费或滥用。
“这并不意味着我们合作的每个政府都完美无缺，”他说，”但这确实让资金去向更加透明。”
新框架的支持者指出，长期的疾病专项项目证明，更严格的监督并不意味着完全放弃全球卫生投资。约霍、斯图尔特和格林都以美国政府的艾滋病防治项目（PEPFAR）为例，称其为两党合作的对外援助典范，既挽救了生命，又加强了美国在海外的关系。
斯图尔特和格林还提到疟疾预防工作，两人均强调儿童健康和营养是国会应继续优先考虑的领域。
约霍还提到使用即食治疗食品（RUTF）治疗严重儿童营养不良，称其为低成本干预措施，具有明确的人道主义影响和广泛的两党支持。
前USAID署长格林表示，该战略围绕他所谓的”自力更生之旅”构建，推动各国从长期援助接受国转变为合作伙伴，在某些情况下最终成为捐赠者自身。
“我们希望每个国家都能从援助接受国，转变为合作伙伴，在理想情况下，成为同行的捐赠者和投资者，”格林说。
在新框架下，格林表示全球卫生援助通过量身定制的双边协议逐国谈判，针对当地条件和对等义务。
“这不是施舍，”他说，”而是美国与另一个国家政府之间的合资企业，旨在建设当地能力并逐步转移责任。”
该战略还更强调利用私营部门工具与政府资金相结合。
格林以与美国Zipline公司的合作为例，该公司利用无人机技术在偏远地区运送血液和医疗用品，说明框架如何将公共卫生目标与美国创新相结合。
不过格林承认，整个系统仍在完善中。虽然协议旨在将资金与绩效和负担分担挂钩，但他表示许多具体基准和执行机制仍在最终确定中。
“婚礼容易，婚姻难，”格林描述将广泛协议转化为可衡量、可执行结果的挑战，”我们仍在努力将这些广泛的承诺转化为实际的、可执行的成果。”
对于新战略的支持者而言，更严格的问责制也是为了应对右翼对外国援助本身长期存在的怀疑。约霍表示，他曾持有这种怀疑态度。
“我曾是那些想要取消外国援助的人之一，”他说，”但后来我意识到自己对有效外国援助的无知。”
他表示，当项目目标明确且可衡量时，支持变得更容易。
“如果代表们有可靠信息，可以向选民解释为何支持某项计划——因为它使美国更安全、更强大、更繁荣——大多数人会支持，”约霍说。
《美国优先全球卫生战略》最终能否兑现承诺或暴露新风险，可能更多取决于国会选择正式化多少权力，以及政府如何严格执行其设定的问责标准。
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What replaced USAID? Inside the Trump administration’s global health overhaul
New framework ties billions in foreign aid to performance benchmarks and pushes countries to assume greater responsibility through bilateral agreements
By Morgan Phillips
Fox News
Published February 4, 2026 7:00am EST
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For months after the Trump administration dismantled the U.S. Agency for International Development, critics warned that America’s global health programs were being gutted. What drew far less attention was what replaced it.
In December 2025, the White House quietly rolled out the America First Global Health Strategy, shifting control of U.S. global health aid from USAID to the State Department and fundamentally rewriting how billions of dollars in foreign assistance are distributed.
The transition has been shaped in part by a small group of former officials now advising the White House from the private sector, including former USAID administrator Mark Green and former lawmakers Ted Yoho and Chris Stewart. They are not running the programs, but they have been involved in pressing for clearer accountability standards, tighter performance metrics and congressional guardrails they say are necessary if the new framework is going to last beyond a single administration.
At the core of the strategy is a sharp break from how U.S. health aid traditionally has worked. The America First Global Health Strategy replaces USAID’s grant-heavy, nongovernmental organization-driven model with country-by-country agreements that tie funding to performance benchmarks and push foreign governments to assume greater responsibility over time. The framework promises tighter control over spending, but many of its enforcement details — including how benchmarks will be set and applied — are still being developed.
The U.S. Agency for International Development (USAID), essentially has been replaced by a new program known as America First Global Health Strategy.(Kevin Dietsch/Getty Images)
So far, the strategy has been implemented through a limited number of bilateral health agreements negotiated country by country. In December 2025, the United States signed a five-year health cooperation agreement with Kenya, covering areas such as HIV/AIDS, malaria and tuberculosis, with U.S. funding tied to continued performance and increased co-investment by the Kenyan government. Similar memorandums of understanding have since been signed or are under negotiation with countries including Nigeria and Cameroon, according to State Department disclosures.
Congress has long appropriated global health funding at a high level, giving USAID broad discretion over how programs were designed and implemented — a structure that left lawmakers with oversight but little involvement in individual funding decisions. Yoho said that discretion allowed the agency to drift over time.
“It lost the purity of purpose of what it was designed to do,” Yoho said. “They lost their mark and they became political and ideological.”
The new strategy, by contrast, explicitly frames global health assistance around U.S. national security, bilateral relationships and economic interests. But because it has not been codified into law, those priorities could be redefined or reversed by a future administration.
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“If it’s not codified in the law, how aid is supposed to be done, it’ll go away if we flip to a Democratic administration,” Yoho said.
Former Rep. Chris Stewart, who served on both the House Intelligence Committee and the Appropriations subcommittee responsible for funding foreign assistance, said that even lawmakers who approved global health spending often had limited visibility into how programs operated once money left Washington.
“Even as an appropriator — someone who supposedly wrote the checks — we didn’t have the oversight that we needed,” Stewart said.
Under the America First Global Health Strategy, Stewart said oversight is intended to begin earlier, with clearer priorities and closer alignment between U.S. objectives and what recipient countries actually want. During his travels, Stewart said foreign leaders repeatedly told him they were less interested in open-ended aid than in building their own capacity.
“We don’t really just want aid,” Stewart said. “We want trade. We want to build our own capacity.”
Stewart said the shift toward government-to-government agreements is intended to make spending more traceable and more directly attributable to the United States, while still requiring firm controls to prevent waste or abuse.
Because it has not been codified into law, current priorities could be redefined or reversed by a future administration.(Kevin Dietsch/Getty Images)
In December, the United States signed a five-year health cooperation agreement with Kenya, covering areas such as HIV/AIDS, malaria and tuberculosis, with U.S. funding tied to continued performance and increased co-investment by the Kenyan government.(iStock)
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“That doesn’t mean every government we work with is perfect,” he said, “but it does make it easier to know where the money is actually going.”
Supporters of the new framework point to longstanding disease-specific programs as evidence that tighter oversight does not require abandoning global health investments altogether. Yoho, Stewart and Green all cited PEPFAR, the U.S. government’s HIV/AIDS initiative, as a model of bipartisan foreign assistance that has saved lives while strengthening U.S. relationships abroad.
Stewart and Green also pointed to malaria prevention efforts, while both emphasized child health and nutrition as areas Congress should continue to prioritize.
Yoho also cited the use of ready-to-use therapeutic food (RUTF) to treat severe childhood malnutrition, describing it as a low-cost intervention with clear humanitarian impact and broad bipartisan support.
Former USAID administrator Green said the strategy is built around accelerating what he calls the “journey to self-reliance,” moving countries from long-term aid recipients to partners — and eventually, in some cases, donors themselves.
“We want every country to go from being an aid recipient, to a partner, to — in a perfect world — a fellow donor and investor,” Green said.
Congress has long appropriated global health funding at a high level, giving USAID broad discretion over how programs were designed and implemented — a structure that left lawmakers with oversight but little involvement in individual funding decisions.(Julia Demaree Nikhinson/AP Photo)
Under the new framework, Green said global health assistance is negotiated nation by nation through bilateral agreements tailored to local conditions and reciprocal obligations.
“This isn’t a handout,” he said. “This instead is a joint venture between the U.S. and the government in another country,” designed to build local capacity and shift responsibility over time.
The strategy also places greater emphasis on leveraging private-sector tools alongside government funding.
Green pointed to partnerships with U.S. companies such as Zipline, which uses drone technology to deliver blood and medical supplies in hard-to-reach areas, as an illustration of how the framework seeks to pair public health goals with American innovation.
Still, Green acknowledged that much of the system remains a work in progress. While the agreements are intended to tie funding to performance and burden-sharing, he said many of the specific benchmarks and enforcement mechanisms are still being finalized.
“A wedding is easy and a marriage is hard,” Green said, describing the challenge of translating broad agreements into measurable, enforceable outcomes.
For supporters of the new strategy, the tighter focus on accountability is also meant to address longstanding skepticism on the right about foreign aid itself. Yoho said he once shared that skepticism.
“I was one of those that wanted to get rid of foreign aid,” he said. “Then I got up there and realized how ignorant I was about good, effective foreign aid.”
He said the argument becomes easier when programs are clearly defined and measurable.
“If representatives have credible information and can go back to their constituents and explain why we should support something — because it makes America safer, stronger, and more prosperous — the majority of people will support it,” Yoho said.
Whether the America First Global Health Strategy ultimately delivers on its promises — or exposes new risks — may depend less on its design than on how much authority Congress chooses to formalize, and how rigorously the administration enforces the accountability standards it has laid out.
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