Schools. Vaccination programs. Medication and medical equipment. Media organizations. Literacy programs.
All face the chopping block after the Trump administration moved to gut the United States Agency for International Development, the government's foreign aid organization. Over the weekend, a federal judge put a temporary hold on Trump's plans to lay off 2,200 employees. President Trump has accused the agency of widespread waste and members of his administration have criticized the funding of programs that do not align with U.S. foreign policy goals. After his inauguration, he put virtually all of the agency's programs on a 90-day pause to be evaluated. Within days, USAID was shut down as an independent agency.
The agency, set up by then-President John F. Kennedy in 1961 at the height of the Cold War, currently provides humanitarian and development assistance in over 100 countries.
Its supporters say it helps save lives, strengthen civil society, assist the needy and promote and preserve democracy, while presenting a gentler version of the U.S. — as a global superpower willing to aid and help some of the world's most vulnerable. A $42 billion soft-power glove, in their eyes, to go along with the Pentagon's nearly $900 billion hard-power fist.
USAID has faced accusations of inefficiency and waste over the years, including that it fails to measure the effectiveness of its programs. Much of USAID's money is handed out as grants or is subcontracted to aid groups and NGOs. Critics contend that USAID's use of American contractors, and its large bureaucracy means that not enough of the money actually ends up helping those in need. It's also been criticized for what some countries have alleged is a backdoor for the U.S. to interfere in their domestic affairs.
Many within USAID have acknowledged the need for reforms and were willing to work with the administration. But a senior USAID official, who spoke to NPR last week on condition of anonymity because they are not authorized to speak on behalf of the agency, decried the Trump administration's methods as a "hatchet job."
Here's a look at some of the work USAID has done around the world — and the effect the cancellation of its work is having on local communities.
Ukraine: A fear of loss, from health care to media
KYIV, Ukraine — Since Russia's full-scale invasion on Feb. 24, 2022, Ukraine has been the largest recipient of USAID funds. It's received $37 billion over the last three years — aid that has touched practically every aspect of Ukrainian life.
The money paid the salaries of emergency service workers; supplied farmers with fertilizer, seeds and storage capacity; and has been used to rebuild Ukraine's power grid after repeated Russian missile strikes.
Oleksandr Merezhko, a member of parliament from President Volodymyr Zelenskyy's party, says the money has provided a lifeline to Ukraine.
"There are lots of programs that are very useful, including support of our war veterans, programs related to health care, support of parliament," said Merezhko.
The chaos at USAID is already having an impact on the ground. Olena Horyacheva, who runs a medical charity Vykhid in the southern city of Mykolaiv, says programs providing treatment for tuberculosis and HIV have already shut. Screening programs for these diseases are also subsidized by USAID funds.
"We paid to deliver antiretroviral therapy [drugs] to HIV patients who could not get to a hospital or see an infectious diseases specialist," said Horyacheva. "We worked with medical institutions so nurses could send out those parcels every month."
The cuts have also hit regional Ukrainian media hard. One media advocacy group estimates that "9 out of 10 outlets rely on subsidies and USAID is the primary donor."
The news website Cykr in the northeastern city of Sumy is one of them, and its editor said 60% of its budget came from USAID.
"So now we have a big challenge," said Dmytro Tyschenko, Cykr's editor. "We're trying to communicate with our European partners to cover [the shortfall]."
Tyschenko adds that the news site only has the money to keep the lights on for another month. The alternative, he warns, is unfiltered social media where Russian propaganda flourishes.
Merezhko, the lawmaker, says he hopes the Trump administration will revive USAID after reviewing or overhauling it.
"It's important not only for Ukraine, it's important for the United States," said Merezhko. "Let's not forget about the information war on the part of Russia and China." —Joanna Kakissis
South Africa: Concern about HIV drugs
JOHANNESBURG — South Africa has the highest number of people living with HIV in the world — over 8 million by some estimates — but with USAID support for the President's Emergency Plan for AIDS Relief, or PEPFAR, the country has made significant inroads with prevention and treatment in recent years.
The effects of USAID cuts are already being felt on the ground — and among the most vulnerable.
At the Engage Men's Health clinic in Johannesburg there's a notice on the door: "Regrettably our clinic is temporarily closed."
Alex, 30, who only used his first name because of the stigma associated with HIV, told NPR he's been coming to this clinic for years to collect his pre-exposure prophylaxis, or PrEP. the medication that prevents HIV infections, and is often prescribed to high-risk individuals. (The drug is also taken by people who are HIV positive, reducing their risk of developing AIDS as well as the chance they can transmit the virus.)
"We had a safe space. This place also caters for LGBT. So, a lot of people, they can be in the closet and they don't want their family to find out, they'd come to this clinic," said Alex.
While the South African government provides the antiretroviral drugs, about 17% of its other HIV funding comes from PEPFAR, amounting to about $440 million a year. The government estimates 15,000 health-care workers could lose their jobs.
"Although the South African government pays for most of the country's antiretroviral medication, so it doesn't receive any help from the U.S. government to pay for the medication, it does receive significant help from non-profit organizations who are funded by the U.S. government to staff public sector clinics with health workers," said Mia Malan, editor of the health journalism site Bekisisa.
"It doesn't help to have all those pills if you can't get them to the people who need them. And for that you need health-care workers," she added.
Professor Salim Abdool Karim, an award-winning epidemiologist, said in South Africa, the biggest blow would be to prevention services.
"Where we will see an impact, where PEPFAR has a disproportionate role to play, is in areas of prevention," says Karim.
While South Africa is one of the richest countries on the continent and is looking at contingency plan to fill the gap, poorer nations like Mozambique and Malawi depend almost entirely on PEPFAR — and losing it could be catastrophic for them, according to Abdool Karim.
"The entire AIDS pandemic will be under threat in that we could now see a resurgence of AIDS infections because patients are stopping their medications," says Karim. —Kate Bartlett
Latin America: A welcome for Trump's stand, with reservations
MEXICO CITY — Some Latin American countries — long-suspicious of U.S. motives in the region — have, on the other hand, welcomed Trump's moves on USAID.
Mexico's President Claudia Sheinbaum said that if the U.S. actually wants to help countries, it should be transparent.
"But USAID has so many parts that the truth is it's better that they close it down," said Sheinbaum in one of her daily briefings.
El Salvador's president Nayib Bukele rejoiced at the news. He wrote on X that the majority of USAID funds are "funneled into opposition groups, NGOs with political agendas."
Both the Salvadorean and Mexican governments have complained bitterly that U.S.-funded journalism and human rights outfits that have uncovered corruption and human rights abuses are meddling in their internal affairs.
In Colombia, President Gustavo Petro said the U.S. shouldn't be funding public employees in his country. Hundreds of immigration officers, he said, were paid with U.S. funds.
"Trump is right," Petro said. "Take your money."
None of this is surprising to those who watch the region closely.
"Not one bit, no," says Jake Johnston, director of International Research at the Center for Economic and Policy Research. "These sort of democracy- promotion things, which are political interventionism in sovereign countries, it is a part of what USAID does."
In both Mexico and El Salvador, for example, USAID-funded investigative journalism outfits have uncovered vast corruption or human rights abuses by the incumbent governments. Both countries have also bitterly complained that USAID funds the opposition.
Another reason for the region's skepticism, said Johnson, is that USAID rarely awards money directly to governments.
"USAID money goes almost entirely to contractors, NGOs or multilateral agencies like the U.N.," says Johnston, the author of Aid State, a book critical of USAID's role in Haiti.
USAID funds private clinics or schools or more, to the point, they fund private corporations in the United States that run clinics or schools in Haiti. That means USAID programs — often with serious overheads — run in parallel to public institutions.
Even food aid, which saves lives, has been controversial. In Haiti, for example, as USAID pumped free rice into the country, local producers of rice could not compete with free so they went out of business. Today, Haiti imports nearly all of its rice and buys it from U.S. companies.
Johnston says USAID has created toxic dependencies and does need an overhaul — but what Trump is simply trying to destroy it.
Johnston says stopping or changing some USAID programs may be necessary, but it would be harmful to do it from one day to another, because many people around the world have come to depend on those programs for survival.
"You're just gonna cause a bunch of people to lose their jobs and a bunch of people to lose life- saving support," says Johnston. — Eyder Peralta
South and central Asia: A loss for secret schools, female journalists
MUMBAI, India — USAID has done a lot of heavy lifting across South Asia.
In Afghanistan — where there's an ongoing humanitarian crisis — the aid agency's education projects have been suspended, including what are known as "secret schools."
These schools are meant to educate hundreds of Afghan girls after the Taliban banned them from all learning beyond sixth grade.
USAID-funded work to support Afghan women includes a project to train female journalists, in partnership with the news outlet Zan Times.
"We need to fully understand what is happening to [Afghan women],them," says the editor Zahra Nader, under a Taliban regime that she describes as creating "gender apartheid in Afghanistan."
The outlet's mission is to tell the stories of Afghan women — which needs Afghan women journalists, says Nader. The outlet says its mission is to try and tell the stories of Afghan women.
"How are we going to cover this? How can we tell their stories when we don't have access to them?" she asked. Nader says the notification of the suspension of funds "came on the day that we were supposed to start our first online class."
"We couldn't dare tell this group of women journalists who are joining us online from Afghanistan," said Nader, in an interview from the U.S.
In Bangladesh, a developing country of 170 million people, where a student-led uprising recently toppled the country's longtime leader, USAID funded everything from vaccines to food security. USAID has long funded local versions of Sesame Street across the globe, from the Palestinian territories to Afghanistan, as a way of teaching tolerance, literacy and empathy to children, particularly those who have experienced war and displacement.Republicans and conservative media outlets have pointed to a recent $20 million grant to create an Iraqi version of Sesame Street as proof of waste at USAID.
USAID funds also helped pay for programs to screen for and treat tuberculosis. A doctor, who worked on the project to teach medics how to screen for the disease, told NPR that USAID money helped train around 3,000 pediatricians. Tuberculosis is highly contagious and it's often children who aren't diagnosed. The doctor spoke on condition of anonymity, fearing his group will be denied future funding from Washington.
He also said that USAID purchased and delivered arranged for 28 ultra-portable X-ray machines for far-flung hospitals to screen for the disease, and that 10 more X-ray machines were on the way.
The suspension of aid, he said "is going to have severe consequences. Many more people are going to die." — Diaa Hadid
Ahmade Hussain contributed reporting from Dhaka, Bangladesh, and Polina Lytvynova from Kyiv.
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