Winning the Contest for Foreign Aid

Understanding aid for global health workers

Published on May 29, 2014by Lauren Anderson

While I was on a fellowship in Vietnam there was talk in the non-governmental organization (NGO) community about how the Vietnamese economy was prospering and whether NGOs should consider diverting resources and staff to other countries. My friends and I soon wondered if we would be out of a job and where those jobs might be moving.

Global aid has sometimes been described as a reverse beauty contest in which parts of the world with significant political, social, and medical needs become the most desirable places to invest international resources. I valued opportunities to get my feet wet working abroad, but became curious about what factors determine where aid is going, which could be useful to consider when looking for longer term career opportunities abroad.

Mapping the money

A few years ago, Center for American Progress mapped U.S. foreign assistance by country according to factors like civil liberties, corruption, and overall development. Their analysis suggested that neither the existence of corruption nor high development alone would prevent a country from receiving aid. Countries continue to receive U.S. assistance despite economic growth, which suggests that my colleagues and I in Vietnam may not have to be too concerned about job security. But the allocation of funding may be much more nuanced.

Kaiser Family Foundation also produced a series to promote better coordination of funding called Mapping the Donor Landscape on Global Health, which focuses on HIV/AIDs, TB, malaria, and reproductive rights. For example, the HIV/AIDS report estimated that the U.S. provides almost two-thirds of all HIV/AIDS international assistance, and together with the Global Fund, to whom the U.S. is the largest donor, accounts for approximately 80 percent of HIV/AIDS assistance worldwide.

Another resource to determine where global aid is going is publicly available data regarding government-to-government spending. Government funding encapsulates government jobs, but also influences NGOs that seek government funding.  Looking at government spending is also useful because it is harder to obtain aggregated numbers across NGOs. Charity Navigator has mapped some interactive data.

One U.S. agency that distributes foreign aid is the United States Agency for International Development (USAID). USAID offers worldwide economic, development and humanitarian assistance in support of U.S. foreign policy goals. Africa receives the most aid and Europe/Eurasia the least.


USAID funding requested specifically for the Global Health Initiative (GHI), a U.S. global health effort through a comprehensive “whole-of-government” approach, follows a similar spending pattern, but includes fewer countries. For GHI, there is a significant drop in Near East region requested funding as compared to the total funding, because the development work in that region focuses less on health.


Part of USAID’s mission is to enhance American and global security and prosperity. A recent article in the Quarterly Journal of Political Science found U.S. HIV/AIDs international assistance has improved the image of the U.S. in countries receiving aid. So, political incentives may be a factor in determining where the U.S. invests internationally as well.

Other resources for tracking global aid include reports like those produced by the Organization for Economic Co-operation and Development (OECD). OECD projected for 2014-2016 major increases in core aid for “middle-income countries in the Far East and South and Central Asia, primarily China, India, Indonesia, Pakistan, Sri Lanka, Uzbekistan and Vietnam.” OECD found a slight projected increase in aid to Africa, but this may result from funding to countries in Northern Africa, such as Kenya and Nigeria, which are already large recipients of aid.

Making cuts

For impoverished countries falling short of Millennium Development Goals (MDGs), primarily in sub-Saharan Africa, OECD found a reduction of program aid of nearly half a billion dollars. This is not to suggest a causal relationship between failure to meet MDGs and reduction in aid—it can have other causes. For example, attacks on health workers in Somalia have caused Doctors without Borders, an organization known for managing in conflict countries, to pull out.

Long term, OECD also concluded that core aid to countries globally is expected to stagnate from 2014-2016, which may be a reflection of the current economic environment. Stagnation is consistent with U.S. trends in global health aid.

Multiple factors—need, safety, stability, economics, political ties—influence where global aid is distributed. Trying to understand the future of funding is helpful, but in working abroad, the ultimate goal is to work yourself out of a job. In the contest for foreign aid, we hope that we can improve conditions such that our presence and assistance is no longer necessary—the ultimate win.

Edited by Joshua Brooks and Dana March