In November 2009, with a Congress contemplating a foreign aid overhaul, the news that a physician had just been named to take the long-vacant helm at the United States Agency for International Development came as a heartening sign to global health advocates. It was a sign, advocates hoped, that aggressive action against diseases that prey on the poor would shape the agenda to come.
Dr. Rajiv Shah, who announced his resignation today, promised attention to oversight and transparency in an agency that had come to be seen as a funding pipeline for U.S.-based contractors, functioning frequently with little oversight. His “transformational goals” included delivering technologies “from bench to bush,” to prevent HIV and cure tuberculosis.
The former Department of Agriculture official brought, as the Secretary of State John Kerry recognized in a statement today, focus on food security, and attention to some of the neglected childhood diseases.
But in the spending-constrained spring of 2013, with progress in strides against HIV and tuberculosis threatened, he surprised legislators on both sides of the aisle with sanguine acceptance of the adminstration’s proposal to cut funding for both the U.S. President’s Emergency Plan for AIDS Relief and his own agency’s global TB budget. This past spring he did it again, neglecting mention of tuberculosis altogether in his statement to Congress, and assuring legislators that responses to TB would not be damaged by a proposed $45 million cut to USAID’s TB program. Congress, as well as this infectious diseases physician researcher, disagreed.
Shah’s ability to realize the goal of heightened oversight and transparency over the agency’s contracts with U.S.-based nongovernment organizations remains unclear. A report released this week shows more than a third of USAID global health spending going to U.S.-based organizations. It notes that in recent years the government has taken steps to make data on that spending and what it buys more accessible. It also notes that questions remain about the impact of U.S.-based organizations in global health efforts.