Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis

For the past 20 years, the USA has been the leading government donor to humanitarian response plans, development aid, and multilateral development banks, mainly through the US Agency for International Development (USAID). USAID was established in 1961 as an independent agency in the executive branch under the direct authority and guidance of the Secretary of State.1 The agency’s aim was twofold: the first was to provide humanitarian assistance, and the second to also assist and support economic growth and self-resilience of developing countries, especially those deemed strategic for the US economic and geopolitical impact.2 In each mission and country where USAID has been operational, the agency engaged with diverse partners, such as central governments, private entities, local organisations, and international and national non-governmental organisations operating mostly bilaterally. Over the years, and despite a relatively modest effort in relation to its national wealth, the USA’s importance as a donor for development and humanitarian aid has overshadowed any other donor. Although the USA has indeed been the largest donor in absolute terms—providing more than US$55 billion in official development assistance (ODA) in 2023 and accounting for approximately 30% of total Development Assistance Committee (DAC) countries’ ODA—it ranked only 25th out of 30 DAC members in terms of ODA relative to national income, allocating just 0·24% of its gross national income. By contrast, countries such as Norway (1·09%) and Luxembourg (1·00%) exceeded the 0·7% target of the UN, reflecting a substantially higher proportional commitment to international development.