Where do we go from here? 5 ideas for reimagining global development

The impact of the U.S. government’s abrupt cancellation of more than 5,000 foreign assistance programs has been devastating for the people around the world who have lost access to food, health services and critical education programs overnight. In addition, many global and local organizations are facing existential crises, and aid workers across the globe have lost their jobs and livelihoods. At the same time, several other countries are also cutting official development assistance, compounding the situation. As a result, low- and middle-income country (LMIC) governments are grappling with how they will continue to deliver crucial services and maintain momentum on development initiatives.

No doubt, these are difficult times for our global development community. But as we are now forced to accept a new reality, we can begin to consider what opportunities might emerge. As resources flowing to LMICs are sharply reduced, incentives facing the leaders of those countries, other donors, and international development partners have drastically changed.

One obvious opportunity is to lean further into locally led development, something many of us have been working toward for quite some time. Our community has often championed a vision in which local leaders set priorities and local institutions deliver services — and where local organizations and experts are central to all of this. But meaningful progress toward this vision has been slower than many of us would like.

Now is an important moment to actively engage with country leaders to assess their most urgent needs. But we must also interrogate why localization has been so challenging, and what our community can do differently going forward.

Rather than abandon local leaders and institutions, here are five ways the global development community can change to enable their success:

1. Support more effective domestic financing.

With the sudden end of almost all U.S. foreign aid, some countries are having to make drastic and troubling changes, such as reducing the size of their health workforce. But we are also seeing some country governments step up to fill gaps in funding and think creatively about how they can move forward with less foreign assistance. For example, in mid-February Nigerian lawmakers approved an additional $200 million for the health sector as part of a 2025 spending plan to offset the shortfall from USAID cuts. And leaders of other countries are now facing the reality that they will need to mobilize more domestic funding for critical programs and services. But with limited resources, they face tough decisions about how to allocate funds for maximum impact and how to manage those funds for effective and appropriate use. Country leaders will need to generate resources through fair and effective taxation systems, and create evidence-driven and politically-aware processes to prioritize returns on investment. They will need to adopt mechanisms to purchase services from public and private providers in ways that achieve social goals and expand economic opportunity.

2. Reduce fragmentation of systems.

While foreign aid has driven significant progress worldwide, it has contributed to fragmentation and siloed approaches within countries. For example, health programs are often structured around specific health conditions (e.g. HIV, neglected tropical diseases). And though these programs are effective in their focus areas, they can miss opportunities for a more holistic and integrated approach that provides benefits across entire populations. For example, primary health care (PHC) is widely recognized as the backbone of health care delivery and public health. By strengthening PHC systems overall — as a platform to address specific diseases — leaders can ensure that people receive timely, comprehensive and continuous care for a wide range of health-related concerns and conditions while emphasizing prevention and health promotion. Not only is this more efficient, it ultimately fosters a healthier, more resilient society.

This vision of strong integrated health systems aligns with the vision of localization. Country leaders have been calling for this, while the global development field, with its well-intentioned focus on priority health conditions, has perpetuated fragmentation. Those who have operated in silos advocating for their chosen health condition now have an opportunity to promote funding mechanisms and delivery platforms that take a more holistic approach to people’s health needs. For example, Ghana has developed primary care networks to provide patient-centered care, which are now being rolled out across the country. These networks enable previously fragmented clinics, pharmacies and community health workers to work better together to deliver the full range of primary care services to people. Now the government plans to introduce a comprehensive health promotion and prevention package covering multiple services funded with domestic resources and delivered by the primary care networks.

3. Align development partner support around country plans.

In the wake of USAID’s demise, LMICs are still receiving outside aid from other bilateral donors like the UK and European governments, from multilateral institutions like the World Bank, from global partnerships like Gavi and the Global Fund, and from foundations like Gates. It’s more important than ever that these more limited resources work in synergy and with laser focus to achieve greater outcomes with less.

Now is the time for every institution to interrogate their own agendas and ensure that funding flows and technical support align around country plans. It’s also important that development partners thoughtfully program resources to complement one another, working in concert rather than competing or fragmenting. Donor alignment is most important at the country level. Strong leaders, like Dr. Muhammad Ali Pate, Nigeria’s Minister of State for Health and Social Welfare, offer an example for how countries can develop their own clear plans and then align funders to support their implementation, with each partner funding components of the plan in a complementary way.

4. Invest in technologies that create more efficient and effective systems.

It is fortuitous that digital technologies and AI are taking major leaps forward at the same time as a massive shift in global development. While digital technology will not be a panacea, an obvious approach to fewer resources will be to reimagine systems — such as how countries deliver health services and education — to take advantage of new technologies. Relatedly, how data is collected, stored and used for decision-making at the point of service delivery, in policymaking and in resource allocation offers huge opportunities to improve efficiency and effectiveness.

But developing a fragmented array of new applications will not be enough. Countries will need to consider how to strategically employ new technologies and integrate and scale them into existing systems, making interoperability and open APIs the norm instead of the exception. Data governance will also be crucially important. For example, Tanzania has made a major leap forward by digitizing teacher professional development through a new learning management platform owned by the government and led by the University of Dar es Salaam. Now 98% of teachers are regularly undertaking professional development with accessible, usable, quality content that improves their teaching. In addition, many countries are beginning to envision how AI will support more efficient and effective diagnosis and disease surveillance in health systems with limited numbers of highly trained health workers.

5. Build new, more nimble approaches to support the success of local institutions.

USAID was the largest supporter of technical assistance to LMICs. That technical assistance was highly valuable, but it relied heavily on models that have sometimes created dependencies and parallel systems. Now is the time to adopt more agile and nimble approaches to supporting LMIC system strengthening efforts. Future approaches to technical assistance should rely more on local institutions for expertise, and coaching for government leaders who are the doers, while acknowledging that there is a need to both aggregate knowledge about what works and then widely disseminate and support uptake of evidence-based solutions. A crucial component of this rethinking is strengthening the learning and evidence ecosystem change agents rely on, including think tanks, universities, civil society and private sector organizations. This is a pivotal moment to prioritize support for the local partner ecosystems and for country governments.

One way to do so is by enabling cross-country learning and helping to translate global evidence into practice. Collaborative, peer-to-peer learning networks, where local leaders are in the driver’s seat, provide the opportunity for leaders to share common challenges and solutions, jointly problem solve, review evidence together, and learn from one another about how to effectively implement. Collaborative learning has proven to effectively change practice at a much lower cost than traditional projectized technical assistance programs. This requires coordination by organizations with ties across countries and strong technical facilitation skills who can foster the development of networks and effective synthesis and use of knowledge.

Another approach is Technical Assistance Hubs — often aligned with major thematic funding from a development partner and cross-country in nature — where local partner organizations are the go-to source of support for country and sub-national governments, and international partners provide backbone support to identify local partners, match demands for support with appropriate local experts, offer light-touch technical support, and ensure lessons across countries are synthesized and shared. These hubs can help strengthen learning ecosystems, nurturing the development of local capacity for evidence generation, uptake, and learning to inform policy making and implementation.

Helpdesk Models are another agile way to offer country governments timely support on complex issues, while leveraging the deep technical expertise of rosters of on-call specialists who help decision-makers quickly collect, digest and apply evidence. Agile by design, demand for Helpdesk-style assistance across countries is growing.

***

At Results for Development (R4D), our mission has always been to work with change agents around the world — government, civil society, and private sector leaders — to create self-sustaining systems for health, education and nutrition. And we pride ourselves on pioneering more effective models of global development. In this moment, we are actively engaging with country leaders to assess their most important needs now. The ideas above have emerged from those conversations, and they build on our current engagements with our partner countries and non-U.S. government funders.

As we navigate our new reality, we are trying to see the possibilities, embrace change, and foster new ideas and ways of working. We welcome collaboration and look forward to joining hands with existing and yet-to-be-identified partners to reinvent our field in ways that will support countries to manage through current challenges and build a better future.