USAID: Management Improvements Needed to Better Meet Global Health Mission
Fast Facts
The U.S. Agency for International Development's Bureau for Global Health supports health programs across the world.
We found that the Bureau hasn't:
- documented lessons learned from addressing the COVID-19 pandemic
- assessed its performance bureau wide
- addressed negative behaviors, such as bullying, that affect its culture
- aligned staffing with its mission and priorities since most of its workforce are contractors who can't oversee contracts and grants work
Addressing such issues would help the Bureau respond to future global health crises and carry out its mission. Our recommendations focus on these issues and more.
The Bureau for Global Health supported health programs overseas during COVID-19, like one that provided this oral tuberculosis treatment
Highlights
What GAO Found
The U.S. Agency for International Development's (USAID) Bureau for Global Health's (Bureau) staffing is not aligned with its mission and priorities. More than half of the Bureau's workforce consists of contractors who USAID has determined cannot perform inherently governmental functions. These functions include overseeing the Bureau's contracts and grants—its primary mechanisms for implementing its programming. In addition, the distribution of the Bureau's staff is inconsistent with its program funding levels. Specifically, the Bureau has the greatest number of staff working on HIV/AIDS programming, but receives less funding for this programming compared with its other strategic priorities—preventing child and maternal deaths and combating infectious diseases. Despite these challenges, the Bureau lacks a workforce plan, leaving it with limited ability to address its current and future staffing needs.
Bureau performance assessments have gaps at the Bureau and program levels. The Bureau does not have indicators for bureau-wide performance that measure progress for each of its strategic priorities, or across them. Communicating the Bureau's overall performance is also challenging due to variations in its data. While the Bureau assesses program level performance for its health program areas, its reports to Congress in some of these areas do not always include key information. For example, reports on maternal and child health do not contain results for 18 countries that received more than $200 million between fiscal years 2019 and 2021. By assessing its bureau-wide performance, harmonizing its data, and improving its reports, the Bureau can better evaluate and communicate its results and enhance the quality of the information it is providing to Congress.
Examples of Programming Funded by the Bureau for Global Health
The Bureau has recently faced several challenges to its ability to execute its mission and priorities. These have included challenges posed by the COVID-19 pandemic, including disruptions to existing health services. The Bureau took steps to address COVID-related challenges, such as by providing lengthier supplies of medications during lockdowns. However, while some USAID missions have documented lessons learned from the pandemic, the Bureau has not. Doing so could help the Bureau better respond to future global health emergencies. Finally, though the Bureau has identified negative behaviors that affect its culture, it has not yet institutionalized its efforts to address them.
Why GAO Did This Study
The Bureau supports U.S. efforts to save lives, protect the people most vulnerable to disease, and promote the stability of communities and nations throughout the world. From fiscal years 2019 through 2022, the Bureau had an annual budget between $1 billion and $1.4 billion. The COVID-19 pandemic has highlighted the importance of the Bureau's work to U.S. foreign policy. To respond to disease outbreaks and support existing health programming, the Bureau requires a workforce with a variety of skill sets. Its ability to assess its performance is important to its preparation for future health crises.
GAO was asked to review the Bureau's operations. This report examines (1) the Bureau's staffing and its workforce plans; (2) its performance assessments; and (3) key factors that affect the Bureau's ability to execute its mission and priorities, and the steps it has taken to address them. GAO analyzed USAID staffing data and global health reports. GAO also interviewed USAID officials in Washington, D.C., and at five overseas missions, selected based on factors such as geography, amount of funding, and number of health program areas.
Recommendations
GAO is making six recommendations, including that USAID ensure the Bureau develops a workforce plan, improves performance assessments and reporting, documents lessons learned from the COVID-19 pandemic, and institutionalizes efforts to address negative behaviors identified by the Bureau as affecting its culture. USAID concurred with all of GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| U.S. Agency for International Development |
Priority Rec.
The USAID Administrator should ensure that the Assistant Administrator for Global Health develops and implements a workforce plan for the Bureau. Such a plan could communicate the Bureau's optimal mix of direct hire and non-direct hire staff, as well as senior leaders; outline key actions to better align its staffing with its mission, priorities, and funding; and identify how it plans to address persistent vacancies in CS positions and the underrepresentation of certain racial or ethnic groups in its workforce. (Recommendation 1) |
In its response to our report, USAID concurred with this recommendation. USAID's letter responding to our report in January 2024 noted that the agency continues to make progress on the development of a GH Bureau workforce plan and outlined steps it is taking, including reducing the percentages of both direct hire and non-direct hire vacancies. USAID's letter stated that is using new and existing authorities to increase the number of direct hire staff in the GH Bureau and is taking steps to analyze its staffing needs. USAID's letter states that the GH Bureau is also implementing activities to address barriers to the recruitment and hiring of underrepresented racial and ethnic groups in its workforce. As of March 2024, the GH Bureau is planning to finalize and communicate a workforce plan for the Bureau by September 30, 2024. To close this recommendation, the GH Bureau needs to develop a workforce plan for the Bureau that contains elements described in our recommendation.
|
| U.S. Agency for International Development | The USAID Administrator should ensure that the Assistant Administrator for Global Health takes steps to assess the Bureau's performance at a bureau-wide level, such as by developing indicators to assess its performance in each of its strategic priorities or across all of its strategic priorities. (Recommendation 2) |
In its response to our report, USAID concurred with this recommendation. We will monitor USAID's implementation of this recommendation and provide updated information on its progress.
|
| U.S. Agency for International Development | The USAID Administrator should ensure that the Assistant Administrator for Global Health takes steps to harmonize the Bureau's health program area data, such as by collecting common types of data across its different health program areas, to facilitate reporting of the Bureau's overall performance. (Recommendation 3) |
In its response to our report, USAID concurred with this recommendation. We will monitor USAID's implementation of this recommendation and provide updated information on its progress.
|
| U.S. Agency for International Development | The USAID Administrator should ensure that the Assistant Administrator for Global Health takes steps to improve the comprehensiveness of the Bureau's health program area reporting, such as by including results from all countries receiving maternal and child health funds and including all required elements in its health-related research and development reports. (Recommendation 4) |
In its response to our report, USAID concurred with this recommendation. We will monitor USAID's implementation of this recommendation and provide updated information on its progress.
|
| U.S. Agency for International Development | The USAID Administrator should ensure that the Assistant Administrator for Global Health documents lessons learned from the Bureau's response to the COVID-19 pandemic. (Recommendation 5) |
In its response to our report, USAID concurred with this recommendation. We will monitor USAID's implementation of this recommendation and provide updated information on its progress.
|
| U.S. Agency for International Development |
Priority Rec.
The USAID Administrator should ensure that the Assistant Administrator for Global Health institutionalizes efforts to address negative leadership behaviors identified in the Bureau's January 2022 report on strengthening processes and teamwork, such as by taking steps to (1) establish systems to promote accountability for such behaviors, (2) measure the impact of any changes made to address such behaviors, and (3) ensure senior management support for any such efforts. (Recommendation 6) |
In its response to our report, USAID concurred with this recommendation. USAID's letter responding to our report in January 2024 noted that it is taking actions to establish and promote norms for positive leadership behaviors. USAID's letter also states that in October 2023, the GH Bureau began mandatory trainings on respectful, inclusive, and safe environments for all members of the GH workforce. In addition, the GH Bureau is implementing workshops for managers, supervisors, and staff to identify and share best practices for inclusive and equitable leadership. As of March 2024, the GH Bureau is planning to complete all actions to implement this recommendation by December 31, 2024. To close this recommendation, the GH Bureau needs to show that it has established a system to promote accountability for negative leadership behaviors, has measured the impact of its efforts, and has ensured that senior management support these efforts.
|