**GAO-23-105178**                      Published: Jun 09, 2023. Publicly Released: Jul 10, 2023.                  

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## 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

Skip to Highlights

## 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

See All 6 Recommendations

## Full Report

Highlights Page (1 page)

Full Report (72 pages)

Accessible PDF (82 pages)

## GAO Contacts

Chelsa L. Kenney
kenneyc@gao.gov

(202) 512-2964

## Office of Public Affairs

Chuck Young
youngc1@gao.gov

(202) 512-4800

## Topics

Health Care

AIDSAIDS reliefDiseasesForeign serviceGlobal healthHealth careHealth programsHuman capital managementInfectious diseasesLabor forceLessons learnedMalariapandemicsReproductive health careTuberculosis

## Multimedia

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