February 19 (WASHINGTON) – Today, as the U.S. government undertakes a historic pivot toward direct government-to-government (G2G) global health assistance, the Modernizing Foreign Assistance Network (MFAN) released a new report offering the essential implementation guide to ensure that shift delivers real results.
The report titled Delivering on the Promise of Government-to-Government Assistance: A Roadmap for the U.S. Government International Assistance Pivot, provides the most comprehensive, experience-based guidance to date for implementing G2G assistance at scale. Drawing on lessons from the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID), the Millennium Challenge Corporation (MCC), the Centers for Disease Control (CDC), and others, the roadmap offers practical guidance to manage risk, strengthen partner government systems, and achieve measurable impact. It calls on the U.S. Department of State to develop a clear strategic program framework for G2G and for Congress to hold in‑depth hearings and briefings.
“The shift to government-to-government assistance is one of the most consequential changes in U.S. foreign assistance in a generation. Done well, G2G can be highly impactful, but done poorly it risks development reversals and waste, fraud, and abuse. This report lays out the hard work and the tools needed to ensure U.S. taxpayer investments are impactful and enduring,” said Tod Preston, Executive Director, MFAN.
The release comes amid a sweeping reorientation of U.S. foreign assistance policy in the State Department’s America First Global Health Strategy, which shifts funding from U.S.-based non-governmental organizations to partner governments. Recent multi-billion-dollar health compacts signal a scale of G2G funding far beyond previous efforts.
Although anchored in global health, the report’s roadmap is cross-sectoral – offering guidance relevant to food security, education, and other development areas as G2G assistance expands. It also highlights immediate actions for Congress, partner governments, civil society, and the private sector to support effective implementation and oversight.
“My experience leading a civil society health organization in Mozambique shows thatG2G partnerships are only effective when civil society is empowered to demand transparency and accountability,” said Denise Namburete, Founder and Executive Director of N’weti, a global health non-profit organization in Mozambique, and a member of MFAN. “Public monitoring of agreements, budgets, and service delivery is essential to prevent corruption and ensure public funds improve people’s health.”
The report outlines nine actionable recommendations to help the U.S. government deliver results and strengthen partner systems – covering areas such as civil society engagement, joint agreement design, milestone-based financing, use of country systems, anti-corruption safeguards, and aligned donor oversight. Case studies from Malawi, Uganda, Liberia, and Ghana show that well-designed G2G programs can improve health outcomes, strengthen government systems, and reinforce accountability, when implemented thoughtfully.
MFAN’s report cautions that while there are benefits of G2G assistance, the risks are real. Careful planning, robust safeguards, and deliberate learning from experience will be essential to protect development gains and ensure this new model delivers on its promise.
The full report and executive summary are available at: LINK.
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About MFAN
The Modernizing Foreign Assistance Network (MFAN) is a bipartisan coalition of international development practitioners, policy advocates, and experts committed to making U.S. foreign assistance more effective, accountable, and results-driven.
For media inquiries, please contact Madeleine Granda, MFAN Policy and Government Affairs Manager, at Madeleine.Granda@modernizeaid.net
