Oversight: Built Not to Self-Perpetuate

Source note: this piece draws on and paraphrases the U.S. Department of State's “America First Global Health Strategy” (September 2025).

Most organizations in this field will tell a government they are working to become unnecessary. Few funders have ever said, in writing, that the industry's actual incentives point the other way.

The U.S. Department of State's 2025 global health strategy does. It states plainly that many implementing organizations “have perverse incentives to self-perpetuate rather than work towards turning functions over to local governments,” and that despite three consecutive presidential administrations setting strategies aimed at local ownership, progress on that goal has been minimal — not, the strategy is careful to note, for lack of willingness on the part of recipient governments, but because of how the funding system itself is built.

That is an uncomfortable thing for a funder to say about the sector it funds. It is also, if taken seriously, a useful test — not just for the organizations the strategy is criticizing, but for any organization that wants to claim it is different.

What the test actually is

The honest version of the test isn't whether an organization says the right things about local ownership. Almost every organization in this space says the right things. The test is structural: does the organization's own funding model reward it for finishing, or for continuing?

An organization funded on an open-ended basis, renewed each year against continued need, has no real incentive to reduce that need — whatever its mission statement says. An organization whose funding model assumes government co-financing rising toward full local ownership on a defined schedule, with a stated transition date built into the design rather than added as an afterthought, has the opposite incentive: the model only works, financially and reputationally, if the handoff actually happens.

That distinction is not about which organization means it more sincerely. Sincerity is not verifiable from the outside, and it isn't really the point. What is verifiable is the structure: is there a defined point at which the organization's role ends and the government's full ownership begins, and is that point written into the funding model itself rather than left as an aspiration to revisit later?

The strategy's critique is a fair one to sit with, including for organizations that believe they are the exception. The honest response is not to insist on good intentions. It's to be able to point to the transition date, the co-financing schedule, and the specific point at which the government stops needing the organization at all — and to have that be true whether or not anyone asks.

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