Explaining the Data Behind the NYT Article on Global Health Funding

A recent New York Times article on the restructuring of U.S. foreign aid cited our analysis showing that global health funding became significantly more concentrated among a small number of large, U.S.-based organizations.

"In 2025, a handful of the largest, U.S.-based organizations were given huge new infusions of cash, while smaller groups in developing countries were all but shut out."

That result is not just a data point. It reflects a broader breakdown in how U.S. global health funding has been managed over the past year—marked by abrupt policy shifts, disrupted programs, and decisions that have had immediate consequences for organizations and patients on the ground.

In this post, I will explain exactly where these numbers come from, how we calculated them, and why they matter. This is not just a methodological note. It is an attempt to document, as clearly as possible, what actually happened to U.S. global health funding in FY2025—and why those patterns offer an early signal of what we are now seeing in FY2026. Far from a simple "transition year," FY2025 reveals a pattern of chaotic decision-making in how funding is directed and managed. These patterns that are likely to persist in FY2026, even if the specific recipients and channels change.

The headline finding

The core result is simple:

• The top 25 recipients of U.S. global health funding received 67% of total funding in FY 2024.

• That number rose to 91% in the last semester of FY 2025.

• At the same time, the number of funded organizations in the Global South declined substantially

  
  

In other words, funding became more concentrated among fewer, larger organizations.

Before getting into interpretation, let's talk about how we arrived at those numbers.

Where the data comes from

All of the data in this analysis comes from USAspending.gov, the U.S. government's official database of federal awards.

USAspending records every federal award, including:

• The recipient organization.

• The amount of funding obligated.

• The awarding agency.

• The time period of the award.

  
  

This particular analysis relies on extracted data for the fiscal years 2024 and 2025. The fiscal year 2025 starts on October 1, 2024 and runs through September 30, 2025.

What we actually measured

One of the most important choices in this analysis is what we mean by "funding."

We use obligations, not outlays.

• Obligations represent funds that the government has legally committed

• Outlays represent funds that have actually been spent

At first glance, outlays might seem like the better measure, and often follow obligations over time. In practice, however, outlay data in USAspending is often incomplete or delayed, especially for recent fiscal years.

And one of the most interesting thing about obligations is that appropriated funds have dates by which they must be obligated or expire.

Unit of analysis: who receives the money

We aggregate funding at the level of the prime recipient organization.

This means:

• We count the organization that directly receives funding from the U.S. government

• We do not observe how that funding is distributed to subcontractors or subrecipients

This distinction is important. Many large organizations pass funding on to subcontractors, but those flows are not consistently visible in the data.

How the analysis works

At a high level, the analysis involves three critical steps:

1. Filter the USAspending recipient-level dataset to the global health funding universe we track.

2. Group obligations by prime recipient organization.

3. Sum recipient-level obligations by fiscal year.

From there, we can do all sorts of analysis of the recipients. For example, we can:

• Count the total number of unique recipient organizations.

• Identify the top 25 recipients in each year and calculate their share of total funding.

• Identify the recipients from the Global South and calculate their share of total funding.

  
  

The limits of the data—and the reality underneath

Like any analysis based on administrative financial data, this approach has limitations. The numbers tell part of the story. The rest—how these decisions played out operationally—comes from reporting, like the excellent reporting done by the NYT.

1. When funding surges become operational shocks

Even though most organizations declined to speak to the NYT on the record, it was clear between the lines that these large, sudden obligations were deeply disruptive.

Few of the organizations among the surviving funding recipients would answer questions from The New York Times on the record about the surge in the money they were awarded last year, saying that the U.S. government prohibited them from talking about their contracts with the media. Executives at five of the organizations that saw their funding increase noted that the scope of their work grew sharply alongside the new funds, as programs were hastily remade.

It is not easy to rapidly expand into multiple new countries, take on entirely new technical areas, or scale operations overnight—even if the funding is there. Organizations are built around existing teams, partnerships, and systems. Abruptly increasing funding at this scale forces programs to be hastily reconfigured, often under significant operational strain.

Historically, obligations have been a reasonable proxy for commitment: once funds are legally obligated, they are expected to be executed over time. FY2025 challenged that assumption.

The administration demonstrated that it could pause or unwind previously obligated funding. Recent reporting on the disruption of major procurement pipelines—including large contracts operated by organizations like Chemonics—illustrates how quickly commitments can be curtailed or reshaped midstream.

The implication is important: our obligations analysis captures who the U.S. government is prioritizing for funding at a given moment, not whether those commitments will be honored in a stable or predictable way.

2. Subawards are largely invisible—and "reverse localization" is real

USAspending tracks flows to prime recipients, but not how those funds are distributed downstream. The NYT article notes:

In many cases, the organizations that last year received an increase in funds, along with instructions to swiftly expand their work into a half-dozen or more new countries, subcontracted that work back to the groups who had been the original implementing partners. This created an entire new layer of bureaucracy and administrative costs that did not exist before the so-called efficiency reforms began.

So large international organizations that received expanded awards in 2025 attempted to subcontract work back to the same local organizations that had previously been prime recipients. On paper, this can look like continuity. In reality, it represents a step backward.

This "reverse localization" has real consequences:

• Additional administrative layers introduce new overhead and delays.

• Chaotic, unplanned handover leads to many local organizations losing funding and closing shop.

• The surviving local organizations lose direct funding relationships and negotiating power.

  
  

Even when large organizations attempt to partner with local groups—often because those groups are the ones that actually deliver services—the damage from abrupt funding cuts, layoffs, and organizational closures is not easily reversed.

3. FY2025 was a shock. FY2026 is a moving target.

In the NYT article, the State Department characterized 2025 as a "transition year,"

The department’s statement said that the funding flow picture “is rapidly changing” because of the bilateral health agreements the administration has signed — 27 so far. “As these bilateral compacts get stood up, we are moving health spending onto a stable path towards self reliance, with more funding moving to local governments and partners,” the statement said. “Through these compacts, all funding will be provided in coordination with local health authorities for the first time, reflecting a historic shift in local input and buy in into global health programs.”

Indeed, we have seen recently multiple overlapping shifts in how U.S. global health programs are implemented:

• New bilateral agreements (MOUs/compacts) with partner governments.

• The near-flatlining of the global health pipeline for new awards, alongside the announcement of a new mechanism, the Advancing Global Health APS.

• The administrative constriction of CDC's role and the disruption of the long-standing PEPFAR implementation system.

  
  

But from the outside, these shifts appear to be reactive—attempts to rebuild or reroute systems after the initial dismantling of USAID in early FY2025—rather than the result of a clearly articulated strategy.

There is limited transparency about what the future model is supposed to be, how funding will ultimately flow, or how responsibilities will be divided between governments, international organizations, and local actors.

What comes next

This analysis focuses on what happened during a period of major disruption in 2025. But the story is far from over.

We are particularly concerned about:

• The use of bilateral MOUs/agreements to tie health programs to unrelated U.S. economic interests.

• The weakening of technical agencies like the CDC and long-standing implementation systems like PEPFAR.

• The growing role for political appointees in shaping decisions that were historically driven by technical expertise.

  
  

Taken together, these shifts raise serious concerns about whether there is a coherent global health strategy guiding U.S. policy—or whether decisions are being made in a more ad hoc, reactive way in response to the consequences of earlier disruptions.

In this environment, data becomes even more important.

We will continue to track U.S. global health funding closely—both to understand how these changes unfold and to provide an independent record of what is happening in practice.