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When former USAID Administrator Andrew Natsios looks at the recent dismantling of the agency he once led, he sees both a national security crisis and a bitter irony.  While Natsios believes U.S. foreign aid was due for a major overhaul, he blames a combination of pressures from outside the agency for undermining America’s commitment to long-term development. It was not the agency’s own failings that left it vulnerable, but a series of “clashes” between development and other power structures inside the U.S. government. Speaking on Devex’s Theory of Change podcast, he argued that the growth of the federal “counterbureaucracy” — oversight entities such as the Office of Management and Budget and rigid Federal Acquisition Regulations — paralyzed the agency long before it was formally disassembled. By forcing development officers to produce short-term quantifiable outputs and spend money rapidly, Washington made genuine, multiyear institution building nearly impossible. “What they’re asking us to do is two things which are diametrically opposed,” Natsios argued.  By demanding instant statistical proof of success while berating the agency for not offloading programs to partner governments, the counterbureaucracy trapped the U.S. Agency for International Development in an impossible double bind, Natsios said. The Republican former politician led the agency from 2001 to 2006, during the George W. Bush administration. His forthcoming book, “Guns Are Not Enough: Foreign Aid in the National Interest,” provides an intellectual framework for understanding how the U.S. development bureaucracy worked — and why it often didn’t. Natsios rejected the idea that Elon Musk’s dismantling of USAID through the Department of Government Efficiency was about government effectiveness or balancing the budget. Instead, he sees it as another example of backlashes that tend to follow socioeconomic crises in American history. “All of those previous events in American history were accompanied by massive isolationist, anti-immigrant, ultranationalist, protectionist, high tariff trends in American politics,” he said. He also shared his own theory for why U.S. foreign aid efforts struggle to garner public support from Americans — and his own experience accompanying the conservative media commentator Rush Limbaugh on an eye-opening trip to Afghanistan. Looking ahead, Natsios insisted that piecemeal fixes under the U.S. State Department will fail. Instead, he called for the creation of a cabinet-level, independent department that unifies the U.S. International Development Finance Corporation, the Millennium Challenge Corporation, and global health programs into a single operational agency.  Natsios sees Cold War-era breakthroughs such as the Green Revolution and South Korea's economic transformation as proof that America’s development work succeeded precisely when its mission directors had operational autonomy and field-level authority.

If a Washington, D.C., think tank publishes a voluminous policy paper, but barely anyone reads it, does it have an impact? Not really, according to Todd Moss, long-time development think tank leader and founder of the Energy for Growth Hub. Moss, who joined Devex’s Theory of Change podcast, sees a glaring mismatch between many organizations that claim to be in the business of informing policy decisions and the government officials who actually make those decisions. “The top 10 think tanks in the U.S. produced 1,500 reports last year,” Moss said, referencing recent estimates. “Some of them have real nuggets of wisdom, but lots of them are just incredibly boring and pointless, and no one will read them.” For Moss, the insistence on producing heavy reports and staging ceremonial public panels represents a deeper structural failure: losing sight of actual policy outcomes. Busy government officials, buried under back-to-back 15-minute meetings, rarely have the bandwidth to digest 14-page executive summaries, let alone full-length volumes.  What they need instead, he said, is clear decision memos, outside experts who understand institutional politics, and — in many cases — years of strategic patience. Moss points to a recent breakthrough his own organization contributed to by deploying that playbook: the World Bank’s decision to lift its long-standing ban on financing nuclear energy projects. Changing the mind of a notoriously risk-averse, multishareholder institution took seven years of painstaking mapping, cross-party coalition building, and direct engagement with inside allies, he said. “I was literally told, you will never be able to change this. We will never do this,” Moss said. “When I think about lessons from this, I think about tactics, alliances, and patience.”

What happens when an organization built on maximum cost-effectiveness discovers that one of its flagship programs isn't delivering the results it promised? For Evidence Action, the answer was clear — if uncomfortable: follow the data, own the mistakes, and scale back. In a recent episode of Devex’s Theory of Change podcast, Evidence Action’s new CEO, Danielle Bayer, unpacked the nonprofit organization’s recent decision to wind down its Dispensers for Safe Water program across parts of East Africa, the backlash that followed, and what high-integrity implementation looks like in an evolving development landscape. “Most organizations choose to make decisions and keep them internal,” Bayer said. “In this particular instance, we not only said that the program didn't work as we thought it should, but also that we made mistakes here.” The decision to publicly air these operational mistakes sparked intense debate within the effective altruism and global development communities. While many praised the nonprofit's radical transparency, some critics questioned whether pointing to evidence was being used as a shield for poor implementation. Bayer was candid about the trade-offs: “Admitting mistakes is hard, and it may mean you lose trust with some funders and the public. The truth is all organizations make mistakes. If we're not being transparent, it’s not that mistakes aren't happening — it's just that people aren't sharing them.” She also spoke about what the future of cost-effectiveness looks like in the face of sharply declining global health aid, how Evidence Action codesigns programs with partner governments, and why she urges caution in the face of an upswell of interest in artificial intelligence.

The recent history of U.S. foreign aid has been dominated by budget cuts, institutional dismantling, and massive workforce reductions. Against this backdrop, the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, feels less like a template for modern foreign policy and more like a relic of an unrecognizable past. In an era defined by political fragmentation and widespread skepticism of government-led aid projects, the idea that Washington could launch a massive, $15 billion global initiative to tackle an active health crisis overseas seems almost quaint. Yet on the latest episode of Devex’s Theory of Change podcast, author and veteran global health reporter John Donnelly argues that this distance is precisely why we need to look back at PEPFAR today. In his new book “Lifeline: The Story of PEPFAR, the Greatest Humanitarian Initiative of Our Time,” Donnelly traces how a high-risk political gamble under President George W. Bush morphed into what many consider the single greatest humanitarian achievement of modern times — saving an estimated 26 million lives over two decades. In this episode, Donnelly breaks down the mechanics of that success — and what PEPFAR’s two-decade arc teaches us about government capability, bipartisan political coalitions, and the risks of prolonged emergency intervention.

The California-based drone delivery company Zipline made waves last year when it secured a $150 million pay-for-performance grant from the U.S. State Department to scale up its operations in Africa. That announcement came just months after the State Department took control of the U.S. government’s foreign aid portfolio in the wake of USAID’s dismantling, and the deal with Zipline was portrayed as an emblem of the new direction of U.S. global health aid. One year later, Zipline is working through the sometimes arduous process of negotiating with partner country governments over the terms of their expansion. But the company’s ambitions extend well beyond the five African countries included in the State Department grant.  At the same time, a new partnership with Uber has the company poised for massive expansion inside the United States, from healthcare to consumer goods — driving estimates of Zipline’s potential valuation to $20 billion. Zipline is expanding into urban environments, launching its precision delivery platform in cities such as Kigali, Rwanda, while scaling healthcare partnerships in the U.S. with major institutions like the Cleveland Clinic and the Veterans Affairs hospital system. The same autonomous tech that delivers critical blood products in West Africa is now poised to power instant delivery for retail and food. Zipline’s Africa CEO and head of international expansion, Caitlin Burton, joined Devex’s Theory of Change podcast for a live recording at the Devex Impact House in New York. Burton shared the company’s growth story — from its origins in Rwanda to Uber Eats — and its planetary ambitions. “We have to grow way faster over the next five years than we did in the last five years,” Burton said. “We are just now getting to national scale in really, really, really important places. We need to do that in many, many more places.” Behind Zipline’s expansion plans, there is also a critique of legacy global health institutions and funding structures, which the company found resistant to what they could offer. “People were staking out territory instead of operating a system, and that was weird to us,” Burton said. “There are three things you really need in a health system: you need well-trained health workers that are compensated ... you need the drugs themselves, and then you need a way to get them to the patient,” Burton said. “Everyone seemed to have forgotten about the supply system.”

In a live episode of the Theory of Change podcast, Buddy Shah, CEO of the Clinton Health Access Initiative and chair of the Anthropic Long Term Benefit Trust, shared an inside look at the intersection of global health, market-shaping agreements, and artificial intelligence. "The mistake that many of us are making ... is looking for an AI point solution. What's a cool use case where you can develop an AI tool and slot it into an existing system? And I think the much more important question is: If you could redesign the system for a world where you have very powerful AI tools, what would that look like?" Shah said during the podcast, which was recorded last week at the Devex Impact House in New York on the sidelines of the United Nations General Assembly.  Shah pulled back the curtain on CHAI’s landmark deal to secure generic manufacturing of lenacapavir — a twice-yearly injectable drug offering 99% effectiveness against HIV infection.  By negotiating the price down from $28,000 per year in the U.S. to $40 per patient per year in lower-income countries, Shah explained how CHAI, Gilead, generic manufacturers, and global health partners believe they are creating a path that could spell the end of HIV over the next decade. Addressing his dual role managing corporate governance at Anthropic, Shah previewed how artificial intelligence could fundamentally reshape health delivery in low- and middle-income countries through mobile diagnostics and AI clinical assistants.  He emphasized that LMICs may leapfrog high-income nations in adopting these technologies, while highlighting how incoming philanthropic capital from the AI sector could help fund major systemic solutions.

In a live episode of the Theory of Change podcast recorded at the Devex Impact House in New York on the sidelines of the United Nations General Assembly, David Beasley, the former World Food Programme executive director and former governor of South Carolina, laid out his playbook for navigating today’s increasingly hostile political climate — while leaving the door at least somewhat open for his own return to the political arena. Beasley — who led the U.N.’s food security agency when it won the Nobel Peace Prize — shared his journey from working in South Carolina tobacco fields to negotiating with the Taliban to feed starving children to battling with billionaire Elon Musk on Twitter. He described the culture shock of a United Nations outsider confronted with bureaucracy and jargon, and offered his diagnosis for why the development sector keeps getting its pitch wrong. Beasley offered a bleak assessment of current humanitarian aid cuts, calling the domestic political environment “horrific” and warning that Western nations are actively undermining their own geopolitical stability. “America is great because America is good, and if we ever cease to be good, we cease to be great. And right now, we're not being good,” he said.

In an interview on Devex's Theory of Change podcast, Alight CEO Jocelyn Wyatt warned that the traditional humanitarian business model is facing structural failure. Following the collapse of the U.S. Agency for International Development and the transition of U.S. foreign aid programs to the U.S. State Department, organizations are having to rely on more rigid grants from United Nations agencies that typically cap overhead at 7%, leaving virtually no resources for operational leadership, compliance, or innovation, Wyatt said. Global humanitarian assistance fell by roughly 30% between 2022 and 2025, with 13 of the 20 largest donors cutting relief aid in 2025, according to the latest State of the Humanitarian System report, released last week. Wyatt highlighted how structural defects and funding restrictions in the traditional framework actively undermine long-term progress: The misallocation problem: Private donor funding floods highly publicized, geopolitical conflicts (such as Ukraine), while long-term, acute humanitarian disasters (such as Sudan) receive virtually no private support due to public narrative fatigue, donor bias, and political media coverage.Survival over solutions: With institutional funds shrinking, remaining aid is strictly funneled into immediate lifesaving care, stripping away funding for education, job training, and economic development that actually helps people transition out of displacement.Failing durable pathways: The three traditional solutions for refugees — returning home, integrating locally, or third-country resettlement — have largely stalled or collapsed under political and financial strain. “This world order and these systems that were developed post-World War II have seemed like they're hitting their expiration date, and they will need to be reinvented. But that is not happening in 2026 or 2027, probably 2028. So in the interim, we need to find ways to help people be able to provide for themselves and their families,” Wyatt said. To survive the breakdown of the traditional model, Wyatt argues that humanitarian organizations must pivot toward financial self-reliance and market-driven solutions. “Let's actually put our resources to social enterprise models where we can recycle capital, where we can help people start businesses. Let's actually train people and connect them with employers so that they can get jobs and make money for themselves,” she said. “To think that governments are going to be the continuous providers of financial support to refugees ... I think is just a fallacy at this point,” she added.

In the latest episode of the Theory of Change podcast, human rights activist Kavita Nandini Ramdas discussed the deep systemic contradictions of modern philanthropy, its uneasy relationship with grassroots activism, and why nonprofit organizations must stop playing quiet to keep elite funding. Ramdas, currently a senior strategic adviser at the International Planned Parenthood Federation, has spent years fighting both inside and outside major philanthropy — including as a close adviser to some of the world’s most prominent foundation leaders. What she sees today is a philanthropic sector that is “running afraid from Trump” and recipient organizations that rarely challenge their funders. “It’s really as though we’ve gone back to the medieval ages and Lady Bountiful is riding on her white horse and throwing crumbs to the masses below and we're scurrying around saying, ‘Thank you so much, thank you so much,’” she said. “It’s as though we’ve gone back to feudal times.” The argument: Nonprofits must replace groveling with accountability. “Take the money, but have the damn courage to stand up and say, ‘This action was racist. This intervention is not acceptable,’” Ramdas said. Taking elite funding creates a direct “obligation to voice” — not a mandate for silence. On the Gates Foundation: Ramdas directly called out Bill Gates over his foundation’s agricultural strategy in Africa during a meeting. She pointed out that the Green Revolution had already been an environmental disaster in India — destroying topsoil and drying up aquifers in Punjab — and asked why they were selling the exact same flawed model to Africa. As a result, they brought her in as an adviser. On Adele Simmons, former head of the MacArthur Foundation: “Here she was, this extraordinary person with three young kids — and what she had to deal with, this casual sexism that I saw thrown at her.” On Darren Walker, former head of the Ford Foundation: He told Ramdas that “culture eats strategy for breakfast” — a truth she applies now to philanthropy, noting that no matter how progressive a foundation’s strategy claims to be, it is constantly swallowed by the surrounding patriarchal and capitalist culture.

In the latest episode of the Theory of Change podcast, Nazanin Ash, CEO of Welcome.US, discussed how community-driven sponsorship could revolutionize refugee resettlement, bypass political gridlock, and offer a scalable alternative to overburdened government systems. Global forced displacement is at an all-time high, and standard, bureaucratic response models are failing to keep pace. Ash argued that mobilizing local communities rather than relying solely on government aid can unlock massive potential and provide orderly, human-centered pathways for newcomers. The problem: Traditional global systems are built for short-term, state-versus-state displacement, but modern conflicts — predominantly civil wars — are protracted, lasting decades on average. As a result, massive, unmanaged crises crowd out long-term development funds. “Civil wars burn forever. They’re really tough to resolve. And our international tools for conflict resolution are really bad at solving them,” Ash said. By the numbers: By shifting the focus from a government-managed process to direct community sponsorship, Ash said that Welcome.US demonstrated unprecedented scale during recent crises such as the war in Ukraine: 800,000 newcomers welcomed by American communities in under three yearsFour times as many individuals resettled through private sponsorship than through formal U.S. government pathways over the same timeframe$7 billion in time and money leveraged directly by local sponsors to pay for travel, housing, and integration2 million Americans across 26,000 zip codes participated in sponsoring displaced individuals“The appetite for doing this is so strong. The capacity to do it is so real,” Ash said. Unlike formal government systems that assign refugees to fixed locations based on strict physical requirements, Ash said that private matching platforms allow newcomers to exercise choice and retain dignity. “If you know something about humanitarian crises and forced displacement … what you experience most acutely is the loss of choice and the loss of agency. And of course, nothing about our traditional systems lets you have that choice or agency,” she said. Meanwhile, community members who sponsored families have become active advocates, filing lawsuits, lobbying Congress, and defeating hundreds of anti-immigrant state bills. “Proximity changes what you protect,” Ash said. What to watch: Welcome.US currently operates in the United States, and Ash said the organization has plenty of work on its plate. “But we did purchase the rights to Welcome.world,” she added.

What is “country ownership,” really? And what gets in the way of making it a reality? Against a backdrop of historic cuts to development assistance by many of the world’s largest donors, the chorus of voices calling for national governments to set — and finance — their own development agendas is growing louder. Yemi Osinbajo, the former vice president of Nigeria and co-chair of the Future of Development Cooperation Coalition, has seen firsthand what happens when international donors and national development priorities are aligned — or not. Osinbajo joined the Devex Theory of Change podcast to challenge the myths and misconceptions around state capacity, corruption, and international finance. "Forget about giving cash or aid. Let's focus on systemic changes that can release the resources that African countries need for their development,” Osinbajo says. That means targeting markets and value chains that currently disadvantage lower-income countries, through systemic partnerships rather than one-off handouts, he says. It also means being honest about who is complicit in propping up systems that are plagued by corruption, or biased against regions perceived as risky, whether they truly are or not.

Twenty-five years ago, when Jacqueline Novogratz founded the impact investing nonprofit Acumen, she still had to prove that markets and entrepreneurship could work for people living in poverty — and help lift them out of it. In the years since, that has moved from a relatively fringe approach to fighting poverty, to the center of global development efforts. Development finance institutions, philanthropies, and asset managers are all looking for investable opportunities — and speaking the language of impact. But something else has happened to — or hasn’t happened — Novogratz said on Devex’s Theory of Change podcast. The institutions and individuals who could provide critical “patient capital” in the early, riskier phases when it is most effective, are not jumping in as needed. For Novogratz, it points to a needed reckoning for a social impact sector that has grown up, but still hasn’t realized its potential. “The capital that is available, and there's a lot of capital, is too expensive, it’s too risk averse, and as a result, we see a lot of talk and a lot of hand-wringing when we could be structuring that capital under the rubric of impact investing and really creating impact,” she says.

For over two decades, the U.S. government has been a lynchpin in the global fight against HIV, pouring billions of dollars into treatment, prevention, and health systems strengthening through initiatives like the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR. Then came Elon Musk, the foreign aid freeze, and a disruptive set of reforms to U.S. global health programs under President Donald Trump’s “America First” Global Health Strategy. Against the backdrop of this tumultuous moment, the question remains: Was the old framework built to sustain solutions, or merely to sustain itself? Mark Dybul, who led PEPFAR from 2006 to 2009, joined the Theory of Change podcast to deliver a blunt assessment of the legacy and current trajectory of foreign assistance. Reflecting on the evolution of former President George W. Bush’s signature global health initiative, Dybul addressed the sharp criticisms now driving a broader push for reform. While acknowledging the lifesaving impact of past initiatives, Dybul pointed to a fundamental failure in long-term strategy: The shift toward true local ownership never fully materialized. In Dybul’s view, Musk’s Department of Government Efficiency surfaced uneasy truths about how the U.S. government has worked with countries to end the AIDS epidemic — and the opportunities that were missed along the way. "The diagnosis was correct. That indictment was correct. I mean, to be honest, it turned my stomach that 25 years later we were spending the same amount of money as when I walked out the door. That wasn't the plan." He also pushed back on projections that PEPFAR funding cuts could cause thousands of deaths, arguing that these underestimate governments’ ability to protect health programs — as well as opportunities for greater efficiency. As global health systems undergo a rapid overhaul, Dybul argues that the next 12 to 18 months represent a critical window. They must either adapt to a model centered on country sovereignty, local innovation, and mutual economic partnership, or risk watching the entire architecture collapse.

Philanthropists and global development donors have made a lot of promises about supporting local leaders and community-based organizations. But their insistence on finding scalable models might be getting in the way of a simpler achievement: helping people. Kakenya Ntaiya is a one-woman case study in persistence.  As a girl in southwestern Kenya, she underwent the traditional Masaai practice of female genital mutilation — a precursor to marriage and motherhood. But she negotiated with her father to stay in school, secured a scholarship to attend college in the United States, and used her education to scrutinize the very cultural practices that she — and the other women in her village — were born into. As the founder of Kakenya’s Dream, a nonprofit organization, Ntaiya has returned to Kenya to open up spaces for discussion of cultural taboos — and educational opportunities for thousands of girls.  Ntaiya joined the Theory of Change podcast to share her experiences navigating complex community politics, pushing for cultural change, and confronting the blind spots in modern international philanthropy that get in the way of improving people’s lives.

U.S. foreign aid advocacy groups are soul-searching in the wake of the Trump administration’s dismantling of the U.S. Agency for International Development and deep cuts to U.S. foreign assistance. Bipartisan support for U.S. aid programs crumbled quickly in the face of Elon Musk’s attack on the agency via the Department of Government Efficiency, and USAID’s legacy is now viewed through a starkly polarized political lens. In the aftermath of that collapse, advocacy organizations are trying to regain their footing — including by hiring conservative political veterans into key roles. Jim Richardson, a longtime congressional staffer and former aide to Mike Pompeo, coordinated one of the largest reorganization efforts in USAID’s history during Trump’s first term. He recently joined the U.S. Global Leadership Coalition — one of the most influential “soft power” advocacy groups in Washington, D.C. — as national outreach director. He joined the Theory of Change podcast to discuss the future of U.S. development advocacy — and what it will take to rebuild support for aid programs. "We have to really go back to the basics,” he said.  “Where does the U.S. government have a comparative advantage? What does the power of international assistance do? What can it do?”