The United States Agency for International Development (USAID) officially closed on July 1, 2025. The agency’s functions and foreign aid programmes have been absorbed by the US State Department. USAID implemented a number of landmark connected health programmes in many parts of the world, and developed practical, evidence based approaches to digital health. Its closure will have a major impact on the development of telemedicine and digital health worldwide.

The closure of USAID is a result of the US Government’s shift to prioritising national interests and reducing foreign aid spending. The agency was criticised for inefficiency and mismanagement, with the administration stating that large portions of USAID funding were not aligned with US national interests.

The agency’s closure has significant implications for global development and humanitarian efforts, including for the development and implementation of connected and smart health. The agency provided essential funding and expertise for a number of connected health and telemedicine programmes in the Developing World. It also developed methodologies and expertise in designing and implementing smart and connected health programmes in a global context. The methodologies provided pragmatic approaches and planning for implementing connected health from a potentially low infrastructure starting point, with smart health programmes designed to maximise patient outcomes in challenging healthcare environments.

A study published by UK medical journal The Lancet predicts that the cuts could lead to an additional 14 million deaths by 2030, with a third of those being children. According to The Lancet, this is due to the agency’s role in healthcare, vaccine programmes, and HIV prevention, particularly in supporting local communities and national civil services.

USAID Digital Health Strategy

Between 2020 and 2024 USAID developed a distinct strategy for digital health, which were encompassed in two separate strategy and positioning papers. The first was the “2020-2024 Vision for Action in Digital Health”, while the “2024-2029 Digital Health Position Paper” appeared in 2024.

Between the two papers, USAID’s position evolved from broad priorities to concrete operational guidelines, reflected in the second position paper. With the second, there is an emphasis on accountability and measurable outcomes tied to specific practices.

While the two papers cover the broader area of digital health, much of USAID’s focus was on smart and connected health. This is because many of the projects it involved itself in had specific healthcare goals, were often in remote or underserved areas, and required assembling remote broadband connectivity and edge healthcare technology. There was also an adherence to retaining patient data and processing locally.

Among the core principles USAID defined, are:

• ensure digital health systems achieve their intended impact and resilience within the local context
• interoperability is not a technical preference but a strategic imperative
• design digital systems that prioritise person-centred care
• establish and implement standards for all digital health investments
• facilitate data sovereignty and enable secure data sharing
• strengthen data privacy and cybersecurity

Development Innovation Ventures

USAID implemented an open innovation programme, Development Innovation Ventures (DIV), through which it identified, tested and implemented digital health and other development projects. It operated on a tiered funding model that emphasised evidence-driven development, cost-effectiveness, and potential for widespread scalability for its projects.

Over a 12 year history, DIV resulted in 327 awards, with $260 million disbursed.

USAID also developed a global digital logistics supply chain: the Global Health Supply Chain Programme (GHSC-PSM). This comprised eight complementary programmes that utilised digital logistics technology to build stronger, more resilient health supply chains for some of the planet’s poorest countries. It included digital supply chain tracking and management, activity-based costing, data visualisation and interactive dashboards, digital dispatch optimiser tools, a product e-catalogue, a global traceability tracker, a global standards adherence tool, and a national supply chain assessment toolkit.

Albania Telemedicine Programme

USAID has implemented a number of telemedicine and e-health projects. These were typically tailored to specific country contexts and health challenges.

The agency established Albania’s first National Telemedicine Centre at the Mother Theresa Hospital in the country’s capital, Tirana. At they same time, they implemented an initial five other Regional Telemedicine Centres across various cities, including Berat, Durrës, Elbasan, Fier, Korçë. The initial six grew eventually to fourteen with U.S. Army Corps of Engineers support.

The network aims to deliver quality health services through tele-health technologies for diagnosis, treatment, and prevention of diseases and injuries, as well as for research, evaluation, and continuing education for healthcare providers in Albania.

The project is supported by the Albanian Ministry of Health and the University of Tirana Medical School. The US Army Corps of Engineers has been responsible for constructing or rehabilitating the physical spaces for the regional telemedicine centres. The programme also involves collaboration with the Arizona Telemedicine Programme and the University of Arizona’s Department of Surgery for curriculum development.

Paediatric Telemedicine Haiti and Ghana

The agency worked with the University of Florida to develop a paediatric night-time telemedicine and medication delivery service, MotoMeds, aimed at rural neighbourhoods. The programme has been active since 2019, serving a population of nearly 18,000 children across 50 rural neighbourhoods in Haiti. With recent support from USAID’s Development Innovation Ventures (DIV), a pilot project is expanding MotoMeds to Accra, Ghana, in partnership with the Ghanaian National Ambulance Service. This expansion aims to reduce mortality among children under five and inform future replications of the MotoMeds model in Ghana and other countries.

Telemedicine Pilot North Macedonia

USAID partnered with UNICEF and the Ministry of Health in North Macedonia to launch a telemedicine pilot initiative in October 2022. The initiative aims to increase access to healthcare services, particularly for vulnerable families and those in rural areas, by providing viable alternatives to traditional face-to-face consultations when physical presence is not possible or necessary. The North Macedonia project aims to bridge the barrier between primary care providers and patients in rural areas using remote monitoring devices for physical examinations.

This signifies a move beyond simple tele-consultations to more advanced tele-diagnostics. It represents an application of connected health to improve health equity and system efficiency.

The programme involved the provision of fifty remote health monitoring devices. These devices enable doctors to conduct physical examinations remotely, including listening to a patient’s heart and lungs with high-quality digital sounds, examining ears, throat, and skin with high-quality digital images and video, and measuring heart rate and body temperature.

The pilot allows for the remote diagnosis of acute conditions (such as ear infections, sore throats, fever, cold and flu, allergies, stomach issues, upper respiratory infections, and rashes), monitoring of chronic conditions for vulnerable populations, and post-procedure follow-up, including for COVID-19 patients.

Covid-19 Digitial Health Caucasus

In November 2021, USAID and UNICEF partnered for a one-year programme to support the government of the Caucasus Republic of Georgia’s response to the COVID-19 pandemic. A key component was strengthening existing e-Health infrastructure and technologies to support rural primary healthcare in managing suspected COVID-19 cases.

There was also utilisation of digital platforms for targeted pro-vaccination messages and efforts to counter a major coronavirus disinformation campaign launched by Georgia’s neighbour Russia. It underlined a broader role for digital health role in public health emergencies in community engagement and combating misinformation through smartphone apps, social media communications and messaging targeting the requirements of digital channels.