Over the past seven years, VoxDev has featured a range of research highlighting where coordinated well-designed aid efforts have delivered striking results.
As governments slash their foreign aid budgets, the world faces a silent crisis. Funding shortfalls are already stalling global health, jeopardising humanitarian relief, programmes, and putting hard-won development gains at risk. Yet much of the recent debate around foreign aid focuses on inefficiencies and politics—overlooking a growing body of research showing when and how aid can work.
Drawing on seven years of VoxDev features, this article explores the consequences of aid withdrawal, from disruptions to HIV treatment delivery to the collapse of nutrition programmes. It also highlights cases where coordinated, well-designed aid efforts have delivered striking results—saving lives, protecting food security, and boosting economic productivity. The evidence is clear: how we spend what’s left of the aid budget matters more than ever.
Coordinated health aid efforts are more effective than fragmented ones
The GAVI vaccine programme has coordinated health aid for vaccinations for over 25 years. GAVI was first established in 1999 by the Gates Foundation, UNICEF, WHO, and World Bank. Since 2005, however, more than half of GAVI’s health aid comes from sovereign donors, making it a coordinated global effort (Gavi 2024).
Since 1999, GAVI-supported vaccines have increased coverage rates by 2-5 percentage points across all vaccines; while GAVI’s support for newer vaccines has improved coverage by 10-20 percentage points (Shastry and Tortorice 2025). This support has reduced child mortality from related causes by 1 in 1,000 live births, saving approximately 1.5 million lives in total. The success of the GAVI programme hints at the ineffectiveness of aid fragmentation (i.e. the simultaneous operation of multiple agencies in one setting)—a practice which not only raises coordination concerns, but presents opportunities for corruption as well (Child et al. 2024).
Since 2003, the US—in coordination with multilateral partners such as UNAIDS—has played a crucial role in addressing the global HIV/AIDS epidemic through the President's Emergency Plan for AIDS Relief (PEPFAR) (US Department of State n.d.). By investing in the infrastructure required to deliver anti-retroviral therapies at scale, PEPFAR helped slash the cost of treatment from $1,100 to $58 per person per year by 2023, saving 25 million lives in the process (US Department of State 2023, George W. Bush Presidential Center 2023). Shutting down PEPFAR puts communities worldwide at risk of losing these hard earned gains, potentially undoing decades of coordinated global health efforts (Friedman et al. 2025, McIntosh and Zeitlin 2025).
The loss of critical HIV funding highlights the urgent need for low-cost alternative to traditional prevention interventions. One such approach involves improving public knowledge on actual HIV transmission risks. Research in Malawi shows that providing accurate information—revealing that transmission rates are often lower than public perception—can reduce risky sexual behaviour, especially among those who initially overestimate their risk (Kerwin 2025).
However, Ciancio et al. (2025) suggests that in settings where treatment is unavailable, knowing one’s HIV status can actually reduce survival odds. This disconnect between screening and access to treatment highlights a worrying dilemma, illustrating the severe consequences of expanding access to health information without follow-up care. In a post-PEPFAR world, these interventions must be designed carefully in line with the availability of treatment, else they risk inadvertently worsening health outcomes.
Humanitarian aid cuts will worsen global food and nutrition insecurity
Following cuts to foreign aid, humanitarian relief systems are at risk of collapsing—putting vulnerable populations at risk of losing access to basic needs. In 2024, around 28% of USAID’s budget was allocated to humanitarian relief efforts, surpassing spending on any other sector (McCabe 2025). For years, experts have warned that humanitarian aid budgets were struggling to keep pace with global crises (Husain 2024). In 2025, UN funding coverage for humanitarian relief is less than 7% of the required amount (UNOCHA 2025), underscoring the need to allocate these limited funds effectively in recipient countries (Rozo and Grossman 2025, Annan et al. 2025).
Digital cash transfers are one way of ensuring humanitarian relief is spent effectively. Evidence on humanitarian aid from Afghanistan reveals that digital cash transfers of $45 every two weeks had significant impacts on food security and nutrition (Callen et al. 2024). As a result, children in recipient households became almost 12 percentage points less likely to skip meals in a given week. The study also found no evidence of potential leakage, curtailing concerns of aid contributing to corruption. This can be attributed to mobile payments having no cash out option, as well as successful targeting of recipients via locally elected community development councils.
Similarly, a digital aid programme targeting refugees in Kenya also found that small monthly transfers increased food consumption by almost 9% in recipient households (Delius and Sterck 2024). The effectiveness of digital interventions, however, is contingent on the necessary infrastructure being intact—an ongoing concern in fragile states such as Sudan (Amin 2025).
Western aid has funded judicial reform that enhanced firm productivity in developing countries
The World Bank and USAID have historically played a major role in funding judicial reforms in recipient countries, aimed at improving the quality, speed, and/or accessibility of a judiciary. A judicial reform programme in Kenya, for instance, provided support to train court officials, introduce performance management contracts, and build courts.
A study of over 4,500 of these projects finds that judicial reforms, funded by foreign aid agencies, improve firm productivity in sectors relying on relationship-specific investments, i.e. those dependent on well-functioning judiciaries (Chemin 2019). This finding, however, only holds for comprehensive reforms simultaneously targeting quality, speed, and access. Judicial reform thus encourages the production of complex goods, supporting innovation via protections on intellectual property rights. Related research suggests that aid improves firm performance through alleviating infrastructure and financing constraints in developing countries (Chauvet and Ehrhart 2018).
What does this mean for the future of foreign aid?
Our evidence base highlights the wide-ranging benefits of foreign aid programmes. As aid becomes increasingly scarce, donors and development practitioners alike have a difficult road ahead—as each dollar spent towards aid becomes scarcer, and in the face of global challenges ranging from corruption to hunger, we are forced to focus on what matters most.
The interconnectivity of economies worldwide means that these losses are likely to be felt by donors as well. From Indian generic drugs to Mexican produce (which make up around half of each sector in the US), in the short-term, supply chains will remain globalised.
References
Amin, M (2025), “Rebuilding Sudan’s digital infrastructure amidst conflict,” VoxDev.
Annan, J, L Behaghel, T Ghani, and J Heirman (2025), “VoxDev Event: Using evidence to make humanitarian aid more effective,” VoxDev.
Callen, M, M Findley, M Fajardo-Steinhauser, and T Ghani (n.d.), “Can digital humanitarian aid reach vulnerable populations in fragile states?” VoxDev.
Chauvet, L, and H Ehrhart (2018), “Aid and growth: Evidence from firm-level data,” Journal of Development Economics, 135: 461–477.
Chemin, M (2019), “Judicial efficiency and firm productivity: Evidence from a world database of judicial reforms,” VoxDev.
Child, T B, A L Wright, and Y Xiao (2024), “Aid fragmentation and corruption,” Review of Economics and Statistics: 1–43.
Delius, A, and O Sterck (2024), “Businesses profiteer from humanitarian cash transfers through price hikes,” VoxDev.
Friedman, E, L Gostin, and S Wetter (2025), “PEPFAR funding to fight HIV/AIDS has saved 26 million lives since 2003: How cutting it will hurt Africa,” The Conversation.
Gavi, The Vaccine Alliance (2024), "Annual contributions and proceeds," 30 June 2024.
George W. Bush Presidential Center (2023), “How PEPFAR, the ‘genius plan,’ came together to save 25 million lives.”
Husain, A (2024), “Humanitarian aid and the costs of inaction,” VoxDev.
Kerwin, J (2025), “People think it’s easy to contract HIV. That might not be a good thing,” VoxDev.
McCabe, E (2025), “U.S. Agency for International Development: An overview,” Congressional Research Service.
McIntosh, C, and A Zeitlin (2025), “Cash transfers can outperform more complex economic aid programmes,” VoxDev.
Rozo, S V, and G Grossman (2025), “Refugees and other forcibly displaced populations,” VoxDevLit, 14(1).
Shastry, K, and D Tortorice (2025), “Effective health aid: Evidence from Gavi’s vaccine programme,” VoxDev.
UNOCHA (2025), “Historical coverage of coordinated plans.”
US Department of State (n.d.), “PEPFAR partnerships.”
US Department of State (2023), “Report to Congress on PEPFAR treatment report 22 USC 7611(g): Development of a comprehensive, five-year, global strategy.”