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Covering global health as billions of dollars of aid are cut from programs

ROB SCHMITZ, HOST:

Gabrielle shares her beat covering global health and development with another NPR correspondent, Fatma Tanis. This past year, they have both been digging into the global impact of billions of dollars of U.S. aid being cut from programs around the world. A lot of the headlines in the U.S. focused on Washington - the chaos, the ideology, the politics. So Fatma went to Uganda last September to find out what it looked like on the ground. What she found was something unexpected - not anger, but something harder to explain.

FATMA TANIS, BYLINE: I really got the sense of how the U.S. is just viewed as this, like, major superpower. I remember one community elder who kept referring to Donald Trump as Father Trump when he was talking about, you know, the aid cuts.

SCHMITZ: Fatma was struck by the description.

TANIS: And I asked him, why do you - why are you calling him father? And he said, well, he's the provider.

SCHMITZ: Father Trump. That phrase - equal parts reverence and bewilderment - captures something about how U.S. foreign aid has functioned for decades - not just as money, but as identity, as presence, as power. And with the U.S. pulling back, Fatma wanted to know who was moving in. So for this week's Reporter's Notebook, I sat down with Fatma to talk about who's moving in to take America's place.

TANIS: In Uganda, you still see the remnants of U.S. aid everywhere you go - posters and murals with, you know, the American flag, guidelines about how to deal with, like, the COVID-19 pandemic. You kind of see that everywhere on the ground. And on the other hand, in the big cities, like, the shopping malls are Chinese-built. The roads that you're taking to go everywhere are Chinese-built. The GPS in the cars that people are driving are Chinese GPS, and people are definitely sort of aware of what's coming from where.

And, you know, the Chinese sort of strategy of aid has long been focused on infrastructure, these big, big infrastructure projects. But they have also run into some issues with that - you know, issues of quality. You know, when we were driving on those roads, like, a lot of - there were a lot of places where they had been pretty messed up, and nobody was fixing it. So it - you know, at one point, that road was beautiful and paved, but now when you're driving on it, it's, like, potholes everywhere.

But, you know, China is changing its approach. And that's something that I've been looking into because of these - a lot of the criticism around the way that it does its aid has been hampering its reputation. And so they've been taking an approach that's slightly more similar to what the U.S. had been doing, which is to fund these small projects here and there to win hearts and minds. They actually call them small and beautiful projects, which, you know, go from - like, they're various different - you know, building a bridge in an island or refurbishing a maternal ward in Zimbabwe, helping, you know, medical supplies get into a Latin American country. And so at a moment when the U.S. is moving away from its model of aid and moving more toward a bilateral version, you see China moving the other way, and that's something that's really interesting to watch.

SCHMITZ: That's interesting 'cause I used to cover China, and back when I was covering China, China would focus its aid on, like you said, infrastructure like roads, public transportation and especially ports. And a lot of it was built partly to help that country but also to take resources from that country and then quickly export them to China. So it was, in many ways, self-serving. You know, what you're saying right now is that they're actually shifting to other types of aid basically to help that country develop in its health care and also for education, things like that. But that is an interesting change for a superpower like China.

TANIS: Absolutely. And I think there's something interesting there because the way that governments like the U.S. and China do aid, I mean, there's always an element of it being self-serving. But I think the way that China did it was so obvious that, you know, people viewed - in many places, like Kenya and others, they viewed Chinese aid as suspicious. Like, OK, you're building us a port, but what are you going to get from us? That kind of transactionality was...

SCHMITZ: Right.

TANIS: ...So, so obvious in a way that it wasn't with U.S. aid. And I think now China is moving toward a more subtle form of aid. But I think it's still very much eyeing the positive returns that it's going to get because when China gives something to - you know, when China builds a bridge in an island, there's still positive gains for China. People will view it positively, and that's still a gain.

SCHMITZ: I mean, do the folks that you're speaking to, for example, in Uganda and in other African countries - are they starting to see China in an aspirational way like they saw the U.S. as an aspirational country?

TANIS: I don't think that the China's new model has sort of - I think it's still new...

SCHMITZ: Right.

TANIS: ...In that sense. I think it hasn't had that, like - the decades of influence that U.S. aid has. But I think certainly, you know, China's biggest advantage, perhaps, is the fact that the U.S. is pulling away. And so right now, where the U.S. is not giving anything, China is, and that alone is a win for them.

SCHMITZ: So, Fatma, I wanted to get also into how you report when you're, you know, on the ground. You know, there's this thing that happens in reporting where you go out to cover one story - especially in developing countries, this happens a lot, especially to me - and you end up noticing something completely different, and then you're kind of, you know, pulled in a different direction. How often does that happen to you, and did that happen to you while you were working on these stories, you know, when you were covering aid from China and things like that?

TANIS: Yeah, it certainly does, and I do, you know - when I'm planning my reporting, that's something I definitely build in space for, both, you know, logistically, but also mentally. Most recently when I was in Uganda, there was one story I was working on. You know, obviously, we were covering the USAID shutdown and its impacts and, like, the change in foreign aid policy.

However, I also wanted to do stories that had nothing to do with that. And so there was this one program in a rural part of Uganda that I was profiling. It was a program meant to, you know, push people who were living in extreme poverty out by giving them some cash and coaching. It's a program that, you know, has been - it has had high rates of success elsewhere, and this one was doing something interesting. It was not funded or supported in any way by the U.S. It was funded privately.

And so, you know, we're out there in the field. We're talking to participants of these programs, trying to understand how their lives are changing with, you know, the help of this cash and the coaching. And we realized that there had been something that was stopping people from, like, being able to invest as much as they could have or they had been encouraged to in building their businesses.

And it turned out to be that the U.S. aid cuts had caused a serious slowdown in the local economy because people who weren't in the program, people in the area who had been receiving aid, had - no longer had the resources to spend money in the markets. And that was affecting local businesses. It was also affecting these people in the program who were trying to build businesses. So even a story that I had - I was intentionally trying to do outside of the aid cuts ended up being dragged into it.

SCHMITZ: Fatma Tanis is a global health and development correspondent for NPR. Fatma, thanks so much.

TANIS: Thank you for having me.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Linah Mohammad
Prior to joining NPR in 2022, Mohammad was a producer on The Washington Post's daily flagship podcast Post Reports, where her work was recognized by multiple awards. She was honored with a Peabody award for her work on an episode on the life of George Floyd.
Rob Schmitz is NPR's international correspondent based in Berlin, where he covers the human stories of a vast region reckoning with its past while it tries to guide the world toward a brighter future. From his base in the heart of Europe, Schmitz has covered Germany's levelheaded management of the COVID-19 pandemic, the rise of right-wing nationalist politics in Poland and creeping Chinese government influence inside the Czech Republic.

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