To whom it may concern,

I am Evan LaForge, Co-Founder and Co-Executive Director of Access to Medicines Initiative (AMI). We prevent unintended pregnancies and maternal deaths in Nigeria by making sure that contraceptives are available in public health facilities. For decades, contraceptives have been difficult to access across Nigeria and many other Low Income Countries. We work to ensure no one is turned away due to empty shelves. I am submitting on behalf of AMI because we firmly believe in the importance of Official Development Assistance (ODA) for saving lives and lifting hundreds of millions of people out of extreme poverty.

Right now, the Sexual and Reproductive Health and Rights (SRHR) sector is at a crossroads reflective of the global development sector as a whole. Due to collaborative efforts, largely fueled by ODA and multilateral organisations including the UNFPA, many governments in Low Income Countries have begun to invest in family planning in the last few years. Public health facilities are receiving increasing support, and governments are building sustainable systems to ensure this impact lasts. This is a clear depiction of development aid being deployed as an investment, not a donation. However, with the dismantling of USAID, the largest funder of family planning globally, there is a significant risk of backsliding. When USAID collapsed, many programs were left scrambling for funding if they were not shut down entirely.

It is essential now more than ever to direct funding towards cost-effective and sustainable efforts. Although my primary expertise is in family planning, the same principles hold across the global development sector. I call upon this Committee to consider the following priorities when shaping the future of UK Aid:

1)     Only fund programs that are truly cost-effective.

Right now, there is significant waste in the global development sector. At a minimum, every program should be able to show that it performs better than transferring cash to beneficiaries (see CEGA’s work on cash benchmarking: https://cega.berkeley.edu/collection/cash-benchmarking/). When applicable, programs should also be compared to the strongest alternatives within their sector, ensuring that funding flows to interventions that deliver the most value per pound spent.

2)     Prioritise programs that have an explicit and credible path to long-term sustainability.

If development aid is to function as an investment, programs must demonstrate how impact will be maintained after donors step back. In the SRHR sector, we are already seeing promising models: governments establishing budget lines for contraceptives, integrating supply-chain improvements into state systems, and using donor funds to accelerate rather than indefinitely replace domestic investment. Supporting programs with explicit and realistic sustainability plans (particularly those that have already achieved some level of government investment) will simultaneously preserve impact and improve cost-effectiveness by leveraging local resources.

3)     Let evidence guide funding decisions and shut down unsuccessful programs.

Even well-designed interventions can fail to achieve their intended impact. All funded programs should be required to collect, analyse, and transparently share evidence of their outcomes. Using this evidence, we should compare them to the benchmarks mentioned under point (1). If programs are deemed less cost-effective than these benchmarks, they should either be significantly restructured or shut down. With limited resources, continuing to fund low-impact programs comes at the direct expense of approaches that save more lives and deliver greater long-term value.

By focusing on highly cost-effective programs with clear paths to sustainability and strong evidentiary support, we can ensure that we achieve the greatest impact possible now and into the future.

Thank you for your consideration,

Evan LaForge