Dear Friends and Supporters of the Roberto Clemente Clinic,
Last May, I had the privilege of participating in a thought-provoking roundtable discussion hosted by George Washington University, The New York Center for Foreign Policy Affairs, The Milken Institute School of Public Health at GW University, and Hunger Notes/World Hunger Education Service (WHES).
The conversation brought together representatives from organizations including the American Red Cross, Pew Research Center, Network Partnership for Quality Medical Donations, Relief International (where I also serve on the Board), Water for People, Save the Children, and others to examine how Americans currently think about global giving and foreign assistance – and how these perspectives have evolved over recent decades.
The Reality Behind the Numbers
One of the most striking revelations from our discussion centered on the fundamental disconnect between American perceptions and reality regarding foreign aid spending. Research from the Program for Public Consultation at the University of Maryland revealed that Americans dramatically overestimate how much our government spends on foreign assistance. The majority of survey respondents believed that at least 20% of our federal budget goes to foreign aid, when the actual figure is approximately $29 billion annually – closer to 0.26% of total government spending.
Less than 1%…
This misperception has persisted across multiple studies. A 2013 Pew Research Center poll found that Americans estimated foreign aid to be 25-31% of the budget, with only 19% correctly guessing less than 5%. Similarly, a 2015 Kaiser Family Foundation survey reported an average estimate of 31%, with 86% believing it was at least 2% of the budget.
Perhaps most telling is that until 2025, few Americans outside of Washington DC had ever heard of USAID – even though, according to GW University’s Institute for Public Diplomacy & Global Communication, most residents in Africa’s 54 countries and most of Asia’s 48 countries are well aware of USAID’s presence and work.
Understanding American Motivations for Giving
Our roundtable also explored the deeper motivations behind American charitable giving to international causes. When the U.S. Department of State conducted recent listening sessions about the reasons for foreign assistance, the terms that emerged most frequently for Americans were:
Diplomacy. Soft power. Security. Humanitarian support. Health. Lifesaving. National security.
But beyond these government policy frameworks, we discovered something more personal and profound about American donors. Research presented at our roundtable showed that Americans don’t simply want to fix problems in developing countries – as Americans, we aspire to help others elevate themselves. Through our giving, we want to inspire families and provide them with the tools they need to improve their lives fundamentally.
This resonates deeply with our mission at the Roberto Clemente Health Clinic. Our professional team in Nicaragua works around the clock to do exactly this – helping families in our surrounding communities better their lives through improved health and access to quality health education. (It’s worth noting that our clinic has never received government grants from the U.S. Our entire budget is supported by individual and corporate donors who share this vision of empowerment through health.)
What Moves Americans to Act
We examined what overseas challenges motivate Americans to donate, volunteer, or otherwise engage in foreign assistance. The findings reveal clear priorities:
- Child-focused charities topped the list, with Americans prioritizing the protection of children over other development options
- Child-focused health initiatives ranked second
- Child-sponsorship programs came third
- Educational programs followed
- Emergency response rounded out the top five.
These priorities align remarkably well with our work in Nicaragua, where we focus on community health with particular attention to maternal and child health, health education, sponsorship for direct support, and building local capacity for sustainable healthcare delivery.
The Remarkable Progress We’ve Achieved Together
We discussed the challenges non-profits and U.S. aid organizations have with changing perceptions about the cost-benefit of global giving. It’s crucial to recognize and promote the extraordinary progress that foreign aid and charitable giving have made possible over the decades. The problems we face today have fundamentally changed – and in many cases, livelihoods have dramatically improved – since the 1960s and ’70s.
Consider famines, once a recurring global crisis. Despite concerns in the 1960s and ’70s about population explosions leading to widespread famine, these disasters have become increasingly rare even as the global population has more than doubled. Acute rates of malnutrition have fallen by half compared to what they were in the 1960s. Child mortality rates have plummeted, and international charities have learned how to sustain these improvements over time.
This progress stems from multiple advances: agricultural technology and improved crop yields, breakthroughs in public health, the construction of local roads that enable aid delivery, increases in local truck fleets for distribution, migration to cities with better infrastructure, and the drastic reduction in extreme poverty worldwide.
The numbers tell a powerful story. According to the U.S. Global Leadership Coalition, since 1990, U.S. international assistance has helped lift close to 1 billion people out of extreme poverty. America’s HIV/AIDS programs have helped save over 25 million lives through treatment and prevention. U.S. international assistance has helped alleviate the devastating effects of malaria, a leading cause of death for children under five worldwide. These represent just a few examples of international assistance’s positive impact.
Simultaneously, we’ve witnessed a proliferation of NGOs and the development of laws governing civic action around the world. Government agencies have increased safety nets, IT access has expanded to connect even poor families by phone, and global trade has grown exponentially. All these developments have enabled NGOs like our clinic to move faster, reach remote communities, transfer funds more efficiently, and manage our organizations more effectively than ever before.
Why stop now?
The Concerning Trend in Charitable Giving
However, our roundtable discussion also highlighted a troubling trend that should concern all of us engaged in international charity work. Statistics presented showed that volunteering and charitable giving have declined significantly over the years, even as we’ve proven our collective ability to create transformational change. These declines, coupled with the widespread misunderstanding about government foreign aid ratios, create a challenging environment for organizations like ours that depend on private philanthropy.
Moving Forward with Purpose and Proven Impact
Our work at the Roberto Clemente Health Clinic in Nicaragua (the second poorest country in the western hemisphere) is more critical than ever – so we cannot afford to let this momentum go backwards. In a landscape where Americans increasingly want to see transformational rather than transactional impact, our model of community-based healthcare that builds local capacity and empowers families aligns perfectly with both donor motivations and the proven strategies that have created such remarkable global progress.
We’ve demonstrated collectively what’s possible when we commit to helping others elevate themselves. We can’t stop now. There is so much more we can do, with your help.
As we continue our mission in Nicaragua, we’re building on decades of evidence-based success while adapting to new challenges and opportunities. Each of you who supports our work is part of a proven American tradition of international solidarity – one that has saved millions of lives and lifted nearly a billion people out of extreme poverty. While government foreign aid may be smaller than most people realize, the combined impact of government assistance and private philanthropy has reshaped our world for the better.
Thank you for being part of this vital work. Your support enables us to do more than provide healthcare; it allows us to be partners in building stronger, healthier communities that can thrive for generations to come. To keep the momentum going, donate here. Your support goes a long way in Nicaragua, where the average worker earns less than $20 a day.
In health and solidarity,
Julia C. Guth
Founder and Chair
The Roberto Clemente Health Clinic
[email protected]