If you open the USAID website today, you will only find a Notification of Administrative Leave effective since Sunday, February 23, 2025, 11:59 p.m. EST. And this July marks the first fiscal year after USAID funding froze under the US presidential executive order of January 10, 2025. ALSO READ: How Rwanda is moving to address healthcare gaps left by USAID freeze Under the America First notion, this deliberate act means a $43 billion reduction in humanitarian development foreign aid (USAID budget in 2023). ALSO READ: Rwandans living with HIV wary of uncertainty in US funding While this drastic funding cut impacted several non-profit organizations, health organizations suffered the heaviest blow. According to Kaiser Family Foundation (KFF), a leading source of health policy research, USAID represented 73% ($6.5 billion) of US funding in global health. ALSO READ: USAID halt: Rwanda to make “necessary adjustments” With this change in the global health funding landscape, the new fiscal year presents non-profit health organizations with tough decisions: which programmes do we sustain? Which ones do we scale back, or even let go? If your organization is operating on a tight budget and high stakes, one tool can provide strategic clarity: the BCG matrix. Initially developed by Boston Consulting Group (BCG) for business portfolio analysis, the BCG matrix helps identify products worth investing in. It classifies the products in four categories based on their market growth rate (how many people will likely buy it in the future) and the market share (proportion of users compared to competitors' products). For a non-profit health organization, the BCG matrix classifies organization programmes and products in four quadrants based on the impact (analogous to market growth) and performance (analogous to market share): stars, cash cows, question marks, and dogs. The stars represent high-impact and high-performing programmes. They are flagship programmes that deliver results and are still growing. An example would be a well-performing maternal health initiative with high community demand and measurable outcomes. Such programmes deserve the most significant portion of your new fiscal year budget. The cash cows are your high-performing programmes, but their demand is growing. Take a well-established HIV awareness programme run by trained volunteers with minimal costs. Such programmes should be maintained and used to subsidize the weak programmes. The question marks are your promising but uncertain programmes. Think of a digital health App having the potential to grow as more people become tech-savvy, but you are unsure of its adoption. They have the potential to scale, but have no performance yet. It's up to your leadership to decide whether to give them a chance or phase them out based on your budget constraints. Lastly, the dogs are the programmes with poor results, their demand is not growing, and they have high operational costs. For instance, an NGO mobile clinic with waning visits. Some organizations cling to such programmes to preserve their identity and legacy. However, when a tight budget calls, you are better off letting them go. Why care about this non-profit portfolio analysis? When resources are limited, uninformed decisions are so costly. The BCG matrix offers a rational, data-driven, mission-aligned approach to navigating uncertainties. It guides health leaders to prioritize efficiency, impact, and sustainability over legacy or politics. Beyond strategic planning, BCG ensures transparency and builds trust with donors and stakeholders. The confidence in the organization grows when stakeholders believe that data and strategy back decisions. While the USAID funding cut has already caused much damage to global health, it should also be a wake-up call, not just about funding but also strategy. Using tools like the BCG matrix, health leaders can navigate tough budget decisions as the new fiscal year unfolds and make every dollar spent advance the organization's mission. The author is a medical doctor specialized in health management and global health.
