Theory of Change

The California-based drone delivery company Zipline made waves last year when it secured a $150 million pay-for-performance grant from the U.S. State Department to scale up its operations in Africa.

That announcement came just months after the State Department took control of the U.S. government’s foreign aid portfolio in the wake of USAID’s dismantling, and the deal with Zipline was portrayed as an emblem of the new direction of U.S. global health aid.

One year later, Zipline is working through the sometimes arduous process of negotiating with partner country governments over the terms of their expansion. But the company’s ambitions extend well beyond the five African countries included in the State Department grant. 

At the same time, a new partnership with Uber has the company poised for massive expansion inside the United States, from healthcare to consumer goods — driving estimates of Zipline’s potential valuation to $20 billion.

Zipline is expanding into urban environments, launching its precision delivery platform in cities such as Kigali, Rwanda, while scaling healthcare partnerships in the U.S. with major institutions like the Cleveland Clinic and the Veterans Affairs hospital system. The same autonomous tech that delivers critical blood products in West Africa is now poised to power instant delivery for retail and food.

Zipline’s Africa CEO and head of international expansion, Caitlin Burton, joined Devex’s Theory of Change podcast for a live recording at the Devex Impact House in New York. Burton shared the company’s growth story — from its origins in Rwanda to Uber Eats — and its planetary ambitions.

“We have to grow way faster over the next five years than we did in the last five years,” Burton said. “We are just now getting to national scale in really, really, really important places. We need to do that in many, many more places.”

Behind Zipline’s expansion plans, there is also a critique of legacy global health institutions and funding structures, which the company found resistant to what they could offer.

“People were staking out territory instead of operating a system, and that was weird to us,” Burton said.

“There are three things you really need in a health system: you need well-trained health workers that are compensated ... you need the drugs themselves, and then you need a way to get them to the patient,” Burton said. “Everyone seemed to have forgotten about the supply system.”

In a live episode of the Theory of Change podcast, Buddy Shah, CEO of the Clinton Health Access Initiative and chair of the Anthropic Long Term Benefit Trust, shared an inside look at the intersection of global health, market-shaping agreements, and artificial intelligence.

"The mistake that many of us are making ... is looking for an AI point solution. What's a cool use case where you can develop an AI tool and slot it into an existing system? And I think the much more important question is: If you could redesign the system for a world where you have very powerful AI tools, what would that look like?" Shah said during the podcast, which was recorded last week at the Devex Impact House in New York on the sidelines of the United Nations General Assembly. 

Shah pulled back the curtain on CHAI’s landmark deal to secure generic manufacturing of lenacapavir — a twice-yearly injectable drug offering 99% effectiveness against HIV infection. 

By negotiating the price down from $28,000 per year in the U.S. to $40 per patient per year in lower-income countries, Shah explained how CHAI, Gilead, generic manufacturers, and global health partners believe they are creating a path that could spell the end of HIV over the next decade.

Addressing his dual role managing corporate governance at Anthropic, Shah previewed how artificial intelligence could fundamentally reshape health delivery in low- and middle-income countries through mobile diagnostics and AI clinical assistants. 

He emphasized that LMICs may leapfrog high-income nations in adopting these technologies, while highlighting how incoming philanthropic capital from the AI sector could help fund major systemic solutions.

In a live episode of the Theory of Change podcast recorded at the Devex Impact House in New York on the sidelines of the United Nations General Assembly, David Beasley, the former World Food Programme executive director and former governor of South Carolina, laid out his playbook for navigating today’s increasingly hostile political climate — while leaving the door at least somewhat open for his own return to the political arena.

Beasley — who led the U.N.’s food security agency when it won the Nobel Peace Prize — shared his journey from working in South Carolina tobacco fields to negotiating with the Taliban to feed starving children to battling with billionaire Elon Musk on Twitter.

He described the culture shock of a United Nations outsider confronted with bureaucracy and jargon, and offered his diagnosis for why the development sector keeps getting its pitch wrong.

Beasley offered a bleak assessment of current humanitarian aid cuts, calling the domestic political environment “horrific” and warning that Western nations are actively undermining their own geopolitical stability.

“America is great because America is good, and if we ever cease to be good, we cease to be great. And right now, we're not being good,” he said.

In an interview on Devex's Theory of Change podcast, Alight CEO Jocelyn Wyatt warned that the traditional humanitarian business model is facing structural failure.

Following the collapse of the U.S. Agency for International Development and the transition of U.S. foreign aid programs to the U.S. State Department, organizations are having to rely on more rigid grants from United Nations agencies that typically cap overhead at 7%, leaving virtually no resources for operational leadership, compliance, or innovation, Wyatt said.

Global humanitarian assistance fell by roughly 30% between 2022 and 2025, with 13 of the 20 largest donors cutting relief aid in 2025, according to the latest State of the Humanitarian System report, released last week.

Wyatt highlighted how structural defects and funding restrictions in the traditional framework actively undermine long-term progress:
The misallocation problem: Private donor funding floods highly publicized, geopolitical conflicts (such as Ukraine), while long-term, acute humanitarian disasters (such as Sudan) receive virtually no private support due to public narrative fatigue, donor bias, and political media coverage.
Survival over solutions: With institutional funds shrinking, remaining aid is strictly funneled into immediate lifesaving care, stripping away funding for education, job training, and economic development that actually helps people transition out of displacement.
Failing durable pathways: The three traditional solutions for refugees — returning home, integrating locally, or third-country resettlement — have largely stalled or collapsed under political and financial strain.

“This world order and these systems that were developed post-World War II have seemed like they're hitting their expiration date, and they will need to be reinvented. But that is not happening in 2026 or 2027, probably 2028. So in the interim, we need to find ways to help people be able to provide for themselves and their families,” Wyatt said.

To survive the breakdown of the traditional model, Wyatt argues that humanitarian organizations must pivot toward financial self-reliance and market-driven solutions.

“Let's actually put our resources to social enterprise models where we can recycle capital, where we can help people start businesses. Let's actually train people and connect them with employers so that they can get jobs and make money for themselves,” she said.

“To think that governments are going to be the continuous providers of financial support to refugees ... I think is just a fallacy at this point,” she added.

In the latest episode of the Theory of Change podcast, human rights activist Kavita Nandini Ramdas discussed the deep systemic contradictions of modern philanthropy, its uneasy relationship with grassroots activism, and why nonprofit organizations must stop playing quiet to keep elite funding.

Ramdas, currently a senior strategic adviser at the International Planned Parenthood Federation, has spent years fighting both inside and outside major philanthropy — including as a close adviser to some of the world’s most prominent foundation leaders.

What she sees today is a philanthropic sector that is “running afraid from Trump” and recipient organizations that rarely challenge their funders.

“It’s really as though we’ve gone back to the medieval ages and Lady Bountiful is riding on her white horse and throwing crumbs to the masses below and we're scurrying around saying, ‘Thank you so much, thank you so much,’” she said. “It’s as though we’ve gone back to feudal times.”

The argument: Nonprofits must replace groveling with accountability. “Take the money, but have the damn courage to stand up and say, ‘This action was racist. This intervention is not acceptable,’” Ramdas said. Taking elite funding creates a direct “obligation to voice” — not a mandate for silence.

On the Gates Foundation: Ramdas directly called out Bill Gates over his foundation’s agricultural strategy in Africa during a meeting. She pointed out that the Green Revolution had already been an environmental disaster in India — destroying topsoil and drying up aquifers in Punjab — and asked why they were selling the exact same flawed model to Africa. As a result, they brought her in as an adviser.

On Adele Simmons, former head of the MacArthur Foundation: “Here she was, this extraordinary person with three young kids — and what she had to deal with, this casual sexism that I saw thrown at her.”

On Darren Walker, former head of the Ford Foundation: He told Ramdas that “culture eats strategy for breakfast” — a truth she applies now to philanthropy, noting that no matter how progressive a foundation’s strategy claims to be, it is constantly swallowed by the surrounding patriarchal and capitalist culture.