When it comes to fighting COVID-19 abroad, the U.S. has been the most generous nation in the world, committing $900 million to global health, humanitarian and economic programs in 120 countries, according to the State Department. The money goes to international and local aid groups and health facilities in country.

But there's a catch.

Aid recipients can't use U.S. funds to buy personal protective equipment for health workers — masks and gloves, for example — without prior approval from the U.S. Agency for International Development.

The restriction, first reported by The New Humanitarian on April 29, has drawn criticism from global aid groups that rely on U.S. funds to do life-saving work in the developing world and in countries struggling with the pandemic.

"It just sets up an additional obstacle for implementing partners who also need to be mindful and protect their staff during an already challenging time," says Amanda Glassman, executive director of the Center for Global Development, a think tank.

USAID answered questions about the restriction in an email to NPR and then a follow-up phone interview. USAID requested that the comments be attributed to "a USAID spokesperson."

The measure was put in place to ensure there would be enough PPE for the U.S., the spokesperson told NPR. In the emailresponse, the spokesperson noted: "We continue to remain sensitive to the needs of humanitarian beneficiaries around the world while balancing the urgency of the domestic requirements here in the United States."

It's part of a series of government efforts to save PPE stocks for the U.S. In a press briefing on April 7, Secretary of State Michael Pompeo said the U.S. would no longer be shipping PPE outside the country. That represented a shift in policy. In February, for example, the U.S. sent 17.8 tons of donated medical supplies, including masks and gowns, to China.

"Right now, given the great need for PPE in our own country, our focus will be on keeping critical medical items in the United States until demand is met here," said Pompeo in the briefing.

Indeed, U.S. health workers remain in need of PPE. In mid-April, the American Medical Association sent a letter urging the Federal Emergency Management Agency to address "rampant" PPE shortages in the U.S. "Physicians and other health-care workers in every state have expressed serious concerns regarding the availability of appropriate safety equipment," the letter stated.

In the May 8 phone interview with NPR, the USAID spokesperson said the agency recently began telling aid recipients that they could not use their funds to purchase PPE. This restriction was communicated to the groups via their USAID contact person or included in their grant agreement.

If aid recipients would like to use their COVID-19 funds to purchase PPE, they must submit a request to USAID, according to the USAID spokesperson.

Lisa Hilmi, executive director of Core Group, a global consortium of 9,000 community health organizations, says she has been in regular communications with aid groups around the world. The groups she works told her that they began learning of this new guideline the week of April 20.

According to Hilmi, the groups were informed by their USAID liaisons that they cannot use existing aid funds to buy PPE. In bids for new USAID funding, they must specify that they would like to use the funds to purchase PPE — and get approval from the agency to do so.

After being informed of the need to ask for permission to purchase PPE,says Hilmi, "hundreds of groups filled out this request. But so far, none have heard back from USAID."

Last week, Hilmi says she asked a USAID contact for an update — but "they said they were not aware of what the timeline and process was [to approve the requests]."

Hilmi says she is "frustrated" by the delay in response from the agency to requests for PPE purchase.

"During a pandemic, we expect things to be more nimble," she says. "People's lives are at stake."

NPR asked USAID to comment on the reports of delays in responses regarding the purchase of PPE. USAID did not provide an answer, telling NPR they could not give a reply in time for publication.

Asked whether it is understandable that with shortages in the U.S. of PPE, the U.S. might put priority on establishing its own supply, Glassman of the Center for Global Development replied, "As the wealthiest country on the planet, surely we can do both with a bit of effort."

Aid organizations contacted by NPR that receive U.S. funding have also expressed frustration with the restriction. "It is unacceptable that USAID restricts Partners In Health and NGOs [nongovernmental organizations] like us from purchasing these items with their funds. We are one global community and must fight this disease as one global community. We are not safe until we are all safe," said Cate Oswald, chief policy and partnership officer for the global health group .

In a statement from to NPR, Bernice Romero, senior director of humanitarian policy and advocacy, wrote: "Save the Children is aware of the new guidance and is extremely concerned ... We are urging the U.S. government to make provisions to allow us to procure the protective equipment we need in order to reach vulnerable children and families and protect our staff during this crisis."

Meanwhile, USAID, in public statements, has emphasized the importance of other kinds of pandemic strategies.

In response to a question at a press briefing on May 1, USAID acting administrator John Barsa noted that the COVID response extends beyond medical supplies such as PPE and ventilators. "There's many things in our toolkit to fight the pandemic. So it is more than just equipment," he said.

He noted that the U.S. aid can be used for other efforts, such as raising awareness about COVID-19, boosting access to water and sanitation and improving disease surveillance.

But at least one piece of critical COVID-19 equipment is now being sent by the U.S.

On May 8, Barsa tweeted that the agency sent ventilators to South Africa. "This equipment will be used in South African intensive care units & will in no way impact the availability of these critical supplies for the American people," he wrote.

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