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This is a pretty extreme view. Individual USAID contractors are not the scum of the earth. Most are well-meaning people who truly care about helping others, which is why they signed up to work in international development to begin with. A good portion are returned peace corps volunteers, or even immigrants to America from these developing countries. The idea that someone becomes an expert in maternal health in order to siphon off foreign aid money is kind of laughable.
That said, the industry that has formed around foreign aid is largely there because of the way the government has chosen to distribute aid money. A lot of this type of work was at one time done by the government, but the government has switched to a model where it uses the private sector to compete for technical work and because congress believes the private sector can be held accountable in a way the government can’t be. These companies are highly regulated. The amount of profit they can make is controlled by the government, and is typically only about 2-3% of the price of a contract. From that profit, they are liable to pay for any waste, fraud, or abuse if it is discovered.
The alternative some suggest would be to hand out millions of dollars to developing countries governments. Let me tell you from personal experience, most of these countries don’t have controls in place to appropriately manage this money. If we gave this money directly to developing countries, a good portion of it would end up misused. So, the government hires an American company to run projects and programs for it. Within these projects, typically all but one or two of the staff are host country nationals. That means most of the staff are locals, with just a few expats / Americans there.