The United States has established new health agreements with nine African countries, including Kenya, Nigeria, and Uganda, indicating a significant change in its global health funding strategy. These agreements, characteristic of the Trump administration’s “America First” policy, focus on mutual benefits and aim to reduce U.S. spending on aid. Unlike the previous approach through USAID, this new framework requires direct negotiations with recipient governments and emphasizes co-financing, pushing for self-sufficiency and efficiency in international assistance.
The Center for Global Development reports that these agreements entail a 49% decrease in annual U.S. health funding compared to 2024 projections. In Nigeria, the deal prioritizes support for Christian health providers, stipulating over $2 billion in U.S. aid over five years, alongside Nigeria’s expected $2.9 billion investment in healthcare. This partnership also aligns with Nigerian government reforms addressing violence against Christian populations. The U.S. retains the authority to pause or terminate aid if it does not serve national interests, especially concerning extremist violence.
Other countries like Mozambique and Lesotho will receive critical support amid substantial U.S. aid cuts, with Mozambique set to get over $1.8 billion for HIV and malaria initiatives. Notably, South Africa did not sign an agreement due to ongoing disputes, resulting in a loss of over $436 million in annual funding for HIV treatment.
Moreover, at least four of the signatory countries have agreed to accept U.S. deportees, highlighting a transactional approach to international relations. Overall, these developments mark a shift towards direct government agreements, fundamentally altering U.S. foreign health policy.
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