The US government has signed health agreements with at least nine African countries as part of a new global health funding approach, reflecting the Trump administration’s priorities and aiming to provide less aid while emphasizing mutual benefits. Countries including Kenya, Nigeria, and Rwanda are among the first to enter agreements under this framework, which links aid to direct negotiations between the US and recipient governments.
The new approach marks a departure from traditional US health assistance and mirrors the transactional style of the Trump administration, which seeks to increase self-sufficiency, reduce perceived waste, and align foreign aid with American interests. Critics note that prior US aid cuts have already weakened health systems across Africa, leaving countries struggling to maintain programs responding to disease outbreaks and other critical health needs.
The health deals represent reduced US spending compared to previous agreements, with total annual support for each country falling by nearly half compared to 2024 levels. According to the Center for Global Development, the new model combines funding reductions, higher co-financing expectations, and a shift toward direct government-to-government assistance.
Nigeria’s agreement, for example, emphasizes Christian faith-based health facilities, reflecting US priorities, while the country is still expected to raise additional domestic funding to support broader health initiatives. Mozambique, Lesotho, and Eswatini also received multi-million-dollar agreements to support HIV, malaria, public health data systems, disease surveillance, and outbreak response, helping mitigate gaps caused by earlier aid cuts.
South Africa has not signed a health deal due to disputes with the US and has lost significant USAID funding, including over $436 million in annual support for HIV treatment and prevention, threatening programs and healthcare jobs. Other countries that signed health agreements, such as Rwanda and Uganda, previously agreed to host third-country deportees from the US, although officials deny any direct link between deportation arrangements and health funding.
The new compacts demonstrate the US’s broader strategy of linking health aid to policy priorities and government negotiations, shifting away from traditional multilateral or program-focused assistance. While these deals offer crucial support to some African countries, critics argue they reflect political considerations as much as health needs, leaving countries like South Africa without critical funding.
