Keypoints:
- US signs new health deals with at least nine African countries
- Funding levels fall sharply under negotiated ‘America First’ framework
- Officials deny links to deportation agreements despite overlap
THE United States has signed new health funding agreements with at least nine African countries, formalising a sharp shift away from traditional aid and confirming a significant reduction in US financial support for public health programmes across the continent.
The deals, reached with countries including Kenya, Nigeria, Rwanda and Uganda, are the first concluded under the Trump administration’s new ‘America First’ global health framework. The model replaces earlier health agreements managed through the now-dismantled United States Agency for International Development, moving instead to bilateral negotiations that explicitly limit US contributions.
US officials say the new approach is intended to promote self-sufficiency by requiring recipient countries to take on greater responsibility for financing their own health systems. Critics, however, warn that the framework risks weakening already stretched public health infrastructure in parts of Africa still heavily reliant on external support.
Aid cuts reshape African health systems
The new agreements follow sweeping US aid cuts that have disrupted health systems across the developing world. In Africa, American funding has long underpinned programmes responding to HIV, malaria and infectious disease outbreaks, making the scale of the reductions particularly consequential.
According to the Centre for Global Development, a Washington-based think tank, the new health pacts represent an average 49 percent reduction in annual US health spending compared with 2024 levels. While the agreements provide multi-year funding commitments, they do so at markedly lower amounts.
Nigeria, Africa’s most populous country, alongside Rwanda and Uganda, has publicly confirmed signing health compacts with Washington. Cameroon, Eswatini, Lesotho, Liberia and Mozambique are also among the countries that have reached agreements.
Smaller budgets, stricter terms
Under its deal, Mozambique will receive more than $1.8bn in US support, largely directed towards HIV and malaria programmes. Lesotho secured an agreement worth just over $232 million, while Eswatini’s package caps US support at $205 million.
In Eswatini’s case, the agreement includes a requirement for the government to increase domestic health spending by $37 million, underscoring the transactional nature of the new framework. Similar expectations of increased national contributions are embedded across the deals.
The Trump administration argues that this structure improves accountability and sustainability, ensuring US funds deliver measurable outcomes. Public health experts counter that many African governments face fiscal constraints that make absorbing funding gaps difficult, particularly amid rising debt burdens and economic pressures.
Transactional diplomacy raises questions
The health agreements also reflect President Donald Trump’s broader approach to foreign policy, which favours bilateral negotiations and reduced overseas spending over multilateral aid systems. Supporters say the shift allows Washington to better align funding with national interests and reduce long-term liabilities.
However, the deals have attracted controversy due to their political context. At least four of the African countries that have signed health pacts have previously agreed to accept third-country deportees from the United States, a cornerstone of the Trump administration’s immigration policy.
The US State Department has denied any connection between the health agreements and deportation arrangements. Officials insist the health compacts are negotiated on public health grounds alone.
At the same time, US officials have acknowledged that political considerations beyond health may factor into broader negotiations with partner countries, even if not explicitly written into the agreements.
A turning point for US–Africa health ties
For African governments, the new health deals offer continued engagement with Washington but on reduced terms and with greater domestic financial obligations. Whether the shift leads to stronger self-reliance or deepens vulnerabilities will depend on countries’ capacity to replace shrinking aid with sustainable national funding.
As more agreements are finalised, the long-term implications for disease control, outbreak preparedness and health equity across Africa remain uncertain.
