The US government has signed health deals with at least nine African countries, part of its new approach to global health funding, with agreements geared toward providing less aid.
The agreements signed so far, with Kenya, Nigeria and Rwanda among others, are the first under the new global health framework, which makes aid dependent on negotiations between the recipient country and the US.
Some of the countries that have signed deals either have been hit by US aid cuts or have separate agreements with the Trump administration to accept and host third-country deportees, although officials have denied any linkage.
The Trump administration says the new “America First” global health funding agreements are meant to increase self-sufficiency.
The deals replace previous health agreements under the now-dismantled United States Agency for International Development.
Aid cuts
US aid cuts have crippled health systems across the developing world, including in Africa, where many countries relied on the funding for crucial programs, including those responding to outbreaks of disease.
The new approach to global health aligns with President Donald Trump’s pattern of dealing with other nations transactionally, using direct talks with foreign governments to promote his agenda abroad.
It builds on his sharp turn from traditional US foreign assistance, which supporters say furthered American interests by stabilizing other countries and economies and building alliances.
Nigeria, Africa’s most populous country, alongside Rwanda and Uganda have announced the health pacts.
Cameroon, Eswatini, Lesotho, Liberia and Mozambique also are among those that have signed health deals with the US.
Reduced support
The deals represent a reduction in total US health spending for each country, according to the Center for Global Development, a Washington think tank, with annual US financial support down 49% compared with 2024.
Under its deal, Mozambique will get US support of over $1.8 billion for HIV and malaria programs. Lesotho clinched a deal worth over $232 million.
In the kingdom of Eswatini, the US committed to provide up to $205 million to support public health data systems, disease surveillance and outbreak response, while the country agreed to increase domestic health expenditures by $37 million.
At least four of the countries that have reached deals previously agreed to receive third-country deportees from the US, a controversial immigration policy that has been a trademark of the Trump administration.
The State Department has denied any linkage between the health care compacts and agreements regarding accepting third-country asylum seekers or third-country deportees from the United States.
However, officials have said that political considerations unrelated to health issues may be part of the negotiations.
