Washington, D.C.
The United States has concluded a series of bilateral health cooperation agreements with 14 African countries, totaling around $16 billion in combined U.S. assistance and domestic co-investments. These five-year memorandums of understanding (MOUs), signed under President Trump’s America First Global Health Strategy, aim to combat infectious diseases like HIV/AIDS, tuberculosis, malaria, and polio while strengthening health systems and promoting greater self-reliance among partner nations.
The agreements mark a shift toward direct government-to-government partnerships, emphasizing co-financing, performance benchmarks, and gradual transitions to national ownership. They build on decades of U.S. investment in African health security, including through the President’s Emergency Plan for AIDS Relief (PEPFAR).
Nigeria secured the largest deal at $5.1 billion, followed by Kenya ($2.5 billion) and Uganda ($2.3 billion). Smaller agreements range from $0.2 billion to $0.8 billion, focusing on disease surveillance, maternal and child health, and outbreak preparedness.
Breakdown of Agreements by Country:
- 🇳🇬 Nigeria – $5.1 billion
- 🇰🇪 Kenya – $2.5 billion
- 🇺🇬 Uganda – $2.3 billion
- 🇲🇿 Mozambique – $1.8 billion
- 🇪🇹 Ethiopia – $1.5 billion
- 🇨🇲 Cameroon – $0.8 billion
- 🇧🇼 Botswana – $0.5 billion
- 🇨🇮 Ivory Coast – $0.48 billion
- 🇱🇸 Lesotho – $0.4 billion
- 🇸🇿 Eswatini – $0.2 billion
- 🇷🇼 Rwanda – $0.2 billion
- 🇱🇷 Liberia – $0.2 billion
- 🇲🇬 Madagascar – $0.2 billion
- 🇸🇱 Sierra Leone – $0.2 billion
These pacts require significant domestic contributions from African governments, with the U.S. committing funds contingent on meeting agreed targets. Officials describe the strategy as a way to maximize impact, reduce long-term dependency, and protect American interests by preventing disease outbreaks abroad.
While praised for fostering sustainability, some agreements have faced scrutiny, including concerns over data sharing and implementation challenges in countries like Kenya.
The U.S. State Department continues negotiations with additional nations, signaling an ongoing realignment of global health assistance toward bilateral, results-driven models.