U.S. Strikes ‘America First’ Health Deals With Nine African Countries
The United States has signed new bilateral health agreements with at least nine African countries, marking a major shift from traditional aid-based support to transactional partnerships that align with the priorities of President Donald Trump’s administration.
Countries that have so far signed the agreements include Kenya, Nigeria, Rwanda, Uganda, Mozambique, Cameroon, Eswatini, Lesotho and Liberia. The deals are the first under Washington’s new global health framework, which replaces decades of multilateral assistance coordinated largely through the now-dismantled U.S. Agency for International Development (USAID).
Under the new model, U.S. health funding is tied to direct negotiations with individual governments and is conditioned on mutual benefits, greater domestic co-financing and political considerations linked to Washington’s “America First” agenda.
U.S. officials say the approach is designed to promote self-sufficiency, cut waste and remove what they describe as ideological elements from international assistance. Critics, however, argue that the agreements significantly reduce overall funding and weaken health systems already strained by sweeping U.S. aid cuts.
According to the Center for Global Development, a Washington-based think tank, the deals combine sharp reductions in U.S. contributions with ambitious expectations that African governments will increase their own spending. It estimates that annual U.S. health support under the new agreements is about 49 per cent lower than in 2024.
Nigeria, Africa’s most populous country, signed a five-year health pact that places strong emphasis on Christian faith-based healthcare providers. The U.S. previously provided about $2.3 billion in health assistance to Nigeria between 2021 and 2025, largely through USAID. Under the new agreement, U.S. support is expected to exceed $2 billion, while Nigeria is to contribute about $2.9 billion to strengthen its health sector.
The U.S. State Department said the Nigeria deal reflects reforms aimed at protecting Christian communities from violence and includes dedicated funding for Christian healthcare facilities, adding that Washington reserves the right to suspend programmes that do not align with U.S. national interests.
Other countries see the agreements as a lifeline after aid cuts disrupted critical services. Mozambique is set to receive more than $1.8 billion for HIV and malaria programmes, while Lesotho secured over $232 million. Eswatini will receive up to $205
