The Trump administration is once again offering African countries hundreds of millions of dollars to strengthen their healthcare systems and combat disease, following last year’s dismantling of the main US foreign aid agency, USAID. But this new wave of funding comes with strings attached, and several governments are pushing back.
Kenya’s President William Ruto signed the first of these agreements in Washington last December, a $2.5 billion deal that Secretary of State Marco Rubio hoped would become a template for dozens more across the continent. Even that flagship deal faced delays after activists took legal action to block it over privacy concerns, though it was eventually approved by Kenyan cabinet ministers.
Trump ordered USAID’s closure shortly after taking office, citing wastefulness, a move that gutted health programs across Africa that had depended on US funding. The State Department’s new approach requires partner governments to increase their own health spending, aiming to build self-sufficient systems rather than reliance on foreign aid. In Kenya’s case, the US is contributing $1.6 billion while Kenya commits $850 million over five years.
Rubio has argued this model avoids the pitfalls of the old NGO-based aid system, which he says fostered dependency and wasted money on overhead. He’s framed the new deals as helping countries build lasting capacity rather than simply handing out money.
This marks a broader shift away from coordinated global health efforts through the World Health Organization toward individual agreements tied directly to US strategic and business interests. The US exited the WHO earlier this year, criticizing funding imbalances and the organization’s handling of Covid-19. Notably, the bilateral deals include commitments to favor American pharmaceutical companies in developing and supplying treatments — something US policy documents describe explicitly as a strategic tool for advancing bilateral interests, not simply charity.
By mid-May, 32 countries had signed on, including roughly 20 in Africa. But Ghana, Zimbabwe, and Zambia have all declined, each citing different concerns.
Zambia’s Foreign Minister Mulambo Haimbe said the US tried to bundle the health agreement with a separate deal granting America access to critical minerals, insisting the two should be negotiated independently. The State Department didn’t directly deny the linkage but reaffirmed that US aid functions as strategic investment tied to American interests, expecting partner nations to prioritize US priorities in return.
Further underscoring this approach, the US recently announced a full withdrawal from HIV/AIDS funding in South Africa, which an administration official linked to Pretoria’s failure to act on certain policy demands — including issues related to the country’s Afrikaner minority, tied to widely disputed claims of a “white genocide.”
For other nations, the sticking point has been data. The agreements require sharing patient information and biological samples, including disease-causing pathogens. Kenya’s courts initially paused its deal over patient privacy concerns. Ghana’s Data Protection Commission said it objected to the scope of data required without any reciprocal protections once that information left Ghanaian control. Zimbabwe raised similar objections, worried that any resulting vaccines or treatments developed from shared data wouldn’t necessarily be made available to its own citizens — noting the WHO already has systems in place for equitable data-sharing.
The US maintains this exchange is essential for scientific progress and says the data involved is the same de-identified information that’s long been used to fight infectious disease. But experts note the political context has shifted. One global health governance researcher observed that earlier unequal arrangements could at least be framed publicly as altruistic, whereas today’s deals are far more transactional. Africa’s experience during Covid — where pathogen data helped produce vaccines the continent then struggled to access — has made many governments more cautious this time. Civil society groups, along with South Africa’s health minister, have warned that the US terms don’t reflect African interests, with Pretoria’s health minister bluntly saying no self-respecting nation should agree to share pathogen data for research while receiving only short-term funding in return.
The debate has taken on new urgency amid a fresh Ebola outbreak in the Democratic Republic of Congo. DR Congo was among the first nations to accept a US health deal, and Washington says the arrangement is helping coordinate the country’s outbreak response. But aid workers and former US officials argue that earlier funding cuts to both DR Congo and the WHO weakened frontline readiness. Care’s country director in DR Congo said he was forced to lay off a third of his staff due to USAID cuts, eliminating community health education and outbreak-prevention teams — leaving the country without prepositioned supplies when the outbreak began and costing roughly ten critical days in response time. A former USAID Ebola response leader argued the earlier, more robust aid network likely would have caught the outbreak sooner.
The US disputes that its cuts hurt the response, saying the current approach is more efficient and pointing to $270 million already donated toward the outbreak.
Critics, however, argue the Ebola crisis illustrates the danger of abandoning coordinated global health strategy altogether, since infectious disease doesn’t respect borders and requires collective international action. Still, some analysts have urged patience with the new approach, suggesting it represents a legitimate test of whether targeted, condition-based partnerships can outperform reliance on an international body many see as slow to reform.
So far, adoption remains uneven — Tanzania recently joined the program, but with multiple nations declining, the ultimate reach of Washington’s revamped health strategy remains uncertain.
