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The U.S. government has signed health deals with at least nine African countries, part of its new approach to global health funding, with agreements that reflect the Trump administration’s interests and priorities and are geared toward providing less aid and more mutual benefits.
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 U.S.
Some of the countries that have signed deals either have been hit by U.S. 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 and eliminate what it says are ideology and waste from international assistance. The deals replace a patchwork of previous health agreements under the now-dismantled United States Agency for International Development.
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U.S. 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 U.S. foreign assistance, which supporters say furthered American interests by stabilizing other countries and economies and building alliances.
The deals mark a sharp departure from how the U.S. has provided health care funding over the years and mirrors the Trump administration’s interests.
South Africa, which has lost most of its U.S. funding — including $400 million in annual support — due in part to its disputes with the U.S., has not signed a health deal, despite having one of the world’s highest HIV prevalence rates.
Nigeria, Africa’s most populous country, reached a deal but with an emphasis on Christian-based health facilities, although it has a slight majority Muslim population. Rwanda and Uganda, which each have deportation deals with the U.S., have announced the health pacts.
Cameroon, Eswatini, Lesotho, Liberia and Mozambique also are among those that have signed health deals with the U.S.
According to the Center for Global Development, a Washington think tank, the deals “combine U.S. funding reductions, ambitious co-financing expectations, and a shift toward direct government-to-government assistance.”
The deals represent a reduction in total U.S. health spending for each country, the center said, with annual U.S. financial support down 49% compared with 2024.
