PREVIEW
After four African deals, Washington claims there are advanced negotiations ongoing with 20 more countries for bilateral health pacts
After the United States Agency for International Development (USAID) comes America First healthcare. In the week ending 13 December, Lesotho, Eswatini and Uganda joined Kenya in signing agreements worth billions of dollars over five years as part of the America First Global Health Strategy launched in September (Dispatches, 8/12/25, Ruto moves adeptly to shore up ties with Washington).
The status of Rwanda’s health programme with the US has, however, been put in doubt after Secretary of State Marco Rubio lambasted Kigali’s role in backing the M23 militia’s seizure of Uvira in Kivu Sud province. That programme had been agreed in the aftermath of the Washington-brokered peace deal with Congo-Kinshasa on 4 December.
State Department officials say that there are advanced negotiations with 20 countries. A further 50, who collectively receive the vast majority of US health assistance, are lined up for deals by 31 December. These bilateral agreements will replace USAID, which was shuttered shortly after President Donald Trump took office in January, but they will only be put in place with governments that Washington is willing to do business with. After a major diplomatic spat, South Africa will not be one of the recipients (AC Vol 66 No 6, Targeted by Trump – Africa and Europe draw closer).
The stated logic is that these pacts will bypass the middlemen – NGOs, civil society groups and other third parties – with the money going directly to African treasuries. This, the Trump administration argues, will help African countries take more control over their health budgets and reduce waste. The move poses another major challenge to the Western aid and NGO model (AC Vol 66 No 5, Western aid cuts reshape the geopolitical landscape).
Washington says that 60% of health aid goes to ‘technical assistance, program management, and overheads’ while only 40% reaches frontline services.
In most cases, the funds will replace previous programmes offering treatment and prevention of HIV/AIDS and TB and malaria, as well as for maternal care, polio eradication, and tackling infectious diseases. But they will also promote privatised medicine and faith-based healthcare providers and create opportunities for US businesses, say US officials.
In Kenya, the government has had to play down claims that the agreement’s provisions on data sharing of patient health records for up to 25 years will compromise privacy rights. Even so, some health experts have warned that the information could give US pharmaceutical companies a competitive advantage.
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