PREVIEW
Washington is pushing health contracts including tough conditions on big pharma, sexual health and data access
President Donald J Trump’s administration is reshaping development policy again with 13 bilateral pacts with African states so far as part of the ‘American First Global Health Strategy’. The latest deals are with Ethiopia, Madagascar, Botswana, and Côte d'Ivoire and worth a cumulative US$2.8 billion, taking the overall total to $16bn. The most lucrative are with Nigeria and Kenya, worth $2.1bn and $1.5bn respectively.
The latest agreements follow the blueprint of prioritising programmes offering treatment and prevention of HIV/AIDS and TB and malaria, as well as infectious diseases (Dispatches, 15/12/25, Trump’s USAID 2.0 takes shape). That is standard Western development spending and will be a near like-for-like replacement for much of work done by the USAID agency, which was shuttered weeks after Trump’s inauguration in January.
But there will still be losers. Organisations such as the Red Cross are reporting that funding for sexual and reproductive health programmes has been dramatically reduced (AC Vol 66 No 6, Targeted by Trump – Africa and Europe draw closer).
Several of the agreements have caveats that explicitly promote Washington’s policy interest. Besides promoting private sector medicine that already dominates most health provision across Africa, most notably, Nigeria’s is based on a ‘strong emphasis on promoting Christian faith-based health care providers’, according to a State Department statement which adds that the US ‘expects Nigeria to continue to make progress ensuring that it combats extremist religious violence against vulnerable Christian populations.’
Talks with at least ten other African states are close to completion, says the State Department.
The data sharing aspect of the Kenya deal has been used by petitioners to obtain a Nairobi court injunction preventing William Ruto’s government from ratifying it pending a Supreme Court ruling.
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