By: Chioma Madonna Ndukwu
US Revamps Health Aid as African Countries Sign New Funding Deals
Several African countries have entered new health funding agreements with the United States as Washington reshapes its global health policy under President Donald Trump, shifting away from traditional aid toward negotiated, country-specific deals.
Cameroon, Eswatini, Lesotho, Liberia and Mozambique are among the latest countries to sign on, joining others such as Kenya, Nigeria, Rwanda and Uganda.
The agreements form part of a broader US strategy that ties health assistance to bilateral negotiations and reduced long-term financial commitments.
The deals are the first to emerge under a revamped global health framework introduced by the Trump administration, following the dismantling of the United States Agency for International Development (USAID), which for decades served as the backbone of American health assistance in Africa and other developing regions.
Under the new approach, funding levels are no longer guaranteed and are instead determined through direct talks between Washington and recipient governments. US officials say the policy is designed to encourage African countries to take greater responsibility for financing their own health systems.
For many African nations, the change marks a sharp break from earlier arrangements that provided sustained funding for programmes targeting HIV, malaria, tuberculosis and outbreak response.
US aid cuts in recent years have already strained health services across parts of the continent, where external funding played a critical role in disease surveillance and treatment.
Analysts say the new agreements reflect President Trump’s broader foreign policy style, which prioritises transactional diplomacy over long-standing multilateral commitments.
Supporters of the approach argue it promotes accountability and self-reliance, while critics warn it risks weakening fragile health systems.
According to the Washington-based Center for Global Development, overall US health spending under the new deals is significantly lower than previous commitments, with annual funding falling by nearly half compared to 2024 levels.
Despite the reductions, the agreements still involve substantial sums. Mozambique is set to receive more than $1.8 billion to support HIV and malaria programmes, while Lesotho secured funding exceeding $232 million.
Eswatini’s deal includes up to $205 million aimed at strengthening public health data systems, disease surveillance and emergency response. In return, the government committed to increasing its domestic health budget by approximately $37 million.
Nigeria, Africa’s most populous nation, alongside Rwanda and Uganda, has also confirmed participation in the new framework, though specific funding figures for some countries have not been publicly detailed.
At least four of the African countries that have signed health compacts have also previously agreed to accept third-country deportees from the United States, a policy closely associated with the Trump administration’s immigration agenda.
While the US State Department has denied any direct connection between health funding agreements and deportation arrangements, officials acknowledge that broader political considerations can influence negotiations.
As more African governments weigh whether to join the new framework, the long-term impact of reduced US involvement in global health remains uncertain, particularly for countries still grappling with disease outbreaks and limited domestic resources.
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