A new U.S. foreign assistance strategy aimed at supporting healthcare systems across Africa is generating both interest and controversy, as several African governments scrutinize conditions attached to billions of dollars in proposed funding.
According to the BBC, the Trump administration has shifted away from traditional aid models following the dismantling of the U.S. Agency for International Development (USAID) last year. The administration is now offering direct bilateral healthcare agreements to countries willing to partner with Washington under a new global health strategy.
The largest agreement announced so far is a $2.5 billion healthcare partnership between the United States and Kenya. The deal, initially signed by Kenyan President William Ruto and U.S. Secretary of State Marco Rubio in Washington in December, commits the United States to contribute $1.6 billion while Kenya provides $850 million over five years.
Rubio described the Kenya agreement as the beginning of a broader initiative.
“We hope to sign, I don’t know, 30, 40, how many? Fifty? Well, this is number one. We’ll always remember this one… and we think we’ve picked the perfect partner,” Rubio said, according to the BBC.
The agreement faced delays after activists challenged it in court, but Kenyan cabinet ministers ultimately approved the deal last month.
The Trump administration argues that requiring recipient countries to increase their own healthcare spending will create stronger and more sustainable health systems. Officials contend that previous aid models often relied heavily on non-governmental organizations, creating dependency and increasing administrative costs.
“Our aid to those countries will not just be dollars distributed to an NGO who then will go into the country and impose programmes,” Rubio told a congressional committee, according to the BBC.
“Not only are we treating the acute situations on the ground of people that are sick, we are helping them build the capacity and the capability to do this for themselves,” he added.
The new approach comes after the United States withdrew from the World Health Organization earlier this year. The administration argued that the organization lacked transparency, mishandled the Covid-19 pandemic, and placed an unfair financial burden on Washington.
However, critics say the new bilateral agreements differ significantly from previous global health cooperation efforts because they are tied more closely to American strategic and commercial interests.
According to the BBC, the State Department’s policy framework explicitly states that U.S. pharmaceutical companies and medical firms will receive priority in developing and delivering treatments under the agreements.
The policy document states that America’s global health assistance program is “not just aid” but also serves as “a strategic mechanism to further our bilateral interests around the world.”
By mid-May, 32 countries across Africa, Latin America, and the Caribbean had reportedly accepted the health Memorandums of Understanding. However, several African nations, including Ghana, Zimbabwe, and Zambia, have expressed reservations.
In Zambia, Foreign Minister Mulambo Haimbe criticized what he described as efforts to link healthcare funding to a separate agreement involving access to critical minerals.
“Our colleagues looked at it from the perspective that [the two deals] must be taken as a package to be negotiated and concluded at one particular time,” Haimbe told the BBC.
He further stated that Zambia preferred to negotiate the healthcare and mineral agreements independently.
“The US felt that there is need for there to be a preferential treatment in the use of critical minerals. And the framework was to reflect that,” Haimbe said.
The U.S. State Department defended its position, emphasizing that foreign assistance should advance American interests.
“The Trump administration has made clear, US foreign assistance is not charity — rather it is strategic capital to be wisely invested to advance US interests — and we expect all of our allies and recipient nations to take seriously American strategic and commercial priorities,” a State Department spokesperson told the BBC.
Additional controversy emerged last month when the administration announced a complete withdrawal of U.S. funding for HIV/AIDS programs in South Africa. According to the BBC, a U.S. official linked the decision to Pretoria’s alleged failure to meet certain policy requests from Washington, including concerns involving the country’s Afrikaner minority population.
Some African governments have also raised concerns about provisions related to health data sharing. Officials in several countries reportedly questioned whether the agreements could grant U.S. authorities or companies access to sensitive patient information and biological resources, including disease-causing pathogens such as viruses, bacteria, and parasites.
As negotiations continue, the new American strategy is highlighting a broader debate over the future of global health assistance, balancing the need for sustainable healthcare funding against concerns over sovereignty, commercial influence, and strategic leverage.
According to the BBC, while many governments welcome the prospect of significant new investment in healthcare systems, others remain cautious about the political and economic commitments that may accompany the funding.