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The Trump administration’s new strategy for supporting African nations involves negotiating individual health funding agreements, a departure from traditional aid models. However, this initiative has come under scrutiny from experts who highlight potential risks and significant gaps in the proposed arrangements.
The New Approach to Health Funding
Since returning to the White House in early 2025, President Trump has drastically altered the landscape of American foreign aid, particularly in Africa. With a significant reduction of funding for the United States Agency for International Development (USAID) — nearly 90% of its reproductive health programmes were cut — the administration is now pursuing bilateral agreements directly with individual countries. Publicly, this shift is framed as empowering nations to take control of their health financing, yet many experts warn it could lead to severe consequences for public health.
The administration has managed to sign 32 agreements worldwide, amounting to a total of $20.3 billion, of which $12.8 billion is contributed by the US government. Despite these impressive figures, health policy analyst Jennifer Kates asserts that these agreements do not adequately replace the support that existed before the cuts took effect. Particularly concerning is the absence of family planning initiatives in the agreements that have been made public; none of the six known Memoranda of Understanding (MOUs) include provisions for reproductive health.
Local Impact: A Case Study from Ghana
On the ground in Ghana, health officials report troubling developments. Since October, the country has experienced a shortage of condoms, a critical resource in the fight against sexually transmitted infections and unwanted pregnancies. The US President’s Emergency Plan for AIDS Relief (Pepfar) was previously a major supplier of contraceptives, but funding cessation has left stockpiles stuck at ports. Sarah Shaw, advocacy director for MSI Reproductive Choices, notes an alarming rise in teenage pregnancies and HIV infections, indicating the immediate impact of the funding freeze.
The situation exemplifies the broader implications of the Trump administration’s health policy. Countries like Ghana, Zimbabwe, and Zambia have been hesitant to accept the new agreements, largely due to concerns over the ambitious financial commitments being demanded and the perceived inequity in the arrangements.
Challenges Ahead: Financial Commitments and Sovereignty Concerns
The financial targets outlined in the agreements are daunting. For instance, Kenya is expected to contribute $850 million over the agreement period, a significant challenge given its annual health expenditure of approximately $2.2 billion and existing debt pressures. These strains are compounded by the fact that many nations fear the agreements are less about health partnerships and more about extracting resources and data without reciprocal benefits.
This sentiment was echoed by Alexandra Tarzikhan, a global health policy specialist at Doctors Without Borders, who pointed out the growing concern among countries about their sovereignty and data privacy. Ghana’s Data Protection Commission highlighted the excessive scope of health data access requested in the US agreement, which they felt encroached beyond what would typically be necessary.
An Unequal Exchange?
In Zambia, the draft agreement has raised significant eyebrows by tying health cooperation to access to the country’s mineral resources. Critics suggest this approach could lead to an exploitation of vulnerable nations under the guise of health partnerships. Zimbabwe has firmly rejected the deal, labelling it an “unequal exchange,” reflecting a broader apprehension about the nature of these agreements.
Asia Russell, executive director of HealthGAP, voiced her concerns regarding the lack of transparency in how taxpayer money is being used in these agreements, noting that they appear to focus on exploitation rather than genuine health collaboration. The potential impact on access to life-saving services is particularly alarming, as delays in implementing these agreements could jeopardise healthcare in these nations.
A spokesperson from the State Department defended the new health agreements, asserting that they aim to deliver vital care in key global health areas, including HIV/AIDS, tuberculosis, and maternal and child health. They dismissed allegations that the US is neglecting women’s health, stating that assistance continues to support a variety of essential services.
Why it Matters
This shift from traditional aid models to bilateral health agreements has significant implications for public health in African nations. The concerns raised by experts about the adequacy and equity of these deals must be heeded, as they could lead to broader health crises if vital services are not maintained or prioritized. The future of healthcare in these regions depends not only on the financial commitments made but also on ensuring that the agreements foster genuine partnerships rather than exploitative relationships. The world is watching, and the stakes couldn’t be higher.
