US Alters Global Health Aid Approach With New African Agreements

The United States has shifted its global health aid strategy by establishing a new framework for cooperation with several African countries. This development involves reduced US funding and increased cost-sharing requirements for recipient nations.

Under the new approach, the Trump administration signed bilateral health agreements with at least nine African countries. These deals set out specific funding commitments and require greater financial participation from partner governments.

Kenya signed a health agreement with the US on December 4, 2025, which allocates over $1.6 billion in US funding over five years. Kenya will contribute $850 million of its own resources as part of the arrangement.

Uganda also entered a bilateral health cooperation agreement with the US, which will provide up to $1.7 billion in US funding over five years. Mozambique’s agreement includes more than $1.8 billion in US support, focused on HIV and malaria programs.

What the numbers show

• Annual US health spending in Africa is down 49% from 2024 levels
• USAID funding for the President’s Malaria Initiative was reduced by 47% as of mid-2025
• Kenya’s deal involves $1.6 billion in US funds and $850 million from Kenya over five years
• Uganda’s agreement provides up to $1.7 billion in US funding over five years
• Eswatini’s deal caps US support at $205 million and requires $37 million in additional domestic health spending

Lesotho secured a US health agreement valued at just over $232 million. Eswatini’s deal limits US support to $205 million and includes a requirement for Eswatini to raise its own health spending by $37 million.

The new agreements reflect a broader reduction in US health aid to Africa, with annual spending nearly halved compared to the previous year. The agreements also place greater emphasis on co-financing, requiring recipient countries to increase their own contributions to health programs.

In response to these changes, Nigerian lawmakers approved $200 million in additional funding for the country’s health sector. This measure was taken to help offset the impact of reduced US aid.

Some regions have experienced direct effects from the aid reductions. In eastern Congo, for example, rape survivors faced shortages of post-rape medical care after US aid cuts led to the end of PEP kit distribution.

* This article is based on publicly available information at the time of writing.