In a move that has reshaped the landscape of U.S. global health assistance, the Trump administration has signed new health agreements with nine African countries, cutting total aid by nearly half and shifting the focus toward mutual benefits and self-sufficiency.
The New Framework
These agreements are the first under a new global health framework that makes aid contingent on direct negotiations between the United States and each recipient nation. The framework replaces a patchwork of prior USAID arrangements and is described by the administration as an “America First” approach that aims to eliminate ideology and waste from international assistance.
Countries and Commitments
- Kenya – Signed a health pact that replaces previous USAID support.
- Nigeria – The deal emphasizes Christian-based health facilities and includes a five-year commitment of over $2 billion from the U.S. while Nigeria is expected to raise $2.9 billion domestically.
- Rwanda – Signed a $228 million agreement that requires $158 million from the U.S.
- Uganda – Signed a nearly $2.3 billion deal, with the U.S. providing up to $1.7 billion.
- Cameroon – Signed a health agreement under the new framework.
- Eswatini – The U.S. will provide up to $205 million to support public-health data systems, disease surveillance and outbreak response; Eswatini will increase domestic health spending by $37 million.
- Lesotho – Secured a deal worth more than $232 million.
- Liberia – Signed a health agreement as part of the new framework.
- Mozambique – Will receive over $1.8 billion for HIV and malaria programs.
South Africa, which lost $400 million in annual support due to disputes with the U.S., has not signed a new health deal.
Funding Cuts and Co-Financing
The Center for Global Development notes that the agreements combine U.S. funding reductions, ambitious co-financing expectations, and a shift toward direct government-to-government assistance. Annual U.S. financial support for each country is down 49 percent compared with 2024.
Focus on Christian Health Facilities in Nigeria
Under the Nigerian agreement, the U.S. will support “strong emphasis” on Christian faith-based health care providers. The State Department stated that “the president and secretary of state retain the right to pause or terminate any programs which do not align with the national interest,” urging Nigeria to ensure “that it combats extremist religious violence against vulnerable Christian populations.” The deal was negotiated in connection with reforms the Nigerian government has made to protect Christian populations from violence and includes significant dedicated funding to support Christian health care facilities.
Health Pacts and Deportation Deals
At least four of the countries that signed health deals-Rwanda, Uganda, Eswatini, and Mozambique-also have agreements to receive third-country deportees from the United States. The State Department has denied any linkage between the health compacts and the deportation arrangements, though officials say political considerations unrelated to health may influence negotiations.
Impact of Aid Cuts
U.S. aid cuts have crippled health systems across the developing world, including in Africa, where many countries relied on funding for critical programs such as disease outbreak response. The dismantling of USAID left South Africa vulnerable, removing over $436 million in yearly financing for HIV treatment and prevention and putting thousands of jobs at risk.
Key Takeaways
- The Trump administration has signed new health deals with nine African nations, cutting U.S. aid by 49 percent.
- Agreements emphasize self-sufficiency, faith-based facilities in Nigeria, and co-financing from recipient countries.
- Four countries that signed health pacts also have deportation agreements, though the U.S. says there is no direct link.
This shift marks a sharp departure from decades of U.S. health assistance, reflecting a transactional approach that prioritizes American interests and direct government cooperation.
