U.S. Signs Health Agreements with Nine African Nations

Dec 24, 2025, 2:42 AM

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The US government has signed health deals with at least nine African countries, marking a new approach to global health funding that aligns with the Trump administration's priorities. These agreements, which include nations such as Kenya, Nigeria, and Rwanda, are designed to provide less aid while fostering mutual benefits between the US and the recipient countries.

The new health framework makes US aid contingent on negotiations between the recipient country and the US, a departure from previous practices under the now-dismantled United States Agency for International Development (USAID). This shift reflects the Trump administration's "America First" policy, which aims to increase self-sufficiency in recipient nations and eliminate perceived waste in international assistance.

Several of the countries that have signed these deals have experienced cuts in US aid or have separate agreements with the Trump administration to accept third-country deportees. However, US officials have denied any direct linkage between these health agreements and the deportation policies.

The new agreements are seen as a transactional approach to foreign relations, where direct negotiations with foreign governments are used to promote US interests abroad. This strategy contrasts sharply with traditional US foreign assistance, which aimed to stabilize economies and build alliances through more generous aid packages.

Key Agreements and Their Implications

Among the countries that have signed health deals, Nigeria stands out due to its emphasis on Christian-based health facilities, despite having a slight majority Muslim population. The US has committed over $2 billion in support to Nigeria, which is expected to raise an additional $2.9 billion for its health programs. This agreement was negotiated in connection with reforms aimed at protecting Christian populations from violence, highlighting the intertwining of health aid and religious considerations in US foreign policy.

Other countries involved in these agreements include Cameroon, Eswatini, Lesotho, Liberia, and Mozambique. For instance, Mozambique will receive over $1.8 billion for HIV and malaria programs, while Lesotho has secured a deal worth over $232 million. In Eswatini, the US has committed up to $205 million to enhance public health data systems and disease surveillance, contingent upon the country increasing its domestic health expenditures by $37 million.

South Africa's Exclusion

Notably absent from this list is South Africa, which has lost significant US funding—approximately $400 million annually—due to ongoing disputes with the Trump administration. The dismantling of USAID has resulted in a loss of over $436 million in yearly financing for HIV treatment and prevention in South Africa, jeopardizing vital health programs and thousands of jobs in the healthcare sector.

Controversial Deportation Deals

At least four of the countries that signed health agreements have previously agreed to accept third-country deportees from the US, a controversial policy that has characterized the Trump administration's immigration strategy. While the State Department has denied any direct connection between the health compacts and deportation agreements, it acknowledges that political considerations may influence negotiations.

Rwanda, for example, has signed a health pact worth $228 million, with the US providing $158 million in support. Uganda has also entered into a significant health deal valued at nearly $2.3 billion, with US contributions reaching up to $1.7 billion.

Conclusion

The recent health agreements between the US and several African nations represent a significant shift in US foreign health policy, reflecting the transactional nature of the Trump administration's approach. As these countries navigate the complexities of reduced US aid and increased self-sufficiency, the long-term implications for their health systems and international relations remain to be seen. The focus on mutual benefits and specific religious considerations in health care funding may also shape future US engagements in the region.

Associated Press writers Evelyne Musambi in Nairobi, Kenya, Dyepkazah Shibayan in Abuja, Nigeria, Mark Banchereau in Dakar, Senegal, and Matthew Lee in Washington contributed to this report.

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