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Ghana rejected a proposed $109 million health assistance package in April after officials raised alarms over requirements to share citizens’ personal and health data without sufficient safeguards or reciprocal protections, according to a Reuters report cited by Health Policy Watch. Zambia turned away from an agreement exceeding $1 billion whose terms conditioned funding on US access to the country’s copper and cobalt reserves, its foreign minister Mulambo Haimbe said in statements carried by ISS Africa. Zimbabwe similarly walked away from a deal valued at more than $360 million because it demanded pathogen data without guarantees of access to any resulting vaccines, diagnostics or treatments for local populations, government spokesperson Nick Mangwana explained. South Africa has also faced complete withdrawal of its annual US HIV funding, estimated at around $400 million, amid policy disagreements.
The rejections form part of a broader shift in American global health policy after the Trump administration shuttered USAID in 2025 over waste concerns and withdrew from the World Health Organization early this year, a US State Department overview stated. New bilateral memoranda of understanding tie assistance to American strategic and commercial priorities, including preferential access for US pharmaceutical companies, according to multiple reports from Think Global Health. While Ghana, Zambia and Zimbabwe have declined, at least 20 African nations including Kenya, Nigeria, Rwanda, Uganda and Burkina Faso have signed such agreements, US officials told Health Policy Watch.
World Health Organization data places average health expenditure across sub-Saharan Africa at roughly 5.6 percent of GDP, with governments allocating an average 6.7 percent of their budgets to the sector, well short of the 15 percent target agreed in the 2001 Abuja Declaration. The Institute for Health Metrics and Evaluation reported that global health financing fell 21 percent from 2024 to 2025, intensifying reliance on external support in many countries even as conditions attached to that support have grown more contentious. A Health Policy Watch assessment noted that prior USAID cuts had already led to staff layoffs and supply shortages, such as the loss of 36 workers in the Democratic Republic of Congo that delayed Ebola outbreak responses.
Kenya finalised a $2.5 billion five-year health pact last month after initial court suspensions over patient privacy issues, BBC News reported, with the US contributing $1.6 billion and Kenya covering the remainder. The Democratic Republic of Congo accepted its deal, which the US State Department said would help coordinate Ebola efforts alongside a $270 million donation, although former officials told Think Global Health that earlier funding reductions had already slowed detection capabilities. Tanzania has also signed on, joining a list that reflects uneven uptake across the continent, according to an ISS Africa review published in March.
South African Health Minister Aaron Motsoaledi stated that no nation should trade access to pathogen and genome data for financial support, a position reinforced in an open letter from more than 50 African civil society organisations warning against terms not aligned with continental interests. Zambian officials have similarly insisted on separating health negotiations from mineral resource discussions, Haimbe noted in remarks covered by TRT Afrika. The Accra Reset framework launched by African leaders in 2025 has called for stronger national ownership of health financing to reduce fragmentation, a Chatham House analysis from January found.
Critics of the bilateral model, including former US global health coordinator Jeremy Konyndyk, have told Health Policy Watch that the approach risks undermining coordinated international responses to disease outbreaks in favour of narrowly defined national interests. The US maintains that the new deals promote self-reliance by encouraging higher domestic health spending while aligning assistance with mutual strategic goals, according to its published strategy documents. Outcomes of the signed agreements will determine whether the policy strengthens or strains long-term US-Africa health partnerships, analysts at the American Enterprise Institute observed.
