The United States has signed four new Global Health Cooperation Memorandums of Understanding (MOUs) with Ethiopia, Botswana, Sierra Leone and Madagascar, marking a major expansion of Washington’s health engagement in Africa under President Donald Trump’s America First Global Health Strategy.
- The United States has signed four new Global Health Cooperation MOUs with four more African nations.
- These MOUs represent a $2.3 billion investment, with $1.4 billion from the U.S. and $900 million from African governments.
- This approach shifts from traditional aid to co-investment, accountability, and national ownership frameworks.
- Each agreement focuses on specific health priorities, such as HIV/AIDS control, malaria reduction, maternal health, and epidemic readiness.
The agreements, concluded on December 22 and 23, are valued at nearly $2.3 billion, with the U.S. committing about $1.4 billion while the four African governments will jointly provide more than $900 million from their own budgets.
U.S. officials describe the structure as a decisive move away from traditional aid toward co-investment, accountability and national ownership.
This shift follows Washington’s earlier decision under Trump to shut down large parts of conventional foreign aid, particularly in Africa, after years of criticism that U.S. taxpayers were funding systems that never became self-sustaining.
Instead of grants and donor-driven projects, the administration replaced them with binding bilateral health compacts that include strict timelines, measurable targets and penalties for non-performance.
In Ethiopia, the new agreement totals more than $1.46 billion, targeting HIV/AIDS, tuberculosis, malaria, maternal and child health, and outbreak preparedness.
Botswana’s $487 million package focuses on sustaining HIV epidemic control while modernising health data systems.
Sierra Leone’s deal prioritises malaria reduction, disease surveillance and workforce integration, while Madagascar’s agreement aims to strengthen malaria treatment, maternal health and epidemic response.
Together, the four agreements reflect Washington’s attempt to protect U.S. national security by reducing the risk of global disease outbreaks, while also ensuring that African governments shoulder increasing responsibility for their own health systems.
Nigeria and other African states are also signing America First health deals
The four new MOUs follow a growing list of African countries entering similar arrangements with Washington.
Earlier this month, Nigeria signed the largest America First health agreement to date, a five-year $5.1 billion pact, with roughly $3 billion committed by Abuja and $2.1 billion from the United States.
The deal covers HIV/AIDS, malaria, polio eradication, maternal and child health, and epidemic surveillance, and is structured to gradually shift long-term costs to Nigeria’s government.
Other African countries, including Rwanda, Kenya and Uganda have also entered or renewed comparable health cooperation frameworks with the U.S., signaling a continent-wide transition away from donor aid toward contract-based partnerships.
For Africa, the new model offers predictable funding and technical support, but also demands tougher reforms and higher domestic spending.
For Washington, the deals reflect Trump’s recalibration of global health engagement – not through aid, but through enforceable deals designed to deliver results for American taxpayers.
