US Health Deals in Africa: $2.3B & “America First”

The United States has committed nearly $2.3 billion in new health agreements with Ethiopia, Botswana, Sierra Leone, and Madagascar, reflecting a shift towards more accountable foreign aid partnerships with African nations. The agreements, finalized on December 22 and 23, require the African governments to jointly contribute over $900 million from their own budgets.

New Health Agreements Focus on Disease Control and System Modernization

The agreements represent Washington’s attempt to protect U.S. national security by reducing the risk of global disease outbreaks, while also ensuring African governments take greater ownership of their health systems. This shift follows a previous decision under the Trump administration to curtail large-scale conventional foreign aid to Africa, following criticism that funding wasn’t leading to self-sustaining systems.

Ethiopia’s agreement, totaling over $1.46 billion, will target HIV/AIDS, tuberculosis, malaria, maternal and child health, and outbreak preparedness. Botswana’s $487 million package focuses on sustaining HIV epidemic control and modernizing health data systems.

Sierra Leone’s deal prioritizes malaria reduction, disease surveillance, and workforce integration, while Madagascar’s agreement aims to strengthen malaria treatment, maternal health, and epidemic response.

The four agreements follow a growing trend of African countries entering similar arrangements with the United States. The deals cover a range of health priorities, including HIV/AIDS, malaria, polio eradication, maternal and child health, and epidemic surveillance, and are structured to gradually transfer long-term costs to the respective African governments.

For Africa, the new model offers predictable funding and technical support, but also demands tougher reforms and increased domestic spending. For Washington, the deals reflect a recalibration of global health engagement – prioritizing enforceable agreements designed to deliver results for American taxpayers.

Nigeria and other African states are also signing America First health deals.

The deal with Nigeria 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.