US Accused of 'Shameless Exploitation' in Zambian Health Aid Agreement
A leaked draft of a $1bn health financing deal between the United States and Zambia has ignited fierce criticism, with advocates accusing Washington of "shameless exploitation" over terms that include mandatory data sharing and potential access to mining concessions. The memorandum of understanding (MOU), seen by the Guardian, outlines a five-year agreement where Zambia must meet strict targets or risk losing funds.
Stringent Terms and Data Sharing Concerns
The draft reveals that Zambia is expected to commit to sharing health data with the US for 10 years, a duration far exceeding agreements with other African nations. Additionally, the deal predicates health financing on a covert arrangement that could open the country's mining industry to US interests. Asia Russell, director of Health Gap, condemned the terms, stating they condition life-saving services on "plundering the mineral wealth of the country."
This bilateral approach follows the Trump administration's dismantling of most of USAID, shifting health financing directly to governments while requiring increased investments from partner countries. For Zambia, this means accepting $1.012bn in funding in exchange for hiring 40,000 new health workers and contributing an additional $400m over five years, alongside performance improvements.
Risks and Legal Challenges
If Zambia fails to meet these obligations, Washington can terminate the agreement, jeopardising the entire health system. Julius Kachidza, chair of Zambia's Civil Society Self-coordinating Mechanism, expressed concern, noting that disruptions could affect hundreds of thousands, including himself as a person living with HIV. Civil society groups are pressing for amendments, particularly to remove data-sharing requirements, with some considering legal action.
Josiah Kalala of the Chapter One Foundation warned that the deal essentially signs away "the right to access health data of its citizens to another country." Zambia is also required to share information on new pathogens for 25 years, a commitment not seen in other publicly available MOUs.
Economic Concessions and Political Fallout
The US embassy confirmed that the agreement is contingent on collaboration in the mining sector and business reforms to enhance US economic access. The MOU includes monthly briefings with the US embassy to expand commercial investment, described by Kachidza as "being held hostage." Despite denials from former health minister Elijah Muchima, who was fired shortly after his statements, activists fear Zambia is being set up to fail.
With over a third of Zambia's 2026 budget allocated to debt repayments, meeting funding obligations is challenging. The US commitment of $1.012bn over five years is lower than the $1.5bn announced previously, and funding for 2026 is set at $320m, covering programmes like HIV, malaria, and TB treatment.
Ongoing Advocacy and Transparency Efforts
Civil society groups have secured a meeting with the health ministry but received limited clarification on the MOU's ties to economic concessions. Advocates are demanding a seat on the steering committee and have filed an access-to-information request to make the latest version public. Kalala emphasised the need to "get it right at the beginning" to avoid constitutional challenges.
The situation highlights broader issues in global health financing, where aid is increasingly linked to strategic interests, raising ethical and practical concerns for vulnerable nations.
