The Trump administration's strategy to replace broad US aid with individual health agreements in Africa is encountering significant resistance. After slashing billions from support for African nations, the administration is negotiating bilateral health deals, but aid experts point to major drawbacks.
Funding Freeze Impact
Since Donald Trump returned to the White House, the US has cut 90% of USAID's reproductive health programs, withdrawn from UN Women and the UN Population Fund, and expanded the Mexico City Policy to bar all US global health funding from organizations involved in abortion. This has led to tangible consequences, such as a shortage of contraceptives in Ghana, where stocks remain stuck at ports. Sarah Shaw of MSI Reproductive Choices reports an uptick in teenage pregnancies, STIs, and HIV infections.
Bilateral Agreements Under Scrutiny
The administration has signed 32 health Memoranda of Understanding (MOUs) globally, totaling $20.3 billion, including $12.8 billion from the US. However, Jennifer Kates of KFF notes these do not fully replace pre-2025 support. Family planning is absent from the six public MOUs. Countries like Ghana, Zimbabwe, and Zambia have rejected deals due to data privacy concerns, steep financial targets, and demands for resource access. For instance, Kenya must contribute $850 million over the agreement period, a heavy burden given its $2.2 billion annual health budget and significant debt.
Sovereignty and Exploitation Fears
Alexandra Tarzikhan of Doctors Without Borders highlights that pushback centers on sovereignty, particularly data sovereignty, and the perception that agreements shift from public health to geopolitical or extractive arrangements. Asia Russell of HealthGAP criticizes the administration's lack of transparency and poor-quality agreements, citing Zambia's case where HIV treatment access is tied to mineral wealth. A State Department spokesperson defends the MOUs as lifesaving initiatives for HIV/AIDS, tuberculosis, malaria, and maternal health, denying abandonment of women's health.
