US Cuts and Ties Further Health Aid to Africa to Co-funding and Mineral Deals : Shared by Tom McDermott

The new US approach focuses on direct funding to governments which agree either to co-financing deals or to separate deals, such as an agreement on mineral extractions in Zambia.  The shift avoids moving funds to or through NGO implementing partners.  It will be interesting to see how these attempts work out and whether they result in actual new commitments to health programmes by the target governments, and whether they manage to circumvent the complex bureaucratic systems of ministries of finance that have stymied previous efforts to move funds efficiently.

Tom

U.S. Cuts Health Aid and Ties It to Funding Pledges by African Governments

Stephanie Nolen, 

The New York Times, January 15, 2026

Click here for the article

The Trump administration has signed agreements with 16 African countries providing over $11 billion in health aid over five years, replacing the previous USAID system. 

The new deals represent steep funding cuts—69% to Rwanda, 61% to Madagascar, 42% to Liberia, and 34% to Eswatini. U.S. support is now conditioned on co-financing commitments from partner countries, with more funds going directly to governments rather than through NGO implementing partners. 

In Zambia, the U.S. is attempting to tie health funding access to a separate mineral resources deal while proposing to cut Zambia's health funding by over 50%. 

The agreements were negotiated under intense time pressure with limited transparency, sometimes without key health ministry officials' knowledge. Some deals include explicit foreign policy provisions, such as Nigeria's requirement to protect Christian victims of Muslim violence. 

A Kenyan high court has suspended implementation of Kenya's agreement over concerns about pathogen sharing requirements and U.S. access to national health data. The overall funding approach contrasts with Congress, where the House voted to maintain global health funding near previous levels at $9.4 billion for fiscal year 2026, more than twice the administration's intended $3.8 billion.

Quotes:

"That system was failing American taxpayers who were going to fund this in perpetuity. It was failing countries who didn't have control over their own health sovereignty and their own health destinies."—Jeremy Lewin, acting under secretary of state for foreign assistance

"We will be punished sorely if the terms of the agreement aren't met. Yet Malawi is already struggling to finance its health system."—Gift Trapence, chair of H.I.V. organizations network in Malawi

"The health system was on its knees, and that vulnerability made it very likely that the state would sign on to any conditions, just to get some money into the Ministry of Health."—Dr. Musoba Kitui, regional director for health rights advocacy group

"We were already trying to do the impossible with not enough."—Laura Cordier, director of Pivot, Madagascar