The United States has entered into bilateral health agreements with at least nine African countries, including Kenya, Nigeria, Rwanda, Cameroon, Eswatini, Lesotho, Liberia, Mozambique, and Uganda, under a revamped global health framework that prioritizes transactional arrangements and aligns closely with the Trump administration's "America First" agenda.

These pacts represent a fundamental shift from traditional multilateral aid models, replacing programs previously managed through the dismantled United States Agency for International Development with direct government-to-government negotiations that emphasize reduced U.S. funding, increased recipient country contributions, and mutual benefits over unilateral assistance.

According to analyses from think tanks like the Center for Global Development, the agreements have resulted in an average 49% reduction in annual U.S. health spending compared to 2024 levels, while imposing ambitious co-financing requirements on the African nations to promote greater self-sufficiency and eliminate perceived inefficiencies in prior assistance structures.

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Notably, several signatories, such as Rwanda, Uganda, and Eswatini, have existing arrangements to accept third-country deportees from the United States, although State Department officials have firmly denied any direct connection between these immigration policies and the health compacts, insisting that negotiations remain focused on health outcomes despite broader political considerations.

The deals have drawn scrutiny for incorporating administration priorities, exemplified by Nigeria's agreement which places a strong emphasis on supporting Christian faith-based health facilities amid commitments to protect vulnerable populations, while South Africa remains excluded from any new pacts following disputes that led to the loss of substantial prior funding for critical HIV programs.

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