Reported by The Africa Report
What Washington calls a reset on aid, some African governments and activists see as new strings attached, from mining interests to control over health data.
When Donald Trump’s administration rolled out its America First Global Health Strategy, officials in Washington said it was about getting back to basics: clearer rules, shared responsibility and making sure US health aid also protects Americans at home.
The United States has poured more than $200bn into global health programmes since 2001, backing HIV treatment, malaria prevention and disease surveillance across Africa and beyond. But the mood has shifted. What used to be spoken about mainly in the language of solidarity comes with firmer conditions and sharper expectations.
Push back in Zambia and Zimbabwe
In parts of Africa, the reaction has been uneasy. Zambia halted talks on a health agreement with the US after it was tied to cooperation around copper and cobalt. Zimbabwe walked away from a deal over clauses requiring rapid sharing of pathogen data. And in Kenya, the High Court suspended parts of a health cooperation framework over concerns about how citizens’ health data would be handled.
At the same time, more than a dozen other governments, including the Democratic Republic of Congo and Burkina Faso, have signed on.
So, why are some governments pushing back while others are moving ahead?
A different way of doing health aid
The America First Global Health Strategy shifts US assistance away from multilateral channels towards direct, multi-year agreements with individual governments.
Washington says it remains committed to fighting HIV/AIDS, tuberculosis, malaria and polio, while prioritising maternal and child health, surveillance and outbreak preparedness. But the delivery model is changing.
Under the new framework:
Commodities will gradually shift from US-led procurement to national control, with phased co-investment.
Frontline health workers funded by the US will be absorbed into government payrolls over time.
Data systems will be expanded and digitised to improve tracking of major diseases and outbreaks.
Co-investment will require countries to increase domestic health spending.
Performance incentives will link funding to measurable health targets.
US officials say this builds self-reliance and protects taxpayers while strengthening outbreaks. Washington argues that this structure protects US taxpayers, reduces duplication and helps countries build durable systems that can stand on their own. It also reflects a more security-driven lens, including stronger surveillance and reporting systems, which are framed as essential to preventing future outbreaks from spreading globally.
Critics say the architecture gives Washington greater influence over how health budgets are structured, how data is managed and how progress is measured, reinforcing the sense in some capitals that partnership now comes with closer oversight and firmer conditions.
Minerals, data and the courts
The pushback has been most visible in Zambia, Zimbabwe and Kenya, but for different reasons.
In Zambia, negotiations over a proposed $1bn health agreement stalled after funding was linked to cooperation around copper and cobalt. For many in Lusaka, that crossed a line. A programme aimed at tackling HIV/AIDS and malaria was suddenly sitting alongside discussions about strategic minerals. The size of the deal only sharpened concerns that health was being drawn into wider geopolitical bargaining.
In Zimbabwe, the government walked away from a $367m agreement over clauses requiring rapid sharing of pathogen and outbreak data without clear guarantees on how that information would be used or what Zimbabwe would gain in return. Officials described it as an “unequal exchange”, reflecting lingering distrust shaped by the Covid era.
In Kenya, a health cooperation framework worth more than $1.6bn, with some estimates putting the broader arrangement closer to $2.5bn, was partially suspended by the High Court. The case centres on how citizens’ health and personal data would be transferred and managed. In a country where digital rights are fiercely debated, the scale of the agreement made the questions even more politically charged.
Why are some governments signing?
Not every capital across Africa is wary.
According to the US State Department, agreements have been signed with Botswana, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, Eswatini, Ethiopia, Kenya (now pending court review), Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone and Uganda.
The DRC signed a $1.2bn partnership covering HIV/AIDS, tuberculosis, malaria and maternal health, combining US assistance with increased domestic spending.
Burkina Faso has also agreed to a five-year MOU, committing to integrate US-funded workers into its national workforce gradually.
For countries facing high HIV or malaria burdens and shrinking aid budgets globally, according to analysts, multi-year commitments remain attractive. The co-investment requirement can also be presented domestically as a step towards long-term independence.
“Much depends on the politics at home,” a former health policy official at the Africa Centres for Disease Control and Prevention (Africa CDC), tells The Africa Report.
In countries where the agreements fit neatly with what governments already want to do, they tend to move ahead without much noise. “But when they touch raw nerves, whether it’s control over minerals, access to sensitive data or long-standing sovereignty concerns, the pushback comes quickly,” says the official who prefers not to be named due to the nature of his work.
The sovereignty debate
Critics of Trump’s strategy argue that linking health funding to strategic interests, whether minerals or broader bilateral compacts, muddies the purpose of aid.
Improving access to medicine and creating avenues of national wealth from the resources in their own soil
Ace Robinson, founder and principal at Equity Is the Word, says African governments are drawing lessons from other policy arenas. “Let’s be clear. Sovereign African nations watched closely when support for military aid to end an escalating conflict and subsequent humanitarian crisis between the DRC and Rwanda became contingent on those countries giving access to mineral resources to the friends and private funders of the sitting US president,” he tells The Africa Report.
Robinson argues that several data-sharing agreements supported by Washington have appeared tied to access to biological or mineral resources, fuelling suspicion that public health frameworks could double as gateways to extraction.
“African people have a much lower tolerance of political corruption than in Western democracies,” he says. “Humanitarian aid must centre on the humans in need. All agreements must enrich and empower the countries receiving the aid – improving access to medicine and creating avenues of national wealth from the resources in their own soil.”
For governments already wary of unequal exchange, the perception that health funding could be linked, even indirectly, to resource leverage reinforces sovereignty concerns. “It does not take rocket science to understand that stripping people of resources while demanding that they do more could never work,” Robinson adds.
The former Africa CDC official echoes the broader anxiety. Expanded data-sharing provisions, he says, risk giving Washington access to sensitive epidemiological information without clear mechanisms for benefit sharing.
“Health aid works best when it’s predictable and insulated from politics. Once it’s folded into strategic bargaining, trust becomes fragile.”