JOHANNESBURG — The U.S. government has signed health deals with at least nine African countries, part of its new approach to global health funding, with agreements that reflect the Trump administration’s interests and priorities and are geared toward providing less aid and more mutual benefits.
The agreements signed so far, with Kenya, Nigeria and Rwanda among others, are the first under the new global health framework, which makes aid dependent on negotiations between the recipient country and the U.S.
Some of the countries that have signed deals either have been hit by U.S. aid cuts or have separate agreements with the Trump administration to accept and host third-country deportees, although officials have denied any linkage.
The Trump administration says the new “America First” global health funding agreements are meant to increase self-sufficiency and eliminate what it says are ideology and waste from international assistance. The deals replace a patchwork of previous health agreements under the now-dismantled U.S. Agency for International Development.
U.S. aid cuts have crippled health systems across the developing world, including in Africa, where many countries relied on the funding for crucial programs, including those responding to outbreaks of disease.
The new approach to global health aligns with President Trump’s pattern of dealing with other nations transactionally, using direct talks with foreign governments to promote his agenda abroad. It builds on his sharp turn from traditional U.S. foreign assistance, which supporters say furthered American interests by stabilizing other countries and economies and building alliances.
A different strategy
The deals mark a sharp departure from how the U.S. has provided healthcare funding over the years and mirrors the Trump administration’s interests.
South Africa, which has lost most of its U.S. funding — including $400 million in annual support — due in part to its disputes with the U.S., has not signed a health deal, despite having one of the world’s highest HIV prevalence rates.
Nigeria, Africa’s most populous country, reached a deal but with an emphasis on Christian-based health facilities, although it has a slight majority Muslim population. Rwanda and Uganda, which each have deportation deals with the U.S., have announced health pacts.
Cameroon, Eswatini, Lesotho, Liberia and Mozambique also are among those that have signed health deals with the U.S.
According to the Center for Global Development, a Washington think tank, the deals “combine U.S. funding reductions, ambitious co-financing expectations, and a shift toward direct government-to-government assistance.”
The deals represent a reduction in total U.S. health spending for each country, the center said, with annual U.S. financial support down 49% compared with 2024.
A faith-based deal in Nigeria, a lifeline for several others
Under its deal, Nigeria, a major beneficiary of USAID funds, would get support that has a “strong emphasis” on Christian faith-based healthcare providers.
The U.S. provided approximately $2.3 billion in health assistance to Nigeria between 2021 and 2025, mostly through USAID, official data shows. The new five-year agreement will see U.S. support at over $2 billion, while Nigeria is expected to raise $2.9 billion to boost its healthcare programs.
The agreement “was negotiated in connection with reforms the Nigerian government has made to prioritize protecting Christian populations from violence and includes significant dedicated funding to support Christian healthcare facilities,” the State Department said in a statement.
The department said “the president and secretary of State retain the right to pause or terminate any programs which do not align with the national interest,” urging Nigeria to ensure “that it combats extremist religious violence against vulnerable Christian populations.”
For several other countries, the new deals could be a lifeline after U.S. aid cuts crippled their healthcare systems and left them racing to fill the gaps.
Under its deal, Mozambique will get U.S. support of over $1.8 billion for HIV and malaria programs. Lesotho, one of the poorest countries in the world, clinched a deal worth over $232 million.
In the tiny kingdom of Eswatini, the U.S. committed to provide up to $205 million to support public health data systems, disease surveillance and outbreak response, while the country agreed to increase domestic health expenditures by $37 million.
No deal for South Africa after disputes
South Africa is noticeably absent from the list of signatories following tensions with the Trump administration.
Trump has said he will cut all financial assistance to South Africa over his widely rejected claims that it is violently persecuting its Afrikaner white minority.
The dismantling of USAID resulted in the loss of over $436 million in yearly financing for HIV treatment and prevention in South Africa, putting the program and thousands of jobs in the healthcare industry at risk.
Health compacts with countries that signed deportation deals
At least four of the countries that have reached deals previously agreed to receive third-country deportees from the U.S., a controversial immigration policy that has been a trademark of the Trump administration.
The State Department has denied any linkage between the healthcare compacts and agreements regarding accepting third-country asylum seekers or third-country deportees from the United States. However, officials have said that political considerations unrelated to health issues may be part of the negotiations.
Rwanda, one of the countries with a deportation deal with the U.S., signed a $228-million health pact requiring the U.S. to support it with $158 million.
Uganda, another such country, signed a health deal worth nearly $2.3 billion in which the U.S. will provide up to $1.7 billion. Eswatini also has started receiving flights with deported prisoners from the United States.
Magome and Gumede write for the Associated Press. AP writers Evelyne Musambi in Nairobi, Kenya; Dyepkazah Shibayan in Abuja, Nigeria; Mark Banchereau in Dakar, Senegal; and Matthew Lee in Washington contributed to this report.
