As the Trump administration doubles down on its "America First" mantra, several African nations are pushing back against what they see as an overly conditional approach to foreign aid. The shift in policy, which has seen USAID closed and replaced with direct bilateral agreements, is raising eyebrows across the continent. With millions of dollars in healthcare funding at stake, recipient governments are questioning whether the new deals serve their interests or merely advance American strategic and commercial goals.
The controversy centres on a £1.9 billion deal with Kenya, which was only recently approved by cabinet ministers after facing legal challenges from activists. The agreement, signed last December, requires Kenya to increase its own health spending in exchange for a US contribution of £1.3 billion over five years. While the Trump administration claims that this approach will foster self-reliant systems and reduce dependency on NGOs, critics argue that it is simply another example of "development as diplomacy", where aid is used to further American interests.
One of the most contentious aspects of these new bilateral deals is an explicit promise to prioritise US pharmaceutical and medical firms in the development and delivery of treatments. A policy document states, "Our global health foreign assistance programme is not just aid - it is a strategic mechanism to further our bilateral interests around the world." This marks a significant departure from a model of global cooperation anchored in the World Health Organization (WHO), which the US withdrew from earlier this year.
Despite 32 countries having accepted these health Memorandums of Understanding by mid-May, some nations are resisting signing. Ghana, Zimbabwe, and Zambia have all expressed concerns about the conditional nature of the agreements, with Zambia's Foreign Minister, Mulambo Haimbe, criticising what he described as an American effort to link health funding to US economic interests.
This new approach has significant implications for global health initiatives and international relations. As the UK considers its own role in international development, it is worth noting that these changes may also impact British aid efforts. With a growing emphasis on bilateral agreements driven by national interests, the landscape of international development and health cooperation is likely to shift dramatically in the coming years.
As African nations navigate this new landscape, they are being forced to weigh their relationships with Washington against their commitment to global public health. The outcome will have far-reaching consequences for the world's most vulnerable populations – and for the future of international cooperation itself.