Zambia has formally entered into a five-year health financing agreement with the United States, concluding months of public debate regarding the potential exchange of citizens' medical data and mineral rights for aid. The memorandum of understanding, signed in Lusaka on Thursday, includes a data-sharing agreement, under which the US will contribute approximately $1.5bn (£1.1bn), with Zambia also providing funding.
The agreement follows the closure of the US Agency for International Development (USAID) last year by US President Donald Trump, who cited wasteful spending. Washington has since pursued similar deals with several African nations, advocating for partner governments to assume a greater share of costs. Kenya, Tanzania, and Uganda have signed comparable agreements, while Ghana and Zimbabwe have rejected them due to conditions concerning data and specimen sharing.
Concerns about privacy, intellectual property, and benefit-sharing have reportedly been addressed in the revised text of Zambia's new deal. Health Minister Roma Chilengi stated earlier this week that provisions requiring Zambia to send biological specimens to the US have been removed, and that the agreement will not permit the sharing of individual patient records. Data exchange, he clarified, will be restricted to information necessary for monitoring and evaluating programmes funded by the deal.
Earlier this year, a leaked draft prompted civil society groups, including the Chapter One Foundation, to raise alarms about broader data-sharing terms than those accepted by other African countries. HIV advocates also demanded the publication of the text. Reports linking health funding to preferential access for US companies to Zambia's mineral reserves were also highlighted by opposition figures and activists, though the then-US ambassador, Michael Gonzales, denied these claims.
The new agreement replaces previous US programme support and is intended to fund initiatives for HIV/Aids, tuberculosis, malaria, maternal and child health, disease surveillance, and broader health system development, including the recruitment of community health workers. The US characterises this arrangement as a shift from a donor-recipient model to one of shared responsibility, with US funding expected to decrease over the five years as Zambia increases its domestic spending.