The Trump administration is offering African nations hundreds of millions of dollars to support their healthcare systems and fight disease, but the deals come with strings attached — and several governments are pushing back. This matters because it marks a significant shift in how the US delivers foreign aid: away from the traditional model of funding NGOs and multilateral bodies like the World Health Organization, and towards direct, bilateral agreements tied explicitly to US strategic and commercial interests. The change follows Trump's closure of USAID and withdrawal from the WHO, which gutted health programmes across the continent.

The new agreements require recipient governments to increase their own health spending and to prioritise US pharmaceutical and medical firms. Kenya signed a landmark $2.5bn deal — with the US contributing $1.6bn and Kenya pledging $850m over five years — though it was delayed by legal challenges before ministers approved it. By mid-May, 32 countries had accepted the health memorandums, including at least 20 in Africa. But Ghana, Zimbabwe and Zambia have resisted, citing concerns over data protection, US access to patient information and pathogens, and attempts to link health funding to critical minerals access. Washington has also withdrawn HIV/Aids funding from South Africa, tying the move to political demands including the treatment of the Afrikaner minority.