US Finalizes $2.3 Billion Health Pacts with Four African Nations Under 'America First' Strategy

New Bilateral Health Agreements Signed

The United States officially signed four new global health memorandums of understanding (MoUs) on December 23, 2025, with Madagascar, Sierra Leone, Botswana, and Ethiopia. These agreements collectively amount to nearly $2.3 billion over a five-year period, marking a significant step in the US 'America First Global Health Strategy'. The US commitment totals approximately $1.4 billion, while the four African nations have pledged to mobilize over $900 million in domestic resources as co-investment.

'America First' Approach to Global Health

This initiative is a core component of the 'America First Global Health Strategy,' which was launched in September 2025. The strategy represents a shift from traditional aid models, focusing instead on results-driven partnerships, strict implementation timelines, and monitoring mechanisms that include explicit consequences for non-compliance. The US State Department has stated that this approach is 'aimed at ensuring that American health assistance delivers measurable outcomes while reducing long-term dependence by recipient countries'. It prioritizes bilateral, government-to-government agreements over multilateral mechanisms and the traditional role of non-governmental organizations.

Targeted Health Initiatives by Country

The MoUs outline specific health priorities for each partner nation:

• For Ethiopia, the agreement focuses on investments addressing HIV/AIDS, tuberculosis, malaria, polio eradication, maternal and child health, and infectious disease preparedness. It also includes ongoing support for the country's response to the Marburg virus.
• Botswana's agreement includes plans to modernize electronic medical records and enhance disease surveillance systems.
• In Sierra Leone, the US plans to front-load more than $30 million in 2026 to rapidly strengthen disease surveillance, laboratory capacity, the health workforce, and data systems.
• Madagascar's agreement targets investments in malaria, maternal and child health, and global health security, alongside transitioning the infectious disease-focused community health workforce to national ownership.

Broader Context of US Engagement in Africa

These four agreements expand upon a framework initiated earlier in December 2025 with Kenya, Uganda, and Rwanda. Other African nations that have recently signed similar bilateral health pacts under this strategy include Eswatini, Lesotho, Mozambique, Cameroon, Nigeria, and Liberia. The new model emphasizes shared financial responsibility and accountability, with the aim of fostering self-reliance in the health sectors of partner countries.