US signs new health deals with 9 African countries that mirror Trump's
priorities
[December 23, 2025]
By MOGOMOTSI MAGOME and MICHELLE GUMEDE
JOHANNESBURG (AP) — 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 United States 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 Donald 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 health
care 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 the 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 health
care 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
health care programs.
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A donation plaque recognizing "The American People" hangs outside a
clinic in Thaba-Tsoeu, Lesotho, July 13, 2025. (AP Photo/Bram
Janssen, File)
 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 health
care 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 health care 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 health care
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 health care
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. Also
Eswatini, which has started receiving flights with deported
prisoners from the U.S.
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Associated Press 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.
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