US announces $2.3bn health deals with 4 African countries under America First strategy

The agreements, concluded on December 22 and 23, are valued at nearly $2.3 billion, with the U.S. committing about $1.4 billion while the four African governments will jointly provide more than $900 million from their own budgets.

This shift follows Washington’s earlier decision under Trump to shut down large parts of conventional foreign aid, particularly in Africa, after years of criticism that U.S. taxpayers were funding systems that never became self-sustaining.

In Ethiopia, the new agreement totals more than $1.46 billion, targeting HIV/AIDS, tuberculosis, malaria, maternal and child health, and outbreak preparedness.

Botswana’s $487 million package focuses on sustaining HIV epidemic control while modernising health data systems.

Sierra Leone’s deal prioritises malaria reduction, disease surveillance and workforce integration, while Madagascar’s agreement aims to strengthen malaria treatment, maternal health and epidemic response.

Together, the four agreements reflect Washington’s attempt to protect U.S. national security by reducing the risk of global disease outbreaks, while also ensuring that African governments shoulder increasing responsibility for their own health systems.

The four new MOUs follow a growing list of African countries entering similar arrangements with Washington.

The deal covers HIV/AIDS, malaria, polio eradication, maternal and child health, and epidemic surveillance, and is structured to gradually shift long-term costs to Nigeria’s government.

For Africa, the new model offers predictable funding and technical support, but also demands tougher reforms and higher domestic spending.

For Washington, the deals reflect Trump’s recalibration of global health engagement – not through aid, but through enforceable deals designed to deliver results for American taxpayers.