‘America First’ Policy Reshapes U.S. Global Health Aid Strategy

The Trump administration has fundamentally restructured U.S. global health aid through its America First Global Health Strategy, dissolving USAID after one year, withdrawing from the World Health Organization, and signing memoranda of understanding with 29 countries worth at least $20.2 billion from 2026 to 2030. These bilateral agreements require recipient governments to fund roughly 37% of total spending and shift funding control from nongovernmental organizations to national governments, while redirecting priorities toward health security and away from family planning and maternal health. Global health financing dropped 21% from 2024 to 2025, and some countries like Mozambique and Liberia will see combined health spending decline by 17% and 6% respectively by 2030 despite coinvestment commitments. Zambia and Zimbabwe rejected the agreements citing unfair data-sharing terms, while the U.S. State Department faces a lawsuit from Public Citizen over transparency after removing published agreement texts from its Freedom of Information Act library.

Withdrawal from multilateral health institutions and shift to bilateral agreements

• ▪Cambodia and Tajikistan signed memoranda of understanding with the United States on April 7, marking the first bilateral health agreements to be signed outside of Africa or Latin America
• ▪Global health financing dropped 21% from 2024 to 2025 according to the Institute for Health Metrics and Evaluation

Cofinancing requirements and country spending capacity

• ▪46 African Union countries signed the 2001 Abuja Declaration to allocate 15% of their government budgets to health
• ▪African governments devote roughly 7% of their national budgets to health on average as of 2024
• ▪Botswana allocated more than 15% of its government budget to health in 2023
• ▪The 29 memoranda of understanding govern spending between 2026 and 2030 and total at least $20.2 billion
• ▪Nigeria expects to increase its health spending from 5% of its national budget in 2025 to at least 6% from 2026 to 2030 despite committing to coinvest $3 billion
• ▪97.2% of Mozambique's gross domestic product was owed in public debt in 2025, the highest of all memorandum of understanding partner countries

Variations in MOU terms and implementation challenges

• ▪Public Citizen sued the U.S. State Department on April 3 to produce the health-funding agreements under the Freedom of Information Act
• ▪Liberia's coinvestment packages will drop 35% from 2028 to 2029 before elevating again in the agreement's final year
• ▪Liberia's combined health spending will shrink 6% by 2030 under its memorandum of understanding terms
• ▪The U.S. State Department released five full memorandum of understanding texts through its Freedom of Information Act library on March 12
• ▪The U.S. State Department removed the five memorandum of understanding texts from its Freedom of Information Act library approximately one week after March 12
• ▪Kenya expects to see its annual health investment grow $135 million from its 2026 contribution by the end of its memorandum of understanding

Perspective of Recipient governments with high debt burdens

• ▪Liberia will experience a 6% reduction in combined health spending by 2030 despite participating in the America First Global Health Strategy