US plans to cut health funding to 18 countries by 59% by 2030

An analysis by Public Citizen and Partners In Health reveals that the Trump administration plans to cut United States global health funding to 18 countries by 59% by 2030, a $2 billion reduction. Under bilateral agreements signed in 2025, recipient nations face steep funding cuts and strict co-financing requirements that must be raised directly without other donor support. These cuts are projected to cause significant health workforce shortages across seven African countries by 2030.

US bilateral health funding cuts

• ▪Under the bilateral agreements, Rwanda faces a 97% reduction in United States health funding, while Liberia faces 84%, Burundi 78%, Madagascar 77%, and Sierra Leone 71%.
• ▪The United States plans to cut health funding to 18 countries by 59% of pre-2025 levels by 2030, according to an analysis by Public Citizen and Partners In Health.
• ▪The planned reduction in United States global health funding under the bilateral agreements amounts to a cut of approximately $2 billion compared to aid dispensed before 2025.
• ▪The bilateral Memorandums of Understanding were signed as part of the "America First Global Health Strategy" adopted by the Trump administration in 2025.

Country co-financing requirements

• ▪The United States bilateral Memorandums of Understanding require recipient countries to make substantial co-financing commitments for activities identified as priorities by the United States.
• ▪In 11 out of 18 recipient countries, the required co-financing commitments fail to cover the United States funding cuts over five years compared to pre-2025 funding.
• ▪The bilateral agreements stipulate that country co-investments must be raised directly by the recipient country and cannot include funding from other donors or multilateral organizations.
• ▪Under the bilateral agreements, Malawi must mobilize new funding equal to 56% of its total health expenditure to meet its annualized co-financing commitment.

Penalty mechanisms for shortfalls

• ▪Uganda and Côte d'Ivoire face a two-to-one funding reduction penalty if they fail to meet their co-financing commitments under the bilateral agreements.
• ▪The United States government reserves the right to reduce or cease health funding if recipient countries fail to meet their co-financing commitments.
• ▪No penalties for co-financing shortfalls are specified in the bilateral agreements with Rwanda, Liberia, Lesotho, Eswatini, Sierra Leone, Madagascar, Burundi, Botswana, and South Sudan.
• ▪If Ethiopia, Kenya, Mozambique, Cameroon, and Malawi fail to meet co-financing commitments, the United States will reduce its funding by $1 for every $1 shortfall.

Health workforce reductions

• ▪Cameroon faces a 20% reduction in community health workers and nurses under the bilateral agreements despite already facing a severe shortage.
• ▪Seven African countries, including Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar, and Malawi, will have fewer health workers by 2030 due to reduced United States commitments.
• ▪Under the bilateral agreements, Burundi will lose all United States-funded community health workers, while Malawi will lose 3,436 and Madagascar will lose 8,200.

Pathogen specimen-sharing agreements

• ▪Several countries stated that the data-sharing agreements appended to the United States agreements directly undermine the pathogen access and benefit-sharing system negotiated at the World Health Organization.
• ▪The bilateral agreements reduce the duration of data-sharing and pathogen specimen-sharing agreements, which were initially for up to 25 years, to match the five-year agreement duration.
• ▪Zimbabwe decided not to pursue a bilateral health agreement with the United States due to objections over data-sharing requirements.

Congressional appropriations gap

• ▪The Trump administration is working to cut global health funding to developing nations by tens of billions of dollars by 2030, according to an analysis of secretive agreements.
• ▪Peter Maybarduk of Public Citizen stated that the bilateral agreements suggest the Trump administration is on course to underspend on global health by billions of dollars compared to congressional appropriations.

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