Tensions are growing between the United States and African nations over new health agreements, with debates intensifying over data ownership, unequal terms and long-term control.
While some governments have signed agreements to secure much-needed funding under Washington’s America First strategy, others are rejecting or renegotiating deals, citing issues related to autonomy, data control and the long-term benefits.
U.S. health memoranda for Africa
At the center of these debates is the alleged growing “control” by the U.S. over African health systems through billion-dollar-worth Memoranda of Understanding (MOUs), which Washington introduced in late 2025.
By 23 March 2026, the U.S. had signed such agreements with 23 African governments, worth more than US$20 billion, of which over 35% is expected to be allocated by the recipient governments over the next three to five years.
Unlike treaties or other documents, MOUs can be concluded much more quickly because they make it possible to bypass parliamentary approval or public scrutiny, which raises concerns about transparency and accountability.
Moreover, experts note that the documents explicitly stipulate their non-binding nature, “creating no enforceable rights or obligations under international or domestic law”.
This means that neither side can take legal action if the other fails to follow through. At the same time, experts warn that such a provision may pave the way for future legally-binding agreements that are built on these initial terms.
Data sovereignty or ‘colonialism’?
Against this background, questions about how data is handled have become a central point of contention, as many agreements require countries to share sensitive health data and biological samples. Kenya’s MOU, for example, obliges the country to detect potential epidemics within seven days and alert the U.S. within 24 hours.
U.S. officials, including Secretary of State Marco Rubio, state that data sharing means “greater security” by enabling quicker outbreak detection and response.
However, African health experts have described this approach as “digital colonialism”. According to Sophia Harman, International Politics Professor at Queen Mary University of London, the U.S. is advancing its own interests and extracting benefits for its companies while leveraging global health influence to compete with China.
Geopolitical, economic and religious influence
Beyond the data, some agreements have also raised questions about geopolitical and economic conditions. Reports suggest that certain deals may be linked to non-health issues, including access to strategic mining resources or specific political requirements.
Zambia rejected a US$1 billion U.S. health deal due to clauses linking aid to mining partnerships, specifically access to copper and cobalt.
Asia Russell of Health Global Access Project criticized the agreement, saying it “would slash U.S. funding to life-saving programs while prioritizing mining corporations over Zambians with HIV”.
At the same time, the signing by Nigeria of a US$2 billion-worth deal with the U.S. has raised criticism concerning potential religious influence, as support will be skewed towards Christian faith-based healthcare providers despite the country having a slight majority Muslim population.
Top 5 signatory countries and their financial commitments
The deals signed with the 23 African countries vary from less than US$100 million to over US$2 billion. While presented as major funding packages, these agreements combine U.S. support with significant domestic contributions, requiring the partner countries to increase their own health spending over a five-year period. In many cases, governments are expected to finance a substantial share of the total cost.
Nigeria’s deal is the largest, valued at US$5.1 billion, with roughly US$3 billion expected from domestic sources.
Kenya and Uganda have agreements worth US$2.5 billion and US$2.3 billion, respectively. Kenya has committed to contribute 34% and Uganda 25%.
Mozambique’s deal exceeds US$1.8 billion, with the government’s contribution set at 4%.
Ethiopia’s agreement is valued at US$1.5 billion which is tied to co-financing commitments of 31%.
What they gain
Analysts explain that countries with high HIV and malaria burdens will see the benefits of multi-year deals that offer stability amid shrinking aid budgets. Co-investment can also boost domestic ownership, they note.
For signatories, the immediate benefit is a significant influx of funding to stabilize health systems strained by recent crises. However, the longer-term risks are structural as, under MOUs, countries must take over financing responsibility within five years, despite the U.S. cutting its baseline investment by 40% in some cases.
Who has rejected the deals?
Zimbabwe rejected a US$367 million U.S. health memorandum in February 2026. Although the deal targeted HIV, TB, and malaria, it required the country to share sensitive data without assurances on being able to access future medical innovations.
Kenya’s High Court suspended a US$1.6 billion health deal amid concerns over citizens’ data privacy.
Zambia rejected a US$1 billion U.S. health deal to combat HIV/AIDS and malaria due to clauses linking aid to mining partnerships.
What they may lose
Zimbabwe, Zambia, and Kenya face high HIV rates, which they have managed to decrease over the last few years due to expanded treatment. Zimbabwe has reported 1.3 million people living with HIV, Zambia about 1.2 million cases, and Kenya approximately 1.5 million cases.
Against this backdrop, health experts have warned that losing U.S. funding will add uncertainty for health services and could disrupt treatment continuity. Millions depend on these programs, they warned, and losing them could reverse years of progress.
So, partnership or leverage?
The question remains whether these partnerships primarily serve African health priorities or broader U.S. strategic interests. Evidence suggests a mix of both.
According to analysis by the Kaiser Family Foundation, the agreements provide short-term funding stability and aim to encourage long-term domestic investment in health systems. However, researchers and global health experts have also pointed to the risks, including unequal bargaining power, data control imbalances and shifting financial burdens onto recipient countries.
Ultimately, experts argue, the impact of these deals will depend on how governments negotiate safeguards, balance immediate health needs with long-term autonomy, and ensure that partnerships translate into equitable access to future medical innovations.