The United States has signed four new global health memorandums of understanding (MoUs) with Madagascar, Sierra Leone, Botswana, and Ethiopia, totaling nearly $2.3 billion, the State Department announced Tuesday.
The agreements are part of the Trump administration’s “America First Global Health Strategy,” launched in September to improve self-reliance in partner countries’ health sectors. According to the State Department, each MoU includes specific benchmarks, timelines, and consequences for nonperformance, designed to ensure U.S. assistance delivers measurable results against priority disease threats while reducing long-term dependency.
Across the four countries, the United States has committed nearly $1.4 billion, while the recipient nations are contributing over $900 million of their own resources.
Expanding Health Partnerships
In addition to these agreements, the U.S. embassy in Ivory Coast announced a five-year health cooperation MoU, with the State Department pledging up to 273 billion CFA francs ($491 million) and Ivory Coast committing 252 billion CFA francs toward strengthening disease detection and health worker capacity.
Earlier in December, the U.S. signed a five-year agreement with Eswatini, providing up to $205 million for health data collection, disease monitoring, response systems, and HIV prevention and treatment, with Eswatini adding $37 million in domestic health funding.
The Trump administration has also established similar health cooperation agreements with Kenya, Rwanda, Uganda, and Lesotho, reflecting a broader push to enhance disease monitoring, health workforce development, and pandemic preparedness across Africa.
By tying funding to clear performance metrics, the U.S. aims to ensure that its global health investments achieve tangible outcomes while encouraging African nations to increase their own contributions to public health.
