Advancing the America First Global Health Strategy Through a Landmark Bilateral Global Health MOU with Côte d’Ivoire

The America First Global Health Strategy is the U.S. State Department’s new overall plan for how the U.S. does global health aid. It is framed around making America “safer, stronger, and more prosperous” and has three main goals:

1. Make America safer – stop infectious disease outbreaks abroad before they reach U.S. borders by improving surveillance, labs, outbreak response, and preparedness in other countries.
2. Make America stronger – shift from open‑ended aid to time‑limited, country‑owned cooperation through multi‑year bilateral agreements that require partner governments to co‑invest more of their own money and gradually take over responsibility for health workers, commodities, and systems.
3. Make America more prosperous – use health aid to open markets and create opportunities for U.S. firms (for example in medicines, supply chains, data systems and other health technologies) while continuing global disease-control goals (HIV, TB, malaria, polio, maternal/child health).

The Côte d’Ivoire MOU is one of these bilateral deals: it channels U.S. health funds into epidemic surveillance, labs, supply‑chain and data modernization, and frontline health systems, while requiring large new domestic health spending and eventual “full country ownership.”

In this context, a Memorandum of Understanding (MOU) is a formal written cooperation agreement between the U.S. government and Côte d’Ivoire that sets out shared goals, financing commitments, performance expectations, and how the partnership will work over five years.

Under U.S. practice, these new global health MOUs are framed as policy and funding frameworks rather than treaties, and internal documentation and expert analysis describe them as non‑binding political agreements (unlike a ratified treaty or “compact,” which would be legally binding in international law). They still matter in practice because they guide how U.S. agencies program money and what partner governments are expected to do, but they are not enforceable in an international court.

“Recipient country co‑investment” means Côte d’Ivoire must put substantial its own government money into the same health priorities the U.S. is funding, instead of relying mainly on U.S. aid.

For this specific MOU, that means in practice:

• Côte d’Ivoire commits $450 million in new domestic health funding over five years alongside up to $487 million from the U.S.
• At least $125 million of that Ivorian money must go to taking over full responsibility for frontline health workers and essential health commodities that U.S. funds had been supporting.
• More broadly, like other America First MOUs, Côte d’Ivoire is expected to gradually assume procurement of health commodities, pay for more of its health workforce from its own budget, and increase overall domestic health spending over the life of the agreement.

Public documents describe what will be funded and the principle of accountability, but they do not spell out a detailed oversight structure for this specific MOU. Based on the strategy and fact sheets, oversight will likely look like this:

• U.S. side: The State Department’s Bureau of Global Health Security and Diplomacy and other U.S. agencies that manage health funds (for example, PEPFAR‑implementing agencies such as CDC and USAID) are responsible for monitoring performance and tying continued U.S. funding to results under the America First Global Health Strategy.
• Joint monitoring: The bilateral health agreements are supposed to “streamline performance monitoring” and link U.S. support to countries’ achievement of agreed‑upon health metrics, with “performance incentives and transition assistance” for meeting or exceeding targets. That implies joint U.S.–partner government review mechanisms, but the Côte d’Ivoire press statement does not describe them in detail.
• Côte d’Ivoire side: The Ivorian government is responsible for budgeting, spending, and accounting for its $450 million in domestic co‑investment, and—consistent with other MOUs—would be expected to track domestic health expenditures and report on them to the U.S. and to any joint oversight body.

No open-source document reviewed specifies a named auditor (for example, a particular inspector general’s office or external audit firm) or provides a detailed audit plan for this MOU.

Public information only specifies how much of Côte d’Ivoire’s co‑investment is earmarked for frontline workers and commodities, not a detailed spending breakdown.

What is known:

• Côte d’Ivoire must dedicate $125 million of its $450 million co‑investment to “taking on full responsibility for frontline health workers and essential health commodities.” This means shifting payment of salaries/benefits for key health staff and purchasing items like medicines, test kits, vaccines, and other core supplies from Ivorian government budgets instead of U.S. funds.

However, available U.S. government documents do not say exactly:

• how that $125 million will be split between salaries vs. specific commodities,
• which health worker cadres (for example, nurses, community health workers, lab staff) are included, or
• which disease programs (HIV, TB, malaria, maternal/child health, etc.) the commodities line will cover.

Those details would typically be in implementation plans or country operational plans that are not publicly attached to this press statement.

The MOU itself is described only at a high level, so it does not list named companies or tender rules. From the strategy and fact sheets, the opportunities and likely selection process are as follows:

Types of opportunities for U.S. companies

• The Côte d’Ivoire press statement says the MOU “expands opportunities for U.S. companies” by supporting modern logistics, data, and supply‑chain solutions that are “critical to infectious disease control and response.”
• The broader strategy’s “Making America More Prosperous” pillar highlights foreign‑assistance procurement and “commercial partnerships,” indicating demand for U.S. firms that provide:
  • medicines and medical products,
  • supply‑chain management and cold‑chain logistics,
  • health information systems and data platforms,
  • laboratory and diagnostic technologies.

How suppliers are likely to be selected

• U.S.-funded procurements are typically run under U.S. federal acquisition rules and agency grant/contracts procedures (for example, USAID, CDC), using competitive tenders open to qualified firms, with an explicit preference for U.S. companies in some cases.
• As the agreements transition commodity purchasing and staffing costs to partner governments, Côte d’Ivoire’s own procurement laws and tender processes will increasingly govern who supplies medicines, equipment, logistics, and IT systems, with the U.S. encouraging use of transparent, performance‑based contracting.

The public MOU‑related documents do not provide a specific procurement manual or list of tender criteria unique to this agreement.

Neither the Côte d’Ivoire press statement nor the general fact sheet publishes a clause spelling out concrete penalties (such as automatic suspension or repayment) if Côte d’Ivoire fails to meet its co‑investment or “ownership” commitments.

What is described instead are incentive‑based and conditional‑funding approaches across these agreements:

• The fact sheet states that “U.S. government financial support will be linked to countries’ ability to meet or exceed key health metrics with financial incentives for countries who exceed those metrics.” This means future U.S. funding levels and forms of support can be adjusted up or down based on performance.
• It also emphasizes that partner governments must increase domestic health expenditures and gradually take over procurement of commodities and payment of frontline health workers; if they do not, the U.S. has the option—under its ordinary budget and foreign‑assistance authorities—to withhold, reprogram, or redesign support.

In short, the accountability mechanism is mainly that continued or incentive funding is conditional on performance and co‑investment, but publicly available documents do not spell out detailed consequences or enforcement procedures unique to Côte d’Ivoire’s MOU.