Delivering on President Trump’s Commitment: America First Global Health Strategy and Bilateral Health MOUs

The America First Global Health Strategy is the Trump administration’s overarching plan for how the U.S. will do global health aid. Released by the State Department on September 18, 2025, it is built around three pillars:

1. Safer – keep Americans safe by detecting and helping contain infectious disease outbreaks abroad before they reach U.S. shores, through global surveillance, rapid response, and surge support.
2. Stronger – use multi‑year bilateral agreements (MOUs) with “key countries” to advance U.S. interests while maintaining funding for frontline health workers and commodities, building national data systems, and shifting from NGO‑run projects to government‑led health systems with co‑financing and performance benchmarks.
3. More Prosperous – promote American economic interests by sourcing health products from U.S. companies and protecting the U.S. economy from outbreak‑driven disruptions.

The strategy explicitly aims to reduce what it calls “dependency” and “overhead” in traditional aid, rapidly transition technical assistance and some service delivery responsibilities to partner governments, and complete bilateral health MOUs with countries receiving most U.S. health assistance by the end of 2025.

Bilateral health MOUs (memoranda of understanding) are non‑binding, government‑to‑government framework agreements that set the terms for multi‑year U.S. health cooperation with a specific country.

Under the America First Global Health Strategy, these MOUs typically include:

• Scope and funding: 5‑year cooperation packages combining U.S. funding and partner‑country co‑investment, often totaling hundreds of millions to several billions of dollars per country.
• Focus areas: HIV/AIDS, tuberculosis, malaria, polio, maternal and child health, laboratory systems, data systems, disease surveillance, and outbreak preparedness.
• Frontline support: U.S. commitment to fund 100% of frontline health commodities and frontline health workers initially, with a phased transition of commodity procurement and health worker salaries onto partner‑government budgets.
• Domestic co‑investment: explicit requirements for governments to increase their own health spending; U.S. funding can be reduced if co‑investment targets are not met.
• Data and performance: expansion of national digital health and surveillance systems, health‑data sharing, and performance benchmarks; U.S. funding is tied to achieving agreed health metrics, with “performance incentives” for over‑achievement.

Because MOUs are statements of intent rather than treaties, they rely on political commitment and annual appropriations rather than legal enforceability, but they are central to how the new strategy restructures U.S. health aid.

According to the mirrored text of the State Department fact sheet, the bilateral health MOUs referenced in “Delivering on President Trump’s Commitment: America First Global Health Strategy and Bilateral Health MOUs” cover nine African countries:

• Kenya
• Rwanda
• Liberia
• Uganda
• Lesotho
• Eswatini
• Mozambique
• Cameroon
• Nigeria

External analysis confirms that an initial wave of eight MOUs was signed with sub‑Saharan African governments and that these are framed as the first set of bilateral health compacts under the America First Global Health Strategy.

The fact sheet “Delivering on President Trump’s Commitment: America First Global Health Strategy and Bilateral Health MOUs” is listed by the State Department under the Office of the Spokesperson, and cross‑referenced in the Bureau of African Affairs’ releases pages.

In typical State Department practice, such fact sheets are formally issued “by the Office of the Spokesperson,” rather than in the name of a single named official.

The “Exception: forbidden” message indicates a technical or access‑control problem on the State Department server (for example, a permission or firewall setting) rather than a publicly documented policy reason. The Department has not provided a public explanation for this specific error.

However, the same text of the December 22, 2025 fact sheet is available via:

• Republished version on the MENAFN site labeled as content from the U.S. Department of State.
• References and summaries in reputable analyses of the new bilateral health agreements, which cite the State Department press releases.

There is currently no alternate, freely accessible official state.gov copy of the full fact sheet, but these mirrors and analytic pieces provide its substance.

Yes. The fact sheet announced large, quantified funding packages and other concrete commitments under the strategy.

Based on the mirrored U.S. text and independent analysis:

• Total scale: More than $8 billion in direct U.S. investment and over $5 billion in partner‑country co‑investment across nine African countries.
• Country‑level packages (examples):
  • Kenya: $2.5 billion total (over $1.6 billion U.S., over $850 million Kenya).
  • Uganda: $2.3 billion total (over $1.7 billion U.S., over $500 million Uganda).
  • Nigeria: $5.1 billion total (about $2.1 billion U.S., nearly $3 billion Nigeria).
  • Mozambique: over $1.8 billion U.S. funding plus a 30% increase in domestic health spending.
• Program areas: HIV/AIDS, TB, malaria, polio, maternal and child health, health commodities, frontline workers, data and lab systems, disease surveillance, and outbreak preparedness.
• Structural commitments: phasing commodity procurement and salaries to national systems; performance‑based funding; and binding co‑investment and spending‑increase pledges by partner governments.

CGD’s review of the signed MOUs confirms that each compact pairs a 5‑year U.S. funding commitment with negotiated domestic‑spending increases and outlines detailed investment areas and conditions.

The MOUs would significantly reshape U.S. health programs and relationships with partners in Africa in several ways:

• Shift from NGO‑run aid to government‑to‑government deals: Funding and responsibilities move from U.S.‑funded NGOs to African governments, with more money flowing through national systems and faith‑based providers, and less via traditional project‑style technical assistance.
• Co‑financing and fiscal pressure: Countries must increase domestic health spending and meet co‑investment targets, or risk cuts in U.S. funding. Analyses show these compacts generally reduce net U.S. health spending versus previous levels, forcing governments to fill gaps in HIV, TB, malaria, and other services.
• Frontline services and transitions: In the short term, the U.S. commits to cover 100% of frontline commodities and health workers, but over 5 years, procurement and salaries are supposed to move onto national budgets, which may strain already limited fiscal space.
• Data, surveillance, and sovereignty issues: MOUs emphasize expanded national digital health and surveillance systems and sharing of health data and pathogen samples. Civil‑society groups and courts (e.g., in Kenya) have raised concerns about privacy, consent, and whether such deals were negotiated without adequate public or parliamentary oversight.

Overall, for African partners these MOUs promise more ownership and longer‑term planning but also entail substantial financial, governance, and data‑sovereignty risks if co‑financing or implementation falter.