The Trump administration has signed the first in what are expected to be dozens of “America First” global health funding agreements that will prioritize combating infectious diseases in countries deemed to be aligned with the president’s broader foreign policy goals and positions.
The five-year, $2.5 billion agreement with Kenya was signed Thursday by Kenyan President William Ruto and Secretary of State Marco Rubio to replace a patchwork of previous health agreements that had traditionally been run by the US Agency for International Development for decades until the Trump administration dismantled it earlier this year.
The elimination of USAID as a separate agency sparked widespread criticism and concern in the global health community as its immediate impact resulted in the defunding of hundreds of programs focused on the developing world, including cuts to maternal and child care, nutrition and anti-HIV/AIDS programs.
Rubio said the agreement with Kenya “aims to strengthen US leadership and excellence in global health while eliminating dependency, ideology, inefficiency, and waste from our foreign assistance architecture.” He also praised Kenya for its role in leading and contributing to the international stabilization force working to combat powerful gangs in Haiti.
Ruto lauded the agreement and said Kenya would continue to play a role in Haiti as the gang suppression force transitions to a broader operation.
Details of the deal with Kenya
Under the health deal with Kenya, the US will contribute $1.7 billion of the total amount, with the Kenyan government covering the remaining $850 million.
The agreement focuses on preventing and treating diseases such as HIV/AIDS, malaria and tuberculosis with an emphasis on faith-based medical providers, although all clinics and hospitals enrolled in Kenya’s health insurance system will be eligible to receive funding, according to US officials.
“This cooperation framework is quite a departure from the past and will have a lasting impact on health for all,” said Ouma Oluga, Kenya’s principal secretary for medical services.
Family planning programs that comply with US restrictions on the provision of abortion services will also be eligible, according to Jeremy Lewin and Brad Smith, two State Department officials involved in the negotiations. They said the agreement would not discriminate against gay and transgender people or sex workers.
A number of other African countries are expected to sign similar agreements with the US by the end of the year, according to the officials, although two of the continent’s most populous nations — Nigeria and South Africa — are not expected to be among that group due to political differences with Trump, according to Lewin and Smith.
However, discussions on a deal with Nigeria are underway despite the “very significant concerns the president has around the persecution of Christians,” Lewin said.
He added that if a health agreement is reached with Nigeria, the administration is hopeful it would “enhance” efforts to address those concerns.
Dismantling USAID had repercussions across Africa, shutting down programs that fought disease and hunger and supported maternal health, and even some that tackled extremism and promoted democracy. It also put thousands of health workers out of jobs because their salaries were funded by US aid.
The impact faced by two African countries is not expected to see such deals
Sub-Saharan Africa’s battle against HIV might be set back years, experts warned, after the closing of USAID affected the President’s Emergency Plan for AIDS Relief, a bipartisan program launched by the administration of George W. Bush in 2003 and which is credited with saving around 25 million lives across the globe.
Africa is the main focus for PEPFAR, and South Africa — which has the highest number of people living with HIV in the world — had relied on USAID and PEPFAR for more than $400 million a year in help to roll out life-saving antiretroviral drugs to some of its more than 5 million people receiving treatment.
American taxpayer money funded nearly 20% of South Africa’s HIV program — the biggest in the world — until the Trump administration cut or froze the funding.
Experts at UNAIDS — the UN agency tasked with fighting the virus globally — warned in July that up to 4 million people worldwide would die if funding wasn’t reinstated.
After stinging criticism that defunding PEPFAR would cost lives, the Trump administration moved to restore some help, including a $115 million grant for South Africa’s HIV program that should help fund it until at least March.
However, Trump has said he will cut all financial assistance to South Africa over his widely rejected claims that it is violently persecuting its Afrikaner white minority.
Trump has also voiced extreme displeasure with Nigeria, another country hard hit by HIV/AIDS, over allegations of discrimination and violence targeting the Christian community.
Nigeria’s health sector was propped up by the international aid, chiefly by USAID, which poured nearly $4 billion into the country’s health care system between 2020 and 2025.
The Nigerian health system had become fragile due to years of underinvestment, with the federal government budgeting an average of 4% to 5% of the national budget to health for its nearly 220 million people in one of the world’s fastest-growing populations.
The sudden cut deepened the crisis, where aid-funded programs had created critical lifelines for millions of people.
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