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

The Trump Administration is proud to announce historic progress in delivering on the America First Global Health Strategy. In just three months, we have moved with unprecedented speed and focus to conclude a series of landmark bilateral Memorandums of Understanding (MOUs) with recipient countries. These MOUs are proof positive that President Trump's leadership is making America safer, stronger, and more prosperous - saving millions of lives and helping recipients stand on their own. The United States will continue to build on this momentum, with additional MOUs to be signed in the coming weeks.

Under President Trump's America First Global Health Strategy, the United States has signed major bilateral health MOUs with Kenya, Rwanda, Liberia, Uganda, Lesotho, Eswatini, Mozambique, Cameroon, and Nigeria - representing more than $8 billion in direct U.S. investment, matched by more than $5 billion in co-investment by recipient countries.

These new MOUs are a game-changer. They maximize the impact of U.S. global health assistance to counter infectious disease threats, strengthen bilateral relationships, and help recipients build resilient, self-reliant health systems - preserving what works in U.S. health foreign assistance while rapidly fixing inefficiencies, reducing dependency, and ensuring that every tax dollar delivers real results for the American people.

• Kenya: Supports Kenya's leadership in charting its own health priorities by shifting more resources into the national system and reducing reliance on NGOs. Invests in data, commodities procurement, and modernization to build sustainable capacity. Incorporates meaningful co-investment commitments from Kenya aligned with ambitious yet realistic performance benchmarks, paving the way for long-term health self-reliance. $2.5 billion (More than $1.6 billion from the United States, more than $850 million from Kenya)
• Rwanda: Outlines a comprehensive vision to save lives and strengthen Rwanda's health system, including by moving away from NGO delivery systems, investing in cutting-edge health care infrastructure, fostering greater national ownership, and positioning Rwanda to take full control of its HIV/AIDS response by year four of the partnership. Builds on the Department's landmark award to Zipline International Inc. to support the construction of American-made advanced robotics to deliver life-saving medical products. Expands private sector partnership and investment, including developing next generation HIV treatments and deploying artificial intelligence (AI) for healthcare. $228 million (Nearly $158 million from the United States, $70 million from Rwanda)
• Liberia: Accelerates Liberia's transition toward self-reliance and sustainability, saving U.S. taxpayers money and securing long-term health outcomes. Supports critical areas such as HIV/AIDS, malaria, maternal and child health, and global health security. Increases Liberia's commitment to domestic health expenditures by almost $51 million to assume greater financial and operational responsibility for domestic health systems. $183 million (More than $132 million from the United States, nearly $51 million from Liberia)
• Uganda: Invests $1.7 billion in U.S. assistance to combat HIV/AIDs, tuberculosis (TB), malaria, and other infectious diseases while strengthening Uganda's health system matched by a more than $500 million pledge from Uganda to co-invest in line with the National Development Plan IV and Uganda's Vision 2040. Furthers Uganda's national health digitization effort. Provides support for faith-based health care providers and health care services to the Ugandan military. $2.3 billion (More than $1.7 billion from the United States, more than $500 million from Uganda)
• Lesotho: Supports Lesotho's efforts to combat HIV/AIDS, while bolstering the health workforce, data systems, and disease surveillance and outbreak response. Includes $132 million commitment from Lesotho to invest in its domestic HIV/AIDS response. Opens the door to innovation by providing internet connectivity for health clinics, as well as advanced robotics delivery of life-saving medical products. $364 million ($232 million from the United States, $132 million from Lesotho)
• Eswatini: Strengthens national health efforts, leverages American technology, and facilitates long-term sustainability of Eswatini's health system. Improves public health data systems, provides access to HIV antiretroviral medications, scales up access to highly effective HIV prevention interventions, including American-made lenacapavir. Increases Eswatini's domestic health care expenditures by $37 million. $242 million ($205 million from the United States, nearly $37 million from Eswatini)
• Mozambique: Expands access to cutting edge solutions to HIV/AIDS prevention, like lenacapavir. Drives advancements in malaria prevention. Increases Mozambique's domestic expenditures on healthcare by nearly 30% over five years. Improves maternal, newborn, and child health while increasing national efforts to eliminate mother-to-child transmission of HIV/AIDS. (More than $1.8 billion from the United States, and an increase of 30% in domestic health expenditures by Mozambique)
• Cameroon: Funds frontline health commodities and healthcare workers, strengthens laboratory networks, and modernizes data systems with secure interoperable digital tools to enhance disease surveillance and outbreak preparedness. $850 million ($400 million in U.S. assistance and a $450 million commitment from Cameroon)
• Nigeria: Strengthens health cooperation and reinforces national long-term leadership of Nigeria's national health systems. Drives joint action in critical areas such as ensuring reliable access to medicines and affordable integrated health care services that combat HIV/AIDS, tuberculosis (TB), and malaria, while improving maternal and child health outcomes. Invests significant resources in the more than 900 faith-based clinics and hospitals across the country. $5.1 billion (approximately $2.1 billion from the United States, nearly $3 billion from Nigeria)

The maximum duration of these MOUs is five years with no future commitment of U.S. assistance.

Each bilateral Memorandum of Understanding reaffirms the United States' commitment to the ambitious goals that we have set over the past decades for combatting the spread of HIV/AIDS, tuberculosis, malaria, and polio, and prioritizes maternal and child health, disease surveillance, and infectious disease outbreak preparedness. The guiding principles in these MOUs include streamlining performance monitoring, reducing non-frontline investment by integrating U.S. programming within a country's broader health system, mobilizing the private sector and faith-based organizations, and requiring increased co-investment from receipt countries for healthcare workers and commodities.

Each Memorandum of Understanding also contains important and innovative provisions that facilitate long-term sustainability such as:

• Commodities: The procurement of commodities will be transitioned from the U.S. government to partner governments gradually over the period of the MOU. The United States has committed to covering 100 percent of frontline healthcare workers and commodities responsible for U.S. foreign assistance for the next fiscal year and will work with countries to co-invest in these efforts over time.
• Frontline Health Workers: Frontline health workers currently funded by the U.S. government will be mapped to the cadres of health workers that can be employed by partner governments, and those cadres of health workers will be transitioned to the partner government payroll over a multi-year period as jointly agreed.
• Data Systems: Funding will support the scale up of partner governments' health data systems to ensure key programmatic data for HIV/AIDS, TB, malaria, polio, and disease outbreaks can be tracked at scale long-term.
• Co-Investment: Partner governments will increase their domestic health expenditures over the MOU period, a critical step in ensuring partner governments have the resources they need to sustain their health response long-term without support from the U.S. government.
• Performance Incentives: 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.

Launched on September 18, 2025, the America First Global Health Strategy outlines a comprehensive vision to protect Americans from infectious disease threats, strengthen global health systems, and promote American innovation abroad.

The strategy prioritizes bilateral MOUs that transition U.S. technical assistance and key functions to partner governments, mobilize private sector and faith-based organizations, and require increased co-investment from recipient countries.

To learn more, visit the America First Global Health Strategy page.

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