Trump’s Agreements with African Nations Slash Health Funding, New Documents Show

WASHINGTON, D.C. - The Trump Administration is planning to radically reduce health funding for 18 low-income countries, a new report from Public Citizen and Partners In Health finds.

The report reviews all currently available Memorandums of Understanding (MOUs) signed as part of the America First Global Health Strategy and shows underspending of congressionally appropriated global health funds by potentially billions of dollars. The agreements spell out terms for renewed health funding after last year's devastating cuts to foreign aid. The analysis found that:

• Compared to pre-2025 global health spending, these new agreements slash funding by about $2 billion across these 18 countries by 2030, despite Congress ordering global health spending to remain relatively steady;
• Across the 18 countries, U.S. government funding would decrease between 43% and 97% compared to baseline levels by the final year of the agreements. Countries with the steepest reductions by 2030 are Rwanda (97%), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Partners In Health provides direct care in Rwanda, Liberia, and Sierra Leone, along with seven other countries, and expects underspending of these funds to impact patients' access to care;
• Under these new agreements, countries will be obligated to pay steep co-financing requirements which seem likely unattainable. Countries that miss co-financing targets may face penalties which could worsen funding cuts, with some countries set to lose much more than others. The documents provide no explanation for the inequitable variance in terms between countries.
  

While there are other avenues for spending congressionally appropriated global health funds, these bilateral MOUs are the primary funding stream, and the State Department has not spelled out how it will make up the underspend.

"These documents suggest that the Trump administration is on course to underspend on global health by billions of dollars compared to what Congress has ordered, risking lives and allowing diseases to spread," said Peter Maybarduk, Access to Medicines director for Public Citizen. "The administration must answer how and when it intends to invest the missing billions for health."

"The mechanism is complicated, but the result is not. These funding cuts will cause death and disease that is preventable," said Vincent Lin, associate director of health policy and advocacy for Partners In Health. "The State Department is setting up other countries for failure with the co-financing requirements outlined in these agreements, but it will be patients who will pay the ultimate price."

Fifteen of these MOUs were obtained by Public Citizen through a Freedom of Information Act (FOIA) request and subsequent lawsuit, in addition to those obtained by other parties. Public Citizen has made all public texts available here. To date, the State Department has negotiated 34 agreements. This week, Public Citizen sued under the Freedom of Information Act to compel the Administration to turn over the text of the remaining deals.

An earlier Public Citizen report observed diverging terms across available agreements and plotted them in a tracker. The negotiation tracker has been updated with the new agreements.

Partners In Health has led an effort to analyze public spending, or lack thereof, in global health, to ensure greater transparency and accountability. The results of their analysis have been utilized to encourage oversight of these congressionally appropriated dollars.

Partners In Health is a non-profit global health organization founded in 1987 that works to provide high-quality care to those who need it most and to strengthen local health systems in partnership with national governments and local institutions. PIH's approach emphasizes social justice, equity, long-term partnership, and comprehensive care to improve health outcomes and address structural barriers to health. As of today, PIH runs programs across four continents, where it provides direct care to millions of patients, through public facilities and community engagement.

Public Citizenis a nonprofit consumer advocacy organization that champions the public interest in the halls of power. We defend democracy, resist corporate power, and fight to ensure that government works for the people - not big corporations. Founded in 1971, we now have 1 million members and supporters throughout the country.

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