The United States has finalized $2.3 billion in health cooperation agreements with Madagascar, Sierra Leone, Botswana, and Ethiopia this week, marking the latest expansion of the America First Global Health Strategy initiated under the Trump administration. The bilateral pacts combine $1.4 billion in US funding with $900 million in partner nation contributions, featuring performance-based benchmarks for disease prevention and health system modernization.
Ethiopia's agreement prioritizes HIV/AIDS, tuberculosis, and Marburg virus preparedness, while Botswana will upgrade electronic medical records and disease surveillance networks. Sierra Leone is set to receive $30 million next year to strengthen laboratory capabilities and health workforce training. Madagascar's package focuses on malaria control and transitioning health programs to national management.
These agreements follow Kenya's December 4 signing of similar terms, though implementation faces temporary delays due to an ongoing data privacy court case. Nigeria, Rwanda, and three other African nations have already joined the initiative since its September 2025 launch.
The State Department emphasized that all memoranda include strict accountability measures, stating: "Clear timelines and consequences for nonperformance ensure US assistance delivers measurable results while reducing long-term dependence." Additional multi-year health agreements with dozens of countries are expected through early 2026.
