Kenya News Inside Health

In December, the United States signed a series of bilateral health cooperation agreements with 14 African countries, reshaping how health aid, disease surveillance, and domestic financing will interact over the next five years. The memorandums of understanding (MOUs) outline US financial support in exchange for faster disease outbreak reporting, expanded digital surveillance, and increased domestic health spending—often alongside broader trade and geopolitical interests.

East Africa in Focus

Kenya, Uganda, and Rwanda emerged as early and prominent signatories, underscoring their strategic importance to US health and security priorities.

Kenya was the first country to sign an MOU, positioning it as a key regional ally. The agreement commits the US to up to $1.6 billion over five years for HIV/AIDS, TB, malaria, maternal and child health, polio eradication, and outbreak preparedness, while Kenya pledges an additional $850 million in domestic health spending.
However, Kenya’s High Court has temporarily halted implementation following legal challenges citing data privacy concerns and parliamentary oversight, with the case returning to court in February.

Uganda will receive nearly $2.3 billion, with the government pledging to co-invest more than $500 million. The agreement supports health digitisation, faith-based health providers, and healthcare services for the Ugandan military, which plays a role in regional security operations.

Rwanda secured $158 million in US support alongside a $70 million domestic commitment, focusing on disease surveillance and priority health services.

Beyond East Africa, Liberia, Lesotho, Eswatini, Mozambique, Cameroon, Nigeria, Madagascar, Sierra Leone, Botswana, Ethiopia, and Côte d’Ivoire also signed MOUs in rapid succession ahead of the year’s end.

Notable Absences and Political Context

Several high-burden countries—including Tanzania, South Africa, and the Democratic Republic of Congo (DRC)—were notably absent from the list of signatories, despite historically receiving significant US health funding through PEPFAR.

In Tanzania, the US has stated it is “reconsidering ties” following concerns over political repression, election-related violence, and restrictions on civil liberties. In South Africa, broader diplomatic tensions have delayed any new health agreements.

Meanwhile, the DRC signed a strategic partnership agreement focused on critical minerals, rather than a health MOU—prompting speculation that access to natural resources may be influencing the sequencing of US health assistance.

From Aid to Accountability

Across all agreements, a clear shift is evident:

• Rapid transition to domestic ownership of health service delivery

• Tighter pathogen-sharing and data-reporting expectations

• Opportunities for US firms to provide logistics, digital systems, and supply-chain support

Most MOUs anticipate a gradual reduction of US funding from the second year onward, as governments assume greater financial responsibility.

With PEPFAR bridging funds expiring on 31 March, the agreements were concluded at speed. However, many MOUs still need to be translated into detailed grant agreements, leaving questions around implementation, sovereignty, and long-term health security outcomes.

Source & Credit:
Adapted from reporting by Emily Bass and Kerry Cullinan, Health Policy Watch.

Inside Health Desk | East Africa 9. January 2026/ Urge- DevWire

US–Africa Health MOUs Signal New Era of Aid, Surveillance, and Geopolitics

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