Image of America First Global Health Strategy document. Photo source: News Wings
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In September 2025, the United States (US) unveiled a new policy document titled the America First Global Health Strategy, outlining how it intends to engage with other countries on key health challenges such as HIV/AIDS, tuberculosis, malaria, polio, and outbreak preparedness.
The strategy positions global health assistance as a tool for advancing US national interests, rather than as an effort driven purely by humanitarian concerns.
So far, 14 countries, including Nigeria, Cameroon, Cote d’Ivoire, Kenya, Uganda, Ethiopia, Malawi, Botswana, Liberia, Eswatini, Lesotho, Mozambique, Madagascar, and Sierra Leone, have signed Memorandums of Understanding (MoUs) under this America First framework.
What the document entails
At the core of the strategy is a sharp critique of the existing global health aid model. The document argues that US health foreign assistance has become inefficient and overly reliant on international non-governmental organisations.
It claims that less than 40% of current funding reaches frontline services such as medicines, diagnostics, and healthcare workers, with the bulk consumed by technical assistance, programme management, and administrative overheads.
This approach, the strategy contends, has led to the creation of parallel health systems in many low- and middle-income countries, particularly in Africa, undermining national ownership and fostering long-term dependence on donor funding.
To address this, the strategy proposes a shift away from parallel systems toward models that place greater responsibility on recipient governments.
The aim is to strengthen domestic health systems and gradually reduce reliance on US support as countries build capacity to manage their own health programmes.
The policy is structured around three broad pillars: making America safer, making America stronger, and making America more prosperous.
In practical terms, this translates into preventing infectious disease outbreaks from reaching the United States, using health assistance to reinforce bilateral relationships, and promoting American health innovation overseas.
What effect does this have on Africa?
- Aids will continue, but with conditions?
The strategy makes clear that the United States does not intend to abruptly withdraw support for major disease programmes in Africa. Funding for HIV, tuberculosis, malaria, and other life-saving interventions will continue in the short term, reassuring countries that rely heavily on US-backed initiatives such as PEPFAR and USAID-supported programmes.
However, this continuity is conditional. Sustained funding will increasingly depend on recipient countries demonstrating progress in domestic financing, governance reforms, and health system ownership.
Where governments fail to meet agreed benchmarks, the strategy allows for future assistance to be reduced or withheld, introducing new uncertainty into long-term health planning.
- African government will carry more responsibility
A central effect of the strategy is the gradual transfer of financial responsibility from the United States to African governments. Countries are expected to co-finance health programmes and eventually absorb costs that have long been covered by US aid.
While this approach is framed as a move toward sustainability and national ownership, it places significant pressure on countries with limited fiscal space. For weaker economies and fragile states, the expectation to replace donor funding raises concerns about whether essential health services can be maintained without disruption.
- There will be reduced role on non-governmental organisations
The document sharply criticises the existing aid model, arguing that too much funding is consumed by programme management and administrative overheads rather than frontline services. As a result, the strategy proposes a reduced role for international non-governmental organisations, which have traditionally implemented a large share of US-funded health programmes in Africa.
Funding will increasingly shift toward government-to-government arrangements, private sector actors, and local partners. This could reshape the health aid landscape, forcing international NGOs to scale back operations or reposition themselves as technical advisers rather than implementers.
- Faith-based health providers gain influence
One notable shift in the strategy is its explicit emphasis on faith-based health providers. The document recognises religious institutions as trusted and influential actors in many communities and positions them as key partners in service delivery and outreach.
In countries such as Nigeria, where religious identity strongly shapes social life, this could translate into greater involvement of churches, mosques, and faith-based organisations in vaccination campaigns, HIV care, and public health messaging. While this may improve community acceptance, it also raises questions about coordination, regulation, and inclusivity within national health systems.
- Health aid will become a geopolitical tool
Perhaps the most far-reaching effect is the reframing of health assistance as an instrument of global competition. The strategy explicitly presents US engagement in Africa as a counterweight to China’s expanding influence on the continent.
By contrasting US grant-based health aid with China’s loan-driven infrastructure investments, the document positions health programmes as part of a broader effort to strengthen bilateral relationships and secure strategic interests. This shift signals that Africa is no longer viewed only through a humanitarian lens but as a central arena where health, security, and geopolitics increasingly intersect.
Conclusion
Africa is no longer just a recipient of US aid but a key arena for implementing American health diplomacy and advancing strategic interests. While countries stand to benefit from sustained support for essential health services, they must navigate new requirements for financing, performance, and national ownership.
