Shift From Aid to Compacts

Under the new framework, health funding is contingent on bilateral negotiations rather than open-ended assistance. Signatories include Kenya, Nigeria, Rwanda, Uganda, Cameroon, Eswatini, Lesotho, Liberia, and Mozambique.

A Washington think tank estimates the deals cut annual U.S. health support by about 49% compared with 2024, while requiring higher domestic spending by partner governments.

Funding Levels and Conditions

Despite overall reductions, the agreements still involve large sums. Mozambique is set to receive over $1.8 billion for HIV and malaria programs, Lesotho secured more than $232 million, and Eswatini up to $205 million, alongside a $37 million increase in domestic health spending.

Nigeria’s pact places a strong emphasis on faith-based health facilities. The U.S. previously provided about $2.3 billion to Nigeria between 2021 and 2025; the new five-year deal commits over $2 billion, with Nigeria expected to raise $2.9 billion domestically.

Politics Around the Deals

At least four signatory countries also have separate agreements to accept third-country deportees from the United States, though officials deny a formal linkage.

South Africa remains excluded after disputes with Washington and the loss of roughly $400 million in annual U.S. health funding.

U.S. officials say the compacts aim to increase sustainability and align aid with national interests, signaling a lasting change in Washington’s engagement with African health systems.