by MARCUS MUSHONGA
HARARE – A growing number of African countries are reassessing the terms of newly structured bilateral health agreements with the United States, with some governments signalling concern over sovereignty, financing conditions and data governance — even as others have signed on to secure continued funding for critical disease programmes.
Washington has recently shifted from largely multilateral health funding mechanisms toward direct government-to-government Memorandums of Understanding (MOUs).
The new framework restructures long-standing cooperation on HIV/AIDS, tuberculosis, malaria and pandemic preparedness into bilateral compacts that emphasise performance reporting, financial co-investment and measurable outcomes.
At least 14 African countries have signed agreements under this revised model, including Kenya, Nigeria, Uganda, Rwanda, Lesotho, Eswatini, Mozambique, Cameroon, Botswana, Côte d’Ivoire, Malawi, Ghana, Liberia and Ethiopia.
Governments that signed have generally cited the need to maintain continuity in life-saving HIV treatment programmes, strengthen laboratory systems and secure funding predictability.
Several of these countries rely heavily on U.S. support for national HIV responses. Officials have described the agreements as necessary to ensure uninterrupted antiretroviral therapy, digital health system upgrades and workforce training.
However, not all governments have moved forward without hesitation.
Zimbabwe withdrew from negotiations over a proposed multi-year funding arrangement reportedly worth hundreds of millions of dollars.
Officials indicated that certain provisions required further scrutiny to protect national interests. Zambia also delayed finalisation of parts of its agreement pending internal legal review.
While public statements from these governments have not confirmed specific objections to database access, analysts say concerns in policy circles focus on data sovereignty, cost-sharing obligations and the long-term implications of integrating national health information systems with externally funded monitoring platforms.
U.S. embassies in affected countries have maintained that the agreements are designed to improve accountability and sustainability.
Officials argue that measurable reporting standards are standard practice in international development and are necessary to ensure that taxpayer-funded programmes achieve demonstrable health outcomes.
Public reaction across Africa has been mixed. Some commentators have praised governments that sought additional safeguards, framing caution as a defence of sovereignty.
Others have warned that delaying agreements risks disrupting essential health services that support millions of patients.
Health policy experts note that modern global health financing increasingly depends on digital surveillance systems to track disease trends, treatment adherence and outbreak response.
This has elevated debates over who controls sensitive epidemiological data and how it may be used.
The controversy also reflects broader geopolitical dynamics.
In recent years, African governments have diversified international partnerships, engaging not only the United States but also China, the European Union and multilateral development banks. Negotiating leverage has grown alongside competition among global powers.
Despite tensions, U.S. health assistance remains a cornerstone of disease control efforts in many African nations. Since the early 2000s, American funding has played a central role in reducing HIV-related deaths and expanding access to treatment.
As negotiations continue, the central question is not whether partnerships will persist — but how they will be structured to balance financial support with national autonomy.
– CAJ News
