WASHINGTON — The United States has finalized nearly $2.3 billion in landmark health agreements with Madagascar, Sierra Leone, Botswana, and Ethiopia, marking a strategic pivot toward reducing foreign dependence on American taxpayers while countering global infectious diseases.
The bilateral Memorandums of Understanding (MOUs), signed Dec. 22 and 23, represent a cornerstone of the “America First Global Health Strategy.” Under the deals, the U.S. has committed approximately $1.4 billion, while recipient nations will co-invest more than $900 million of their own resources.
Officials described the agreements as a “decisive shift” toward country ownership, moving away from indefinite aid toward measurable self-reliance.
“This is what America First leadership looks like: the United States leading the global health agenda, protecting its people from infectious disease threats, demanding accountability from U.S. assistance recipients, and delivering results for American taxpayers,” the administration said in a statement Tuesday.
The agreements include strict timelines and consequences for nonperformance. The largest deal was struck with Ethiopia, totaling $1.466 billion. The U.S. will provide $1.016 billion to maintain gains in HIV/AIDS, tuberculosis, and malaria prevention, while Ethiopia contributes $450 million to transition these programs to local leadership.
In Botswana, a $487 million arrangement focuses on HIV epidemic control. Botswana is set to contribute $381 million—more than triple the U.S. investment of $106 million. The deal also includes provisions to modernize medical records using American satellite-based technologies.
The strategy aims to insulate the U.S. from future pandemics by strengthening surveillance abroad. In Sierra Leone, the U.S. will front-load $30 million in 2026 to build laboratory capacity, with the goal of Sierra Leone assuming responsibility for most commodity and workforce costs by 2030.
“The MOU is structured to preserve and transition gains achieved through more than $5 billion in U.S. health assistance to Ethiopia over the past two decades,” the statement noted, emphasizing that the goal is to ensure essential health functions continue under domestic leadership.
In Madagascar, the $175 million agreement targets malaria and maternal health, with a specific mandate to transition the community health workforce to national ownership by 2030.
The administration stated it remains committed to signing similar multi-year MOUs with dozens of other countries in the coming weeks to further reduce the long-term burden on the U.S. budget.
