Washington’s “America First” health push in Africa

The United States has introduced a sweeping overhaul of its global health engagement, replacing the long-standing USAID-led aid model with a new framework called the America First Global Health leadership. This shift represents a move away from traditional grant-based assistance and donor-driven programs, toward direct bilateral agreements that emphasize commercial partnerships and shared financing. The change follows a radical reorientation of U.S. foreign aid policy, including the dismantling of one of the largest aid programs, USAID.

Under the new approach, Washington is negotiating memorandum of Understanding (MOUs) directly with individual African governments, positioning the United States not as a traditional aid provider but as a “strategic business and development partner.” US officials argue that the model “promotes sustainability and accountability” by requiring recipient countries to invest significant domestic resources alongside American funding.

One of the most prominent examples is Kenya, which became among the first African countries to sign such an agreement. Under the proposed deal, the United States pledged up to $1.6 billion over five years to support Kenya’s health sector reforms, while Nairobi committed approximately $850 million from its own budget. The agreement focused heavily on digital health systems, disease surveillance, and data-driven healthcare delivery.

However, what was initially presented as a landmark partnership quickly became the center of controversy.

Within weeks of the MOU’s signing, civil society organizations, digital rights activists, and lawmakers raised alarm over the agreement’s implications. The Consumer Federation of Kenya (COFEK), together with outspoken Senator Okiya Omtatah, filed legal petitions challenging the deal’s legality.

The petitioners argued that the agreement violated multiple Kenyan laws, including the Data Protection Act, the Digital Health Act, and the Health Act. Central to their concern was the handling of sensitive patient health data, particularly provisions that could allow foreign entities access to national health information systems without clear safeguards, consent mechanisms, or parliamentary oversight.

On 11 December 2025, Kenya’s High Court issued a ruling, suspending the implementation of the MOU. The court ordered an immediate halt to any transfer, processing, and sharing of Kenyan health data under the agreement until the case is fully heard and determined.

Kenya’s legal resistance carries broader significance, shedding light on both the mechanics of such agreements and their implications for how African states may engage the new U.S. administration. The administration’s approach to multilateralism has been marked by deep skepticism, while its commitment to global leadership has, at best, appeared faltering. Just this week, the administration recalled over 25 ambassadors, most of them from African countries, a move that can be interpreted as a sign of diminishing American interest in global multilateral engagement, as well as a reflection of its broader isolationist policies and practices.

While many African governments may welcome, as evidenced by their swift signing of the agreement, the promise of large-scale U.S. investment, it is widely believed that the new model risks transferring financial and regulatory burdens onto already overstretched national systems. Concerns also remain that business-oriented partnerships could prioritize strategic and commercial interests over public accountability and equity.

Moreover, this policy shift cannot be separated from global geopolitics. Washington’s new health strategy reflects a broader effort to demonstrate its continued presence on the continent despite a waning influence, particularly as competition intensifies with other global powers such as China, which has expanded its footprint through infrastructure projects, medical cooperation, and vaccine diplomacy.

By repositioning itself as a long-term health partner rather than a donor, the United States appears to be seeking deeper institutional ties. Yet Kenya’s experience illustrates how such ambitions may collide with domestic law, sovereignty concerns, and public trust. Whether this strategy can succeed under an administration inclined toward an isolationist posture remains uncertain. Equally unclear is how this new foreign policy approach will diverge from traditional norms of international engagement. At a time when data privacy has become a central global concern, the sweeping agreements across Africa, a continent still lagging in digital protections, are likely to remain contentious and a source of worry.