Just before the Christmas recess, the US state department announced a set of bilateral health cooperation agreements, signing eight memorandums of understanding with governments in Sub-Saharan Africa. These agreements are being touted by some as a sign of stability in the ocean of chaos that came from the Trump administration’s decision to shut down USAID.
But what exactly are in these agreements and how will they impact things moving forward?
The first agreement was signed with Kenya, with a further seven following, each compact is for a five year US funding commitment, with the negotiating partner agreeing to increase domestic health spending over the same period.
Despite some differences in numbers, the basic gist is that the agreements represent a reduction in total US health spending for each country, with the FY24 stating that the total figure is roughly a 49% decrease on average in annual US financial support.
Most staggeringly is that the least developed countries such as Mozambique (39%) and Liberia (63%) face the steepest cuts in aid whereas Kenya (28%), a wealthier country does not.
With this in mind, what exactly will the money be spent on?
Three of the agreements are currently available for public viewing and show that finance will be spent on health commodities, frontline health workers, data systems, disease surveillance and outbreak response, laboratory systems and a flexible strategic assistance category intended for the sharing of priorities and innovation.
However, what the agreements do not account for is funding for tuberculosis, malaria, maternal and child health. Something that could be particularly problematic for the countries in these agreements, where such issues are significantly prevalent.
Ultimately, whilst these agreements may feel like a better start, there are questions that remain unanswered, particularly given the volatility of the US government.
Vivek Rajkhowa 
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