Across several African countries, governments are entering into bilateral Memoranda of Understanding (MoUs) with the United States government. These agreements are evolving quickly, and while their full implications are not always transparent, they will have significant consequences for health financing, program delivery, and national priorities in HIV, TB, and malaria responses.
At the same time, countries are actively preparing funding requests under the Global Fund’s Eighth Replenishment Cycle (GC8). This creates a critical moment for advocates to understand how external financing shifts, like U.S. bilateral MoUs, could shape what is included, prioritized, or left out of Global Fund grants.
NEW Our Helpful Guide to Reading the MoUs
This resource deck is intended to help advocates read the U.S. government (USG) MoUs for bilateral health funding. It is complemented by two documents:
- A primer for understanding how the transformative impact of the MoUs and their implications for Grant Cycle 8 planning / implementation: find it here
- A template for advocates to inform their internal analysis of priorities and their external engagement with stakeholders: find it here
Key Resources
- Must Attend: Regular advocates’ calls being hosted by PIH
- Must Read: Emily Bass’ Substack
- KFF Tracker: America First MoU Bilateral Global Health Agreements – This tracker provides an overview of the MOUs signed to date. Data are based on press releases issued by the State Department, U.S. embassies, and partner country Ministries of Health, as well as MOU documents (if publicly available). See Methods for more information. This tracker will be updated as agreements are signed and more data become available.
- Think Global Health MoU Tracker – This interactive tool assesses the sustainability and scope of the co-financing obligations under the MOUs. Toward this effort, it analyzes the partner governments’ recent and projected health spending, examine how U.S. funding is expected to change under the agreements, and evaluate the available text of the MOUs.
- US Gov MoUs Negotiation Analysis – Key takeaway from slide deck from March is that areas covered in MOU largely align with scope of previous funding commitments, however, reductions in non-HIV areas are likely unless advocated for by government and nutrition and family planning/reproductive health are excluded across the board.
- One Campaign’s MoU’s Breakdown – This is a breakdown of the African MOUs by country and co-financing requirements as of March 18, 2026. Note that this page will be updated as further MOUs are signed.
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USAID’s Role in Global Health Supply Chain Programs and Implications of Aid Cuts: A Rapid Review – This brief outlines urgent risks now facing countries, from stockouts to loss of technical capacity, and calls for immediate action from governments and partners to stabilize supply chains while planning a longer-term transition to more resilient, domestically financed systems.
- Unmeasurable and Unaccountable – amfAR has released a new report on the America First Global Health Strategy’s first set of seven publicly available Memoranda of Understanding (MOUs) with the countries of Ethiopia, Kenya, Liberia, Mozambique, Nigeria, Rwanda, and Uganda.
- For info on some baseline funding levels go to this link. Useful to compare US funding proposals against previous funding levels as a baseline
- What Can We Learn from Past G2G Assistance – This note catalogs several historic mechanisms for channeling US economic assistance to country systems, offering context as policymakers move from agreements to execution. It concludes with five key points to watch in the implementation of the global health agreements: capacity constraints within the State Department, the use of layered or complementary mechanisms, balancing country ownership and conditionality, navigating congressional risk tolerance, and deploying coordinated technical assistance.
- Zimbabwe rejects the MoU– Zimbabwe has rejected a proposed $367m US health MoU, calling it “lopsided” due to concerns over data sovereignty and inequitable benefit-sharing. According to the report, the agreement required Zimbabwe to provide biological samples and health data without guarantees of access to resulting vaccines, treatments, or diagnostics, effectively supplying “raw materials for scientific discovery” without assured public health returns. The government also pointed to tensions with multilateral norms, particularly equitable frameworks like WHO-led pathogen-sharing systems, highlighting broader concerns that such bilateral deals may commercialize shared data while bypassing fair access principles and existing global health architectures.
- Zimbabwe National Network of People Living with HIV (ZNNP+) Statement – ZNNP+ is concerned about the stalled negotiations and that stems from the heavy reliance of Zimbabwe’s HIV response on US funding. They acknowledge the government’s concerns over data sovereignty and unfair terms, they are urging continued negotiations because any funding gap risks treatment interruptions, drug stockouts, and setbacks in HIV outcomes, particularly for vulnerable populations.
- Zambia rejects the MoU – Zambia has also moved away from the MoU negotiations especially because of the conditionalities around long-term sharing of health data, reportedly far longer than what other countries have been able to negotiate. The rejected MoU also predicates any health financing on an even more covert arrangement that could open up the country’s mining industry to US interests.
- More resources coming soon! Have we missed somethin? Let us know