Trump Administration Reshapes Foreign Assistance with Direct Health Deals

A sweeping overhaul of Washington’s foreign assistance framework has replaced multilateral aid programs with bilateral health deals across the globe. Under the State Department’s America First Global Health Strategy, the U.S. Has secured 36 individual agreements committing $16 billion in assistance—a shift that follows President Trump’s dismantling of the U.S. Agency for International Development (USAID) over cited concerns of fraud, waste, and abuse. Janeen Madan Keller, acting co-director of the Global Health Program at the Center for Global Development, described the initial fallout from dismantling USAID as immediate and severe. “It’s a period that’s best described as chaos,” Madan Keller noted, emphasizing the rapid fallout for communities in low-income nations. She added that “the shift that’s currently unfolding is very large and it’s very rapid.”

In Lusaka on October 8, 2025, U.S. Embassy Chargé d’Affaires Mich Coker joined Zambia’s Minister of Finance and National Planning Situmbeko Musokotwane and Minister of Health Roma Chilengi to formalize a five-year health cooperation memorandum of understanding (MOU). Speaking at the signing, officials highlighted that “this MOU represents a fundamental shift” away “from a traditional donor-recipient model to a true partnership, one grounded in Zambian leadership, in Zambian ownership and in shared accountability.”

Under the terms of the Zambian agreement, the U.S. Will provide $1.5 billion over five years, while Zambia must raise its domestic health expenditures by $975 million. Minister Chilengi indicated the deal could support the recruitment of up to 40,000 healthcare workers.

Strategic Priorities and Transparency Concerns

Despite official praise for boosting local self-reliance, critics argue the bilateral approach introduces transactional conditions into health aid. Asia Russell, executive director of the advocacy group Health GAP, highlighted a major controversy surrounding the Zambian agreement, where activists exposed provisions seeking to condition health funding on access to Zambia’s copper and rare earth mineral resources. Russell also cautioned that focusing on signed documents overlooks public health outcomes such as curbing HIV transmission. The administration is prioritizing “process indicators — not impact indicators — as its first measure of success, which is basically a loser’s gambit with pandemics,” Russell said. “Rubio crowed about signing documents. That doesn’t save lives.”

Data transparency marks another point of departure from former initiatives like PEPFAR. Ramona Godbole, former deputy director of policy, planning and programs at the now-defunct USAID, previously noted that PEPFAR operated as a “gold standard for collecting data on a regular basis and sharing it transparently.” By contrast, current MOUs remain unreleased by the U.S. Government, surfacing only through litigation and Freedom of Information Act requests. Overall global health spending has contracted under the new model. Calculations by KFF show that the $16 billion committed across signed agreements reflects a 34% drop in U.S. Global health aid. Nations unable to negotiate terms have been cut off entirely; Zimbabwe, for example, lost all U.S. Global health funding after failing to reach an agreement.