WASHINGTON — The Trump administration is planning to reduce U.S. health funding to 18 countries by 59% by 2030, representing a cut of approximately $2 billion compared with pre-2025 funding levels, according to an analysis by Public Citizen and Partners In Health.
The analysis examined bilateral health agreements negotiated by the U.S. administration under its “America First Global Health Strategy,” which aims to move countries toward greater self-reliance and away from dependence on U.S. foreign health assistance.
The 18 countries examined are Botswana, Burundi, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Eswatini, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone, South Sudan and Uganda.
The projected reductions vary considerably. Rwanda faces the largest planned cut, at 97%, followed by Liberia at 84%, Burundi at 78%, Madagascar at 77% and Sierra Leone at 71%. Across the countries analyzed, reductions range from 43% to 97% by the final year of the agreements.
What Will the Cuts Affect?
The funding supports programs addressing HIV/AIDS, tuberculosis, malaria and maternal and child health, among other areas of global health. The agreements also require recipient countries to increase their own domestic contributions to health programs.
Public Citizen and Partners In Health warn that countries that fail to meet significant co-financing requirements could face penalties, potentially worsening the reductions in U.S. assistance.
The analysis does not provide a single estimate of how many people could lose access to health services as a result of the planned cuts. However, the countries involved include some of Africa’s most populous nations, including Nigeria, the Democratic Republic of the Congo, Ethiopia and Kenya, meaning the potential effects could extend to millions of people.
The report highlights the scale of the additional financial burden on some governments. Malawi, for example, would need to mobilize new funding equivalent to 56% of its total health expenditure to meet its annual co-financing commitment under the agreement.
The organizations behind the analysis argue that the changes could put pressure on already strained health systems and make it more difficult for countries to maintain essential health programs during the transition away from U.S. assistance.
U.S. Response
The U.S. State Department has defended the agreements, saying countries have long requested multi-year funding arrangements to help them plan their transition away from aid.
The department has also said that it intends to spend all health-related foreign assistance appropriated by Congress, while arguing that the new strategy prioritizes efficiency, transparency, country self-reliance and U.S. innovation.
The analysis comes amid continuing debate over the future of U.S. global health assistance following the dismantling of USAID and the administration’s restructuring of foreign health programs. Public Citizen obtained several of the agreements through litigation and Freedom of Information Act requests.
