New U.S. health aid model boosts self-reliance

The United States is advancing an America First Global Health Strategy (PDF, 4.6MB) through new bilateral health agreements that will further U.S. global health goals, save lives and strengthen countries’ health care systems.

Under the new strategy, the Department of State will reach bilateral health memorandums of understanding (MOUs) with governments to maximize the efficiency and effectiveness of U.S. global health assistance, while equipping countries to build self-reliant health systems and better prevent infectious disease outbreaks. The multiyear agreements require co-investment from countries that receive U.S. assistance.

To date, the United States has signed MOUs with Botswana, Cameroon, Côte d’Ivoire, Ethiopia, Eswatini, Kenya, Lesotho, Liberia, Madagascar, Mozambique, Nigeria, Rwanda, Sierra Leone and Uganda, with dozens more anticipated.

“For far too long, the United States spent billions of dollars on global health by writing checks to NGOs and hoping results would follow,” Secretary of State Marco Rubio said recently. “Too often, recipient nations had little say, accountability was weak, and only a fraction of that money ever reached patients. … That approach was inefficient, ineffective, and unsustainable.”

A fresh start

The new America First Global Health Strategy strengthens recipient nations’ health systems, while building on the United States’ decades of progress fighting HIV/AIDS, malaria, tuberculosis and other infectious diseases around the world.

The MOUs reached with recipient countries will maintain 100% of funding for front-line medical workers and commodities in the first year, with the partner governments gradually taking on full responsibility. Certain technical assistance and other functions will also transition to recipient countries.

“We lay out a vision to end the inefficiencies, waste, and dependency of our current system,” Rubio said, announcing the America First Global Health Strategy in September. “In its place, we cast a positive vision for a future where we stop outbreaks before they reach our shores, enter strong bilateral agreements that promote our national interests while saving millions of lives, and help promote and export American health innovation around the world.”

With self-reliant health systems, countries will be better able to conduct disease monitoring and surveillance, preventing deadly diseases from reaching U.S. shores or harming American citizens abroad.

Greater access to U.S. innovations

The new approach also expands access to U.S. health innovations, improving global health while advancing prosperity. The State Department supports U.S.-based Zipline International’s delivery of medical supplies by drone to remote parts of Côte d’Ivoire, Ghana, Nigeria, Kenya and Rwanda. Under the arrangement, governments pay for services rather than owning infrastructure — similar to a model used in the energy sector. The approach strengthens health systems, while opening new markets and creating jobs.

The U.S. government and the Global Fund recently announced plans to deliver the innovative new HIV-prevention drug lenacapavir to 2 million people in eight to 12 African nations by 2028. Developed by U.S.-based Gilead Sciences, lenacapavir has proven 99% effective in preventing HIV/AIDS with only two doses annually. As part of the U.S. government-led arrangement, Gilead plans to provide lenacapavir at cost, with no profit to the company.

Since 2001, the United States has provided $204 billion in foreign health assistance — twice as much as any other country — saving 26 million lives from HIV/AIDS and significantly reducing malaria deaths and tuberculosis cases globally.

Now, the United States is creating a sustainable funding structure that reduces dependency on American taxpayers, encourages other donors to play a greater role in solving global challenges and enables recipient countries to take ownership of their health systems.