The United States policymakers are reshaping their Africa strategy, swapping traditional development assistance for tightly-controlled “health security” deals.
The shift has triggered a wave of aid withdrawals, new drug donations, and sharp debate across the continent over sovereignty, sustainability and the future of regional health financing
As Washington trims its budget line aid to sub-Saharan Africa, the US is attempting to rebrand the retrenchment as a “health partnership.” The move has sparked fierce criticism across the continent, and in Zimbabwe it has produced a paradox: the government rejected a multi-billion dollar health security agreement with the US, while simultaneously accepting a donation of the experimental HIV drug lenacapavir, aimed at the nation’s 1,3 million people living with HIV/Aids.
The US’s foreign assistance budget for Africa fell by 12% in fiscal year 2025, the first decline since the post Cold War era, according to the US Treasury’s Office of Foreign Assistance. The cut, announced in the full year 2026 budget proposal, targets development assistance for governance, agriculture and education, while preserving a modest portion for health programmes under the President’s Emergency Plan for Aids Relief (Pepfar).
“We are moving away from blanket aid and toward ‘value-added’ engagements,” said Linda Thomas Garcia, senior adviser at the State Department’s Office of African Affairs. “The goal is to ensure every dollar advances measurable outcomes.”
Critics argue that the new framework merely repackages aid withdrawal behind a veneer of health diplomacy.
In February, the State Department unveiled the African Health Resource Initiative (AHRI), a “next generation” health partnership that promises US$8 billion in funding over the next five years for disease surveillance, vaccine manufacturing and pharmaceutical supply chains.
The initiative, however, comes with conditionalities that many African leaders deem “unfair”:
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l Technology transfer clauses that require African firms to use US-patented platforms;
l Data sharing mandates obliging recipient countries to route disease-tracking information to US servers; and
l Procurement preferences that favor American manufacturers, even when cheaper regional alternatives exist.
Human rights NGOs have warned that the conditions echo neo-colonial practices that undermine sovereignty.
“It’s a classic ‘aid for access’ playbook: we grant life-saving medicines, but only if African governments hand over control of their health data and supply chains,” said Kofi Mensah, director of the African Policy Centre in Nairobi.
Harare’s decision to reject the AHRI agreement in February was framed as a stand against “predatory” conditionalities. The government released a statement saying the deal “fails to respect Zimbabwe’s autonomy and places undue burdens on an already strained health system.”
Yet, just days later, Zimbabwe accepted a donation of lenacapavir an investigational, long acting HIV pre-exposure prophylaxis and therapeutic agent from the US Pepfar programme. The drug, which can be administered once every six months, is seen as a breakthrough for the 1,3 million Zimbabweans living with HIV/Aids, according to the Zimbabwe Ministry of Health and Child Care (MoHCC).
The juxtaposition has raised questions about the sustainability of such donations:
l Lenacapavir costs roughly US$1 200 per dose. Even with the initial donation covering 200 000 doses, the MoHCC estimates a US$240 million funding shortfall to maintain the regimen beyond 2027;
l Zimbabwe’s cold chain capacity is limited; only 38% of health facilities meet WHO standards for storing biologics, a figure that has barely improved since 2020; and
l Over 30% of the country’s physicians have emigrated since 2022, leaving an acute shortage of clinicians able to administer a drug that requires specialised training and monitoring.
“We are grateful for the lenacapavir shipment, but without a clear path to local production or affordable pricing, we risk creating a dependence that mirrors the very aid model we rejected,” warned Dr. Tendai Moyo, head of HIV services at Harare Central Hospital.
Lenacapavir (formerly GS 6207) is a capsid inhibitor that blocks HIV replication and can be administered as a semi-annual injection a stark contrast to daily oral regimens.
The US PEPFAR programme earmarked US$15 million for a pilot rollout in Mozambique in July 2025, aiming to treat the country’s 850 000 HIV positive population (PEPFAR 2025). Mozambique accepted the drug, but stipulated that any future scale-up must involve local manufacturing and price-tiered agreements to avoid dependence on donor-driven supply (Ministry of Health Mozambique 2025).
Across the region, first, Nigeria signed an AHPF health security pact in October 2025, committing US$500 million to malaria control in exchange for a “data exchange protocol” with the US Centres for Disease Control. Shortly after, opposition parties denounced the deal as “selling national data to foreign interests”, prompting parliament to demand a review of the agreement (Nwankwo 2026).
Next, Ethiopia accepted an US$80 million US emergency health package in early 2024 following a drought-driven humanitarian crisis. By mid-2024, the package had been rebranded as a “capacity-building partnership”, complete with procurement clauses that favoured US manufacturers over regional suppliers (Tesfaye 2025). The Ethiopian government subsequently announced its refusal to join AHRI, citing “unacceptable sovereignty-eroding conditions” (Ethiopian Ministry of Health 2025).
Finally, South Africa, traditionally a major recipient of development aid, publicly declined participation in the AHRI programme in December 2025. Pretoria instead turned to China’s Belt and Road Health Initiative and the European Union’s Global Health Programme for support, emphasising the need for “independent, continent-led solutions” (Muller 2026). These decisions, underscore a growing continental scepticism toward US health security overtures.
The US’s push for health focused aid also aligns with a strategic interest in securing access to mineral resources, particularly cobalt, lithium and rare earth elements, critical for American clean energy technologies.
Analysts warn that this resource-conditional aid model could exacerbate existing exploitation patterns. “You’re essentially trading public health for private profit,” argued Dr. Amina Dlamini, senior fellow at the Centre for Global Development.
Zimbabwe’s dilemma underscores a broader challenge for African states: how to finance health systems sustainably without surrendering policy autonomy.
Several regional initiatives offer alternative pathways (see table above).
These efforts aim to decentralise financing, promote local manufacturing, and retain data sovereignty key counter measures to the US conditionality model.
The US is unlikely to reverse its overall aid reduction in the near term. Treasury officials have signaled that AHRI will roll out in phases, starting with pilot projects in Kenya and Ghana later this year. Yet the political cost of perceived neo colonial tactics may grow as more governments, like Zimbabwe, voice opposition.
For African leaders, the pressing question remains: Can they leverage new health partnerships to build resilient, locally-controlled systems, or will they find themselves trading health autonomy for short term drug donations? As the continent navigates this crossroads, the stakes extend far beyond HIV treatment reaching into the very fabric of economic independence and sovereign governance.
Nyawo is a development practitioner, writer and public speaker. New Perspectives is a weekly column published in the Zimbabwe Independent, coordinated by Lovemore Kadenge, an independent consultant and managing consultant of Zawale Consultants (Private) Limited, past president of the Zimbabwe Economics Society and past president of the Chartered Governance & Accountancy Institute in Zimbabwe. — [email protected]/ cell: +263 772 382 852.
