US Health Aid Deals Spark Concerns of Exploitation in African Nations

The United States has been proposing unusual bilateral health agreements to developing countries, mostly in Africa, in exchange for access to sensitive health data and critical minerals. These deals have sparked concerns of exploitation and have been met with resistance from several countries.

In November, the US approached Zimbabwean authorities with a proposal that would have provided over $300m in funding in return for sensitive health data. However, Harare felt that the negotiations were 'lopsided' and promptly pulled out.

Zambia also pushed back against a similar proposal, citing 'problematic' clauses that sought access to the country's minerals, including copper, cobalt, and lithium. The US had offered $1bn in funding over five years, but Lusaka requested a review of the proposal.

Data or mineral demands in return for health aid are unprecedented in the history of US-Africa relations. Policy experts argue that tying crucial funding to sensitive national assets could have negative consequences for African nations and the US itself.

'Supporting global health has clear benefits to the United States in terms of prevention of pandemics that can affect Americans too,' said Sarang Shidore, Africa director at the Quincy Institute for Responsible Statecraft. 'Linking such aid to payoffs in the extraction of critical minerals smacks of exploitative practices.'

African nations have long relied on US funding to foot many of their health bills. In 2024, African countries received $5.4bn in US assistance, largely spent on humanitarian, health, and disaster needs.

However, the US has argued that aid cuts suit its America First agenda, which prioritizes national interests. The stance has been met with criticism, with some economists arguing that aid is often ineffective and causes overreliance.

Washington is now focused on government-to-government deals, which have typically required governments to take on an increasing share of their own health budgets in the next four to five years.

Some analysts see this as a positive move to reduce overdependence on foreign funding and force governments to prioritize health spending in their budgets. However, the clauses that Washington is demanding to leverage its aid for data, rare earth elements, and other minerals have caused widespread outrage in some countries.

In the case of Zambia, the US reportedly asked for access to the country's critical minerals in return for $1bn over five years. The US also asked for a one-way data-sharing agreement for 10 years.

If Lusaka fails to ink a deal, US aid funding to the country will be discontinued, which could mean losing the remnants of funding Zambia still receives from the PEPFAR programme.