Trump’s aid pivot: Direct dollars in a new funding plan or a detour for Africa’s health lifeline?

On Dec 17, 2025

Donald Trump’s health aid financing deals between governments put a lot of emphasis on sharing data to improve disease and pathogen surveillance across Africa. This plan eliminates traditional NGO funding model.
Already, Kenya, Uganda, and Rwanda have signed five-year agreements worth $4.5 billion, with a focus on HIV, TB, malaria, and strengthening health systems.
USAid’s closure in March 2025 cut off a lifeline that sent $8 billion a year to African health ecosystem.

The U.S government is starting a new era in health aid in Africa, rolling out billions of dollars in direct bilateral financing for healthcare systems, effectively bypassing the traditional channel of using NGOs ecosystem. The new funding plan is part of Washington’s strategy to change how it gives foreign aid, especially funding that targets healthcare.

Our analysis shows that this approach started taking shape in early 2025 after the U.S. Agency for International Development (USAID) was shut down. The “Reevaluation and Realignment of United States Foreign Aid” policy, which was announced in January 2025 through Executive Order 14169, froze $60 billion in aid for 90 days. And by March, USAID operations globally were shut down.

Trump’s “America First” push effectively ended 65 years of multilateral partnerships between economies in Africa and Washington. But in the last few weeks, Donald Trump’s administration has started making deals between governments that put a lot of emphasis on sharing data to improve disease and pathogen surveillance across the continent.

For Africa, where USAID has provided 40 per cent of HIV funding and 30 per cent of maternal health programs, the effects have been terrible. According to modeling from the Harvard T.H. Chan School, there will be an extra 300,000 deaths in sub-Saharan Africa by November 2025.

The new model sends money straight to African ministries, cutting out “middlemen” like NGOs to save money and give the U.S. more power.

Kenya, Uganda, Rwanda Sign Up New Health Aid Program

Already, Kenya, Uganda, and Rwanda are early takers and have signed five-year agreements worth $4.5 billion, with a focus on HIV, TB, malaria, and strengthening health systems.

Kenya’s $2.5 billion framework, which was signed on December 4, 2025, sets aside $1.6 billion for priority programs. Uganda’s $2.3 billion deal includes $1.7 billion for HIV/TB while Rwanda’s $228 million deal focuses on $70 million for strengthening healthcare systems.

Supporters say it makes accountability easier, while opponents say it is a way to get data and cut down on local input. Already, the Kenya-U.S. deal has been dealt a body blow with High Court order halting its implementation due to mounting concerns on data privacy.

With Africa’s health budgets struggling with $100 billion annual shortfalls according to WHO report, this change in funding raises an important question: does direct funding strengthen or weaken the continent’s health system?

The End of USAID

USAID’s closure in March 2025 cut off a lifeline that sent $8 billion a year to African health ecosystem. Since 2003, PEPFAR alone has saved 20 million lives. The 90-day freeze stopped $2.5 billion worth of programs, including the supply of malaria nets to vulnerable pregnant women as well as children in high risk zones; vaccinations, and HIV treatments in 50 countries.

In Kenya, where USAID paid for half of family planning, the NGO’s closure led to roughly 200,000unintended pregnancies and $50 million in lost productivity according to a status report by Physicians for Human Rights.

Uganda’s HIV programs, which depend on $400 million a year, missed 100,000 treatments, which could lead to a 10 per cent rise in infections (KFF, 2025). Rwanda, a favorite of USAID with $200 million in annual aid, had its maternal health funding cut by 20 per cent, making the maternal mortality rate rise by 15 per cent, statistics by UNICEF shows.

The agency’s end, which was part of Trump’s “shadow revolution” in foreign policy, put bilateral control ahead of multilateralism because of 30 per cent waste in overhead costs (TCF, 2025). This is true, but it doesn’t take into account USAID’s work to build ecosystems.

For example, PATH and FHI 360 localized 70 per cent of their programs and hired 50,000 Africans, notes from Oxfam state. The freeze’s human cost—hundreds of thousands of deaths from cholera and HIV lapses—shows how dangerous it is to make sudden cuts, according to Lancet modeling (2025). In June 2025, Africa’s health ministers met in Addis Ababa and spoke out against the “chilling effect,” which was threatening SDGs with a 38 per cent drop in aid.

Read also: USAID withdrawal leaves Ghana with $156 million healthcare funding gap

The Bilateral Blueprint: The Promise of Direct Funding

The new model does away with “NGO middlemen” and replaces them with government-to-government agreements in order to get “efficient, accountable” aid. Kenya’s $2.5 billion framework, which was signed on December 4, 2025, is modelled to sent $1.6 billion directly to the Ministry of Health for HIV, TB, and systems strengthening.

The $2.3 billion deal with Uganda, signed on December 10, includes $1.7 billion for HIV, TB, and malaria, with the U.S. keeping an eye on things through data-sharing clauses. The $228 million deal with Rwanda, which includes $70 million for health systems, puts a lot of emphasis on pathogen surveillance, which is a top priority for U.S. biosecurity.

Supporters say this gives African countries more power, cuts NGO costs (20–30 per cent of budgets), and fits with Trump’s “America First” strategy. According to a 2025 Ministry of Health report, direct funding could save $100 million a year in administrative costs in Kenya, speeding up the distribution of vaccines.

The deal with Uganda promises $300 million for making things in Uganda, which will cut the need for imports by 25 per cent, Reuters reported. Rwanda, a country the U.S. likes, could use its deal to raise the number of people with health insurance from 85 per cent to 95 per cent by 2030, WHO states. By getting rid of middlemen, the model could get money into the system faster, which could help close 10 per cent of Africa’s $100 billion health gap (WHO, 2025).

Risks of the direct healthcare financing model: Gaps in oversight and data security issues

Oxfam and Physicians for Human Rights, among others, say that skipping over NGOs means losing expertise and accountability. USAID’s NGO network localized 70 per cent of its programs, hired 50,000 Africans, and made sure that the community was on board—things that direct funding might not take into account.

In Kenya, where perceptions of corruption score 31 out of 100 according to Transparency International’s latest survey, direct ministry flows are at risk of leaking, and 20 per cent of health funds are lost to graft, Afrobarometer survey notes.

Already, the Consumer Federation of Kenya, a consumer action group has secured orders in court, barring rollout of certain segments of the healthcare funding model citing data security and patients’ privacy concerns.

Uganda has a history of $500 million in misused aid, which is a red flag for the $1.7 billion authorities will be receiving from Washinton D.C. Rwanda has good governance (score 53/100), but it is being criticized for data-sharing clauses that give the U.S. access to health records, which could be a violation of privacy under the African Union’s Malabo Convention.

The model’s “America First” approach puts U.S. interests, like biosecurity, ahead of all-around aid. For example, pacts include pathogen-sharing rules that are similar to resource extraction during colonial times.

A 2025 study by Chatham House says that Uganda’s maternal mortality rate could go up by 10 per cent because of lost NGO capacity, which would cause 15 per cent of programs to be less effective. People don’t trust the deal because it was signed without a parliamentary debate, as shown by Kenya’s High Court freezing the deal last week.

Evaluating Results: Efficiency Improvements vs. Equity Deterioration

The direct model could lead to better outcome in terms of efficiency. For example, USAID’s 30 per cent overhead meant that only $2.4 billion of the $8 billion went to programs. Bilateral agreements promise 90 per cent field delivery, which could save $300 million across Kenya, Uganda, and Rwanda and pay for 5 million more vaccinations.

Direct funding in Rwanda is in line with the country’s Vision 2050, which aims to have 95 per cent of people using digital health records by 2028 according to WHO notes. Kenya’s agreement could cut HIV transmission by 15 per cent through targeted procurement (State Department, 2025). If corruption is stopped, Uganda’s $1.7 billion could cut TB deaths in half by 2030, Reuters reported.

But things are likely to get worse when it comes to equity and sustainability. NGO cuts take away 50,000 jobs and local knowledge, which could lead to 20 per cent of programs failing because they weren’t done right (Lancet, 2025). People’s Dispatch says that sharing data could lead to “brain drain,” where the U.S. gets intellectual property without sharing the benefits.

If deals favor urban elites, like in Uganda’s past mistakes Africa’s $100 billion health gap gets bigger. Chatham House says that there are short-term benefits in speed (10–15 per cent budget efficiency) and long-term losses in trust and coverage (20 per cent equity drop).

Trump’s overhaul replaces USAID’s wide-ranging safety net with targeted bilateral lifelines. This could close 5–10 per cent of Africa’s health gap through efficiency, but it could also open up 15–20 per cent of the gap through oversight and fairness.

For Kenya, Uganda, and Rwanda to be successful, they need to be open and let people in their own countries own the process. If they fail, it could lead to 300,000 deaths like the 2025 freeze. Africa needs to make sure that all of its deals are mutually beneficial, or else direct funding could lead to dependency. What are the stakes? A healthier future for millions of people, or a bigger gap.

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