The United States has introduced a new bilateral health financing model, prompting varied responses across African nations. The Democratic Republic of Congo (DRC) has officially joined Uganda in embracing this new approach, signing a substantial $1.2 billion, five-year health partnership. This move contrasts sharply with the decisions of Zambia and Zimbabwe, both of whom have rejected similar agreements due to significant concerns surrounding health data sovereignty and the terms associated with the funding.

Under the recently announced agreement, which spans from 2026 to 2031, the DRC is set to receive $900 million in direct assistance from the US government. In return, the Congolese government has committed to increasing its domestic health spending by $300 million. This comprehensive partnership is designed to tackle a range of critical health challenges, including HIV/Aids, tuberculosis, malaria, maternal and child health initiatives, polio eradication, enhanced epidemiological surveillance, development of the health workforce, and strengthening emergency preparedness.

This new financing model represents a significant shift in Washington's global health strategy across Africa. It moves away from traditional donor channels towards direct government-to-government arrangements. A key feature of this template is the requirement for greater domestic co-financing from recipient nations and the establishment of structured data-sharing frameworks. Uganda had previously adopted this model, signing a separate $1.7 billion, five-year partnership, which it described as a sovereign-guided cooperation designed to bolster national health systems while ensuring domestic control over health information.

However, the model has encountered strong opposition. Zambia, for instance, rejected a proposed $1.012 billion agreement after a leaked draft memorandum revealed provisions that would grant extended US access to national health data, alongside stringent performance conditions tied to ongoing funding. Civil society groups in Zambia vociferously warned that such terms could expose the country to external leverage over its critical health system.

Similarly, Zimbabwe decided to pull out of negotiations for a $367 million health pact, with government officials openly characterizing the proposed arrangement as "asymmetrical." Their primary concern centered on the agreement's requirement for sharing biological samples and sensitive health data without explicit guarantees of equitable access to any resulting vaccines or treatments that might be developed from this shared information.

The divergent responses from these African nations highlight a broader restructuring of the United States' global health financing strategy, which is transitioning from traditional aid mechanisms towards bilateral compacts that prioritize domestic investment and direct accountability. With the DRC now aligning with Uganda, and Zambia and Zimbabwe opting to step back, a crucial debate is unfolding across the continent regarding sovereignty, sustainability, and health security in the context of Washington's evolving funding approach.