DRC backs $1.2bn U.S. health deal amid Africa aid split

The Democratic Republic of Congo and the United States signed a five-year, USD 1.2 billion strategic health partnership Thursday, joining a growing number of African nations that have accepted Washington’s restructured model of foreign health assistance — even as others walk away from the table.

The agreement, confirmed in a joint government statement, will run from 2026 to 2031. It combines USD 900 million in U.S. federal funding with USD 300 million in “progressively increased domestic health expenditure” to be committed by Kinshasa — a co-financing model that has become a hallmark of the Trump administration’s post-United States Agency for International Development aid architecture.

The deal targets some of the country’s most acute public health challenges: HIV/AIDS, tuberculosis, malaria, maternal and child mortality, polio eradication, disease surveillance, health workforce training, and emergency preparedness. For a nation that carries one of the world’s heaviest infectious disease burdens, the scope is substantial.

“This structural investment aims to strengthen the resilience of the healthcare system, improve care for the population, and consolidate the country’s healthcare sovereignty.”

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Congo also expressed ambitions beyond its own borders. Officials said the partnership would bolster the country’s role as a regional hub for disease surveillance and rapid epidemic response in Central Africa — a geopolitical dimension that aligns with Washington’s broader health diplomacy push on the continent.

Washington’s new aid playbook

The DRC signing is part of a broader wave of bilateral health compacts that Washington has pursued since President Donald Trump ordered the dismantling of USAID early in his second term. Rather than channelling funds through a central development body, the administration has pivoted to direct country-by-country memoranda of understanding — deals that link U.S. health dollars to domestic spending commitments, data-sharing arrangements, and, in some cases, economic cooperation clauses.

Secretary of State Marco Rubio has been explicit about the strategy. “Foreign assistance is not charity; it is designed to further the national interests of the United States,” a State Department spokesperson told Reuters this week.

The DRC deal mirrors a similar agreement recently reached with Burkina Faso, where a USD 147 million U.S. health package was tied to strengthening primary care systems, disease surveillance, and community-level medical access in the fragile Sahel nation. Burkina Faso pledged USD 119 million in domestic co-financing, incorporating digital health reporting systems and laboratory infrastructure.

A continent divided

Not every African government has been willing to sign. The deals have exposed a deepening fault line over who controls the terms of health aid — and at what cost to national policy autonomy.

Zimbabwe pulled out of talks on a USD 367 million bilateral health agreement with the U.S. on Wednesday, with President Emmerson Mnangagwa describing the proposed memorandum of understanding as compromising national sovereignty. Harare cited concerns over data-sharing provisions and what it characterised as unequal terms.

Zambia, meanwhile, has suspended signing a deal worth more than USD 1 billion after revised drafts included terms that Lusaka said did not align with the government’s interests. Health advocates warned that the Zambian agreement, which would have required around USD 340 million in domestic co-financing, contained problematic data-sharing clauses — including a requirement to share pathogen information with the U.S. for up to 25 years. Three sources told Reuters the deal was also linked to mining collaboration, a claim the Zambian government denied.

“We want to own our data in Africa. We want to own our future,” said Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention, who expressed support for countries seeking to renegotiate terms while also backing those that have signed.

The Africa CDC chief noted that at least 17 African countries have signed memoranda of understanding with the U.S., including Nigeria and Uganda — a sign that despite the resistance, Washington’s health diplomacy is gaining traction across much of the continent.

The calculus of sovereignty

What the divergent responses reveal is something more complex than a simple yes-or-no to American money. African governments are weighing the urgent, immediate need for health funding — particularly for HIV programs that had long depended on the President’s Emergency Plan for AIDS Relief — against longer-term concerns about data sovereignty, policy conditionality, and the credibility that comes with demonstrating independence from foreign donors.

For Congo, a nation that has battled successive Ebola outbreaks, a persistent mpox emergency, and chronic underfunding of its health system, the calculus appears to have favoured engagement. For Zimbabwe and Zambia, the price of the deal — in sovereignty terms — was judged too high, at least for now.

Whether those holdouts return to the table, and on what terms, may define the next chapter of U.S.-Africa health relations.

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