From the newsletter
African countries remain uncertain about the future of global health aid following the US government’s new global health plan. Instead of sending aid through big international programmes, the “America First” strategy will directly deal with each government and establish specific targets and timelines for implementation of projects.
Africa still features in the plan. The continent will receive funding for HIV, TB, malaria and polio medicines, as well as salaries for frontline health workers at least for the 2026 financial year.
Cutting out multilateral organisations, many of which had begun linking health and climate efforts across the continent, deals a setback to climate-health programmes.
More details
The plan resumes about $1.3 billion for HIV, TB and malaria medicines, diagnostics and insecticide-treated nets, plus $827 million for salaries of health workers for 2026 only. After 2026, countries will be expected to co-fund programmes based on income levels.
The strategy will “rapidly decrease” aid that doesn’t go directly to frontline workers or medicines, cutting out international NGOs that have long implemented US-funded projects. Faith-based hospitals and clinics, which deliver over half of healthcare in countries like Uganda and Eswatini, will instead be prioritised.
The US wants all future health aid to be delivered through time-limited bilateral compacts, with deals expected to be signed by the end of 2025 and rolled out from April 2026. Each deal will commit to covering 100% of frontline medicines and staff, but most of the 71 supported countries are expected to “transition to self-reliance” within the term of the agreement.
A senior US official told Semafor that while Africa will remain a focus, Washington plans to invest more in the Western Hemisphere and Asia-Pacific, with a quarter of a billion dollars already earmarked for the Philippines.
Progress in climate-health adaptation has taken shape. Uganda’s Climate Change Health National Adaptation Plan (H-NAP), launched in 2024 with backing from the Rockefeller Foundation and WHO, is a leading example. It aims to climate-proof rural health centres and integrate climate data into health planning so communities can still access care during floods or droughts.
Regionally, initiatives such as Clim-HEALTH Africa are building collaboration. In 2024, over 80 experts from across the continent met in Senegal to draw up a five-year plan to strengthen climate-resilient healthcare, including sharing early-warning systems for disease outbreaks linked to extreme weather. Pulling US funds away from multilateral organisations risks slowing this progress.
Our take
Multilateral organisations like Global Fund, Gavi, WHO and Target Malaria have been central to Africa’s fight against disease and reaching the hardest-to-serve communities.
These bodies have been central to supporting cross-border research, funding local innovations such as solar-powered vaccine storage and harmonising data collection that helps predict disease outbreaks.
Without their resources and reach, African governments could struggle to sustain climate-health projects at scale.