The US has signed four new global health memorandums of understanding (MoUs) with Madagascar, Sierra Leone, Botswana, and Ethiopia, which total nearly $2.3bn in funding, the State Department said on Tuesday, 23 December 2025.

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The Trump administration unveiled its "America First Global Health Strategy" in September, a new approach to overseas aid that seeks to improve target countries' self-reliance in managing their health sectors.
"Each MOU includes clear benchmarks, strict timelines, and consequences for nonperformance – ensuring US assistance delivers results against priority disease threats and reduces long-term dependence on US assistance," the State Department said in a statement.
"Across the four MOUs, which total nearly $2.3bn, the United States has committed almost $1.4bn, with recipient countries co-investing more than $900m of their own resources."
The US embassy in the Ivory Coast's commercial capital Abidjan said a signing of a five-year health co-operation memorandum between the two countries was scheduled for Thursday.
The MoU is aimed at strengthening disease detection and health-worker capacity, the embassy said, adding that the State Department planned to provide up to 273bn CFA francs ($491m) in health support, while Ivory Coast commits to increasing its national funding to 252bn CFA francs.
Earlier this month, the US signed a five-year health co-operation agreement with Eswatini to provide up to $205m for investments in health-data collection, disease monitoring and response and HIV prevention and treatment.
Eswatini, in turn, will increase domestic health spending by $37m during the five-year period.
The US has also signed health co-operation agreements with Kenya, Rwanda, Uganda and Lesotho.
($1 = 556.2500 CFA francs)