By: Chidozie Nwali
The Kingdom of Eswatini has become the latest African nation to sign a multi-million dollar, five-year bilateral health agreement with the United States, following similar recent landmark deals with Kenya and Rwanda. The U.S. state department said eswatini signed the agreement on Friday.
According to the state department, The $242 million agreement with Eswatini focuses heavily on sustaining gains in the HIV/AIDS fight. During the five year period Eswatini will increase domestic health spending by $37 million.
Critically, the deal includes the provision of lenacapavir, a cutting-edge, U.S.-developed drug for HIV prevention, placing Eswatini at the forefront of the global treatment landscape.
Eswatini is a country with a high HIV prevalence rate, roughly one in four adults is affected with the virus.
These agreements signal a significant shift in U.S. foreign aid, moving towards a model of shared investment, national ownership, and increased self-reliance for partner countries under the “America First Global Health Strategy.”
Displacing the older traditionally U.S. Agency for International Development (USAID)-led funding models, this new framework emphasizing a direct government-to-government partnership with explicit financial and operational commitments from both sides.
Pillars of the new health strategy
The multi-year Memorandums of Understanding (MOUs) signed by Eswatini, Kenya, and Rwanda—with other nations like Uganda and Liberia also entering similar pacts—are designed around three core principles:
- The host country commits to increasing its own domestic health expenditure over the five-year period, gradually taking on more financial responsibility as U.S. support decreases.
- Focus is placed on modernizing key national systems, including public health data, disease surveillance, and the transition of the U.S.-funded frontline health workers onto the government payroll.
- The agreements prioritize strengthening the capacity to rapidly detect and respond to infectious disease outbreaks, which protects both the host country and the U.S.
Kenya the first with the deal
Signed first, Kenya’s massive $2.5 billion framework demonstrates the scale of the new strategy. A major component is the commitment to transition health workers currently funded by U.S. aid onto the Kenyan government’s payroll, aiming to stabilize the workforce.
Rwanda with tech-enabled model
Rwanda’s $228 million agreement highlights investments in technology and innovation. It includes support for American companies like Zipline (drone delivery of medical products) and Ginkgo Bioworks (biothreat radar systems), emphasizing a private-sector component that also supports U.S. commercial interests.
During the five-years period Rwanda will increase domestic health spending by $70 million.
Piracy concerns delays the pact
While widely praised for promoting accountability and local ownership, the new bilateral model has also drawn scrutiny. Concerns raised, particularly in Kenya.
Earlier this week, a high court in Kenya, halted any transfer or sharing of sensitive medical and epidemiological data under the with the pact pending the hearing of a motion filed by the Kenya consumer protect agency.
Consumers Federation of Kenya (COFEK), argued that the bilateral pact poses a significant threat to the personal health information of millions of Kenyans. The hearing is expected to commence at the high court by February 2026.
Meanwhile, Certain clauses from the pact require partner countries to adopt U.S. Food and Drug Administration (FDA) approvals as sufficient for emergency medical products, which critics suggest could weaken the authority of local regulatory bodies.
Despite these debates, the signings with Eswatini, Rwanda, and Kenya firmly establish the new blueprint for U.S. global health assistance. U.S. officials have indicated that dozens more of these MOUs are planned for other partner countries in the coming weeks, accelerating the shift away from decades-old aid structures toward a framework built on mutual investment and national self-reliance.
