US accused of ‘shameless exploitation’ over proposed Zambian health aid deal | global health

The US has been accused of “shameless exploitation” over a health funding deal with Zambia worth more than $1bn (£740m), amid warnings the country is getting a raw deal from the Trump administration.

A leaked draft of a five-year memorandum of understanding (MOU) between the two countries, seen by the Guardian, reveals that Zambia may accept worse terms than health funding deals reached by the US along with 16 other African countries.

The terms include a commitment to give Washington access to its health data for 10 years — much longer than other countries have negotiated. Zambia’s agreement also places any health funding on an even more ring-fenced arrangement that could open up the country’s mining industry to US interests.

Asia Russell, director of the HIV advocacy organization Health Gap, said: “These conditions are much worse than other deals. (The US) is conditioning life-saving health services on the plunder of the mineral wealth of the country.

“This is shameless exploitation, which is immoral. It’s also dangerous – when health programs are treated like a bargaining chip by a brutal administration, everyone suffers,” she said.

The Trump administration is pursuing it bilateral global health agreements after dismantle most of the federal development agency, USAID.

The new strategy channels health funding directly to governments, rather than through aid organizations, while also requiring greater investment from partner countries.

Zimbabwe said on Wednesday it was suspending its bilateral health agreement talks with the US over concerns about the sharing of sensitive health data.

In Zambia’s case, Washington offers $1.012 billion in health funding in exchange for Lusaka’s commitment to hire 40,000 new health workers and contribute an additional $400 million in health services over five years while improving the health sector’s performance, according to the leaked draft. The country’s 2026 budget for health services is approximately $1.3 billion.

If Zambia fails on any of these fronts, Washington could terminate the agreement and withdraw its funds.

Julius Kachidza, chairman of Zambia’s Civil society self-coordinating mechanismsupports much of what the MOU is trying to achieve, such as improved services and increased domestic funding, but is concerned that if the country falls short of the stipulated terms, the entire health system would be put at risk.

“I am a person living with HIV,” he said. “If the HIV program in Zambia is distorted or disrupted or derailed, I will be the first victim, along with hundreds of thousands of other people.”

Civil society groups are pushing to amend the agreement. The MOU includes a clause that the entire process will be terminated if an agreement is not reached by April 1.

For advocates, their main demand is to remove any data sharing requirements from the agreement.

Josiah Kalala, director of the Chapter One Foundation, a human rights organization, said: “This is essentially our Zambian government signing away the right to access health data of its citizens to another country.”

Zambia is also preparing to provide Washington with information on any new or emerging pathogens within its borders over the next 25 years.

Other countries have committed to sharing data, but on less demanding terms. None of the publicly available MOUs include 25-year promises to share pathogen data. Kenya has limited the sharing of its health data to seven years but still faces a legal challenge.

Kachidza said Zambian activists would also consider going to court over the deal.

In early December, the US Embassy in Zambia confirmed that the health funding agreement was contingent on “cooperation in the mining sector and clear business sector reforms” that would improve US economic access to the country.

The MOU also commits the Zambian government to monthly briefings with the US Embassy on trade and investment efforts between the two countries, with a goal “to expand US commercial investment in Zambia”.

Kachidza described the situation as “being held hostage.”

A U.S. State Department spokesman declined to discuss details of the MOU, but wrote in a statement: “The administration believes that U.S. foreign aid must demonstrably advance U.S. national interests and use taxpayer dollars efficiently.”

On February 15, Zambia’s Minister of Health, Elijah Muchima, denied that health funding was linked to mining concessions. “The conditions that are on that MOU relate to how the money will be used,” he said on television.

“If there are other external conditions attached to it, I personally am not part of it,” he said. The Zambian president, Hakainde Hichilema, fired Muchima three days later without explanation.

Activists fear Zambia is being set up for failure, although Oliver Kaonga, a Zambian health economist, said it may be possible for the government to meet the new funding commitments. However, Zambia’s spending remains limited, with more than a third of its 2026 budget is spent on debt repayments. “The starting point will be about, ‘can we mobilize resources better?'” he said.

The US is providing Zambia with less health aid under the MOU than before. Washington committed $367 million to Zambia for HIV services last year alone. Total health funding for 2026 is $320 million under the draft MOU, which would cover programs such as disease surveillance and treatment of malaria, TB and HIV.

The overall US commitment of $1.012bn over five years is lower than the $1.5bn deal Muchima announced in November 2025. The US State Department, whose Bureau of Global Health Security and Diplomacy negotiated the agreements, did not respond to a Guardian request for clarification.

As its funding declines, Zambia is expected to continue to improve against performance targets, such as increasing the number of people enrolled in HIV treatment and reducing maternal deaths, or risk losing US support.

Kalala suspects the Zambian government is going ahead with the deal despite the risks, in part because of its “great concern about the sudden loss of funding for the health sector and the political fallout it could cause.”

Zambia’s Ministry of Health did not respond to requests for comment.

In Zambia, civil society groups finally secured a meeting with the Ministry of Health on 3 February. But the two-hour briefing only addressed certain components of the MOU, while several attendees said officials warned them to consider legal action over the data-sharing provisions. Officials declined to clarify whether the MOU funding was tied to economic concessions.

Advocates presented a list of demands, along with the removal of data sharing, including a seat on the steering committee that would monitor progress.

Kalala is also spearheading an access to information request to disclose the latest version of the MOU and the bilateral agreement.

“Once we see the agreement and the agreement, we will even be able to see if we can challenge the constitutionality of some of the provisions,” he said. “We have to get it right at the beginning.”