The Trump administration’s “America First” global health strategy has made it clear that when it offers a country financing to strengthen its health systems, its ultimate goal is to secure something in return — something not always related to health outcomes, such as gaining a competitive edge over China, securing minerals, strengthening military alliances, or accessing data.
The new strategy has a focus on direct bilateral government deals, cofinanced with those governments, and aims to leverage faith-based organizations and the private sector, as opposed to funneling money through nongovernmental organizations.
In U.S. negotiations with Zambia and Nigeria, it made explicit the nonhealth goals it wants to achieve in return for health aid. In Zambia, mining sector reforms are at the heart of negotiations — which are still ongoing, whereas in Nigeria, the signed deal focuses specifically on protecting Christians from violence.