State Dept taps African faith groups for bilateral health deal consults

The United States Department of State is on a tour of African countries where its teams are negotiating bilateral health agreements — and local faith-based organizations are being brought in for consultations. This isn’t surprising, given the State Department’s new ‘America First’ global health strategy, which outlines its intention to leverage faith-based organizations. But given that the memorandums of understanding are signed directly with governments, it leaves questions on a country-by-country basis of what role local faith-based communities will ultimately play when the new bilateral agreements are rolled out. Some country governments have directly engaged faith-based actors, while others haven’t. But the State Department is calling the African faith community in for meetings to consult on the ongoing negotiations. Christian faith leaders from across Africa — including bishops, reverends, and NGOs — gathered in Nairobi this week for the African Faith and Health Leaders Consultation. They offered a plea to ensure faith-based communities are prioritized during these U.S. negotiations and in their aftermath to ensure the faith community plays a key role in healthcare delivery with American funding. Faith-based leaders in Nairobi said they see engagements they’ve had with the State Department thus far as a positive development and different from previous American administrations, where calls for proposals to implement U.S. funding were put out, and then local faith-based organizations were in competition with large international nongovernmental organizations. “Chances of local entities getting this funding was really slim,” said Dr. Tonny Tumwesigye, executive director of Uganda Protestant Medical Bureau. “You can imagine you have a local entity competing with an American entity for financing in Uganda.” “These discussions are different in a way that they are involving us, and I’m happy that we are part of the discussions,” he said. Faith-based networks coordinate health care across over 14,000 health facilities in sub-Saharan Africa, which, depending on the country, can account for 30% to 70% of health care delivery, according to a statement released on Thursday from 10 African countries. Trickling down There are currently ideas presented to the State Department from local faith-based organizations and a lot of sensitization happening around the work they do on the continent, said Doug Fountain, executive director at Christian Connections for International Health. His organization was one of the hosts of the Nairobi event. “One of the best things that has happened is that they’ve invested time and are going country-to-country to get to know what the faith networks really are, what their capacities are, what their demands are,” he said. Fountain said faith-based networks have always had an open door with previous American administrations, and there was always an effort to engage local organizations. But what’s different under the Trump administration is the emphasis put on that engagement. “Right now, one of the things that's happened is a very formal recognition of the capacity of local Christian or other faith health networks to deliver services. In the past, maybe more of the focus was on how NGOs, or faith-based NGOs, get a carved out piece of funding, or how do they compete with others to be able to qualify to get funding?” Fountain said. “The emphasis has changed to how do we deliver on American ideas and strategies by working with local organizations? That’s what feels different right now. That hadn’t been the case so much in the past,” he added. The next step, he said, is for these faith-based organizations to navigate with their own governments around the role they’ll play in implementing MOUs. Nkatha Njeru, the chief executive officer at the Africa Christian Health Associations Platform, said faith-based health players have existed for a long time delivering health care in African countries. They bring a continuity that often doesn’t exist in international development. “We do not operate as projects,” Njeru said, adding that they are looking at these U.S. negotiations from a standpoint of sustaining this work beyond development aid — and want the faith sector to co-create solutions with the State Department and African governments, ensuring they’re context specific. “That might not look exactly how the U.S. government might envision it,” she said. “The priorities of Nigeria may not be the priorities of Kenya. In Kenya, at the moment, health financing is a huge priority for the faith-based. In Nigeria, health products and the supply chain issues are a huge priority.” While the custodians of their population’s health are African governments, these governments also have a lot of competing priorities, Njeru said. “There is a blanket expectation that if the government receives funding, they can then distribute that funding to all faith actors in the country — and that might not be true,” she said. She said faith players often serve people in hard-to-reach areas and marginalized populations that sometimes government services don’t reach. “Calling people to the table for meetings to give their views doesn’t mean substantial engagement, and doesn’t mean resources trickling down to the people that are actually doing 30% to 70% of health care,” Njeru said. Submitting proposals In Uganda, faith-based communities have been involved directly in engagements with the State Department, Uganda Protestant Medical Bureau’s Tonny Tumwesigye told Devex. This is largely because the faith-based sector is deeply ingrained in Uganda’s government health structures, including in the Ministry of Health’s governance. He said the faith-based sector manages 750 health facilities across Uganda, which include about 200,000 people on antiretroviral treatment for HIV. “Policies that are churned out in the Ministry of Health in Uganda, we are part of that process,” he said. And they’ve been recipients of U.S. funding under the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, as primes and subprimes, Tumwesigye said. Last month, when the State Department came to Uganda, faith-based organizations were invited. The meeting was led by Brad Smith, the State Department’s senior adviser for the Bureau of Global Health Security and Diplomacy. Tumwesigye said they submitted documents on their performance and were requested to submit a paper to the State Department and Africa CDC on their vision for health sector sustainability. Another meeting was held on Tuesday, and they’ve been requested to cost out their proposals. One area they proposed is around health insurance. They were pioneers of health insurance in Uganda and have proposed scaling that up through U.S. funding. They’ve also advocated for two funding mechanisms: one through the Ministry of Health, and the other to the faith sector. “The politics in our countries can be fragile. Governments change. Even when governments haven’t changed, technical people can change. So even if you have this road map, maybe for five years, you’re not very certain whether another leader who will come in will have the same thinking,” Tumwesigye said. “We think that for sustaining these services, it’s critical that we are also part of the financing model.” He said he expects the Ugandan agreement will be signed next month, with the expectation that it will be effective in April. “Our hope is that those aspects will be part of the MOU that will be signed,” Tumwesigye said. He said in the past, faith-based networks were part of the cooperative agreement planning process with PEPFAR, but then agreements were open to competition, where international and local organizations would compete. He said the route to sustainability isn’t through international organizations. Another way processes are working differently is that the State Department is challenging them around health sector-wide sustainability approaches in ways they hadn’t previously been when they focused on specific diseases such as HIV, he said. “In the past, we don’t seem to have been challenged as a country to own up,” Tumwesigye said. “The government is being asked: What is your share?” State Department meeting The engagements with faith-based networks have played out differently in Zambia. Faith-based networks haven’t been directly consulted by the government, nor have they submitted proposals, said Karen Edvai Sichali Sichinga, executive director of the Churches Health Association of Zambia. “However, credit to the State Department, we were invited to go to the embassy where we met with Brad Smith,” she said. “He wanted to hear how we work with the government.” She said the State Department has met with about six faith-based organizations in Zambia. American-based organizations have tended to get U.S health funding in the past, Sichinga said, “because they have the capacity, because they rub shoulders in the corridors of power in Washington.” But by and large, the funding from the U.S. would stay with the international NGOs as opposed to reaching local organizations, she said. “I think it’s a good initiative to avoid the middleman.” She said they now need a better understanding of how the future funding might trickle down to faith-based organizations. “[Governments] have a myriad of priorities,” she said. “Giving to faith-based organizations may not be a priority.” She said she hopes the State Department has other strategies to give funding to the faith sector. “We complement the government. There’s no competition about it,” she said. “But we also have had all these 140 years of working with communities, so we can ensure that services get to the poorest of the poor and the most rural communities in Zambia.” Before the taps lock The faith leaders who gathered in Nairobi aren’t holding their breath around U.S. financing guiding the path toward long-term health care sustainability. They emphasized that the heavy burden must fall on African governments to increase domestic health financing, as well as increased collaborations with the private sector and Africa’s wealthy individuals. Bishop Matthew Kukah, of the Catholic Church in Nigeria, said that given American mid-term elections next year — which could change the congressional balance of power — African countries should approach engagement with the U.S. with modesty. He said instead that the continent should look inward to curbing illicit financial flows, which lead to “staggering figures of monies our politicians and businessmen are sending to Europe.” He added there must be a more aggressive approach to holding “the feet of our politicians to the fire.” Local resources to meet health needs are already on the continent, he said. “People with all these huge resources, where every weekend, they are sponsoring huge weddings, huge funerals. It is more expensive to die in Africa than to stay alive, when you look at how much resources are committed to funerals,” he said. “We don’t have to wait until the taps are finally locked in Europe and America. We appreciate this cooperation, but it shouldn’t be an excuse for us not doing the things we need to do,” Kukah added. Update, Friday, Nov. 28, 2025: This piece has been updated to reflect the status of the negotiations in Zambia.