Africa: U.S. Health Aid to African Countries Tied to Harmful Conditions - HRW

Washington — Pacts Require Abortion Surveillance, Rights to Specimen Sharing, Data Access

The United States government is conditioning lifesaving health assistance on broad access to surveillance data and extractive rights to pathogen samples and data for pharmaceutical development, Human Rights Watch said today. Human Rights Watch issued an assessment of seven bilateral health agreements signed in late 2025 with Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia, and Uganda.

"The agreements show the US intends to condition vital health assistance for millions of people on acquiescence to troubling conditions," said Julia Bleckner, senior health researcher at Human Rights Watch. "After the sudden and devastating pullback from US assistance in 2025, governments are now being pressured to accept agreements with contingencies that jeopardize human rights."

The agreements raise serious concerns about access to people's private health care data and about exclusive agreements that would prohibit a more equitable distribution of health care goods, Human Rights Watch said.

The US government has not publicly disclosed details of the 31 agreements reportedly signed with other governments. The agreements with Ethiopia, Kenya, Mozambique, Nigeria, and Uganda were briefly posted to the US State Department's Freedom of Information Act Library on March 13, 2026, under the Case-Zablocki Act, which requires timely public disclosure of international agreements.

They were removed days later, after the New York Times reported that the US had linked a US$1 billion health package to access to Zambia's minerals, with a leaked State Department memo stating that the US would "only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale."

Rwanda and Liberia's agreements were never officially released and became publicly available only through leaks. The US should immediately publish all of these agreements, Human Rights Watch said. It should also disclose information on any ongoing negotiations for access to natural resources in countries that have signed these agreements, in light of the Zambia revelations.

The agreements were negotiated after the US government shut down the US Agency for International Development (USAID) in early 2025, which abruptly cut health care supply chains and shuttered health programs around the world. These cuts included over $800 million in health aid to Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia, and Uganda, creating a public health crisis and threatening to undo decades of