The United States is preparing to sign a series of multi-year Bilateral Agreements on Global Health Cooperation with dozens of countries receiving U.S. health assistance, marking one of the largest shifts in U.S. global health policy in decades.
The agreements, rolled out under the America First Global Health Strategy, aim to strengthen partnerships while transitioning greater long-term responsibility to partner governments.
A New Framework for Global Health Cooperation
U.S. officials say the agreements will establish a “comprehensive and shared vision” for future collaboration on disease prevention and health system resilience. By setting joint goals between the United States and partner governments, the effort is designed to maximize the impact of American assistance and improve long-term global health security.
The agreements continue U.S. commitments to major global health priorities, including HIV/AIDS, tuberculosis, malaria, polio, maternal and child health, disease surveillance, and outbreak preparedness.
Transitioning Key Responsibilities to Partner Governments
A defining feature of the initiative is a gradual, multi-year transition of responsibilities currently managed by the U.S. government. This includes:
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Commodities Procurement: Countries will progressively assume responsibility for purchasing medical supplies, diagnostics, and medications. The U.S. will cover 100% of frontline workers and commodities for the upcoming fiscal year as the transition begins.
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Frontline Health Workforce: U.S.-funded health workers will be aligned with national workforce categories and moved onto partner government payrolls over several years.
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Health Data Systems: Funding will help scale up national data systems capable of independently tracking HIV/AIDS, TB, malaria, polio, and emerging outbreaks.
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Domestic Co-Investment: Partner governments will be expected to increase their own health spending, viewed as essential for sustaining progress when U.S. support phases down.
Performance-Based Incentives to Drive Results
Under the new agreements, U.S. financial support will be directly tied to partner countries’ performance. Nations that meet or exceed key health metrics will qualify for additional incentive funding, a move aimed at driving accountability and accelerating progress across disease programs.
Building on Over Two Decades of U.S. Investment
Since 2001, the United States has invested more than $204 billion to strengthen health systems worldwide. This funding has supported lifesaving treatment programs, bolstered national disease surveillance networks, and advanced international cooperation on major health threats.
Officials say the new agreements retain the strengths of existing U.S. global health programs while addressing systemic inefficiencies—reducing non-frontline spending, integrating U.S. health initiatives into national systems, and mobilizing private-sector and faith-based organizations.
A Key Pillar of the America First Global Health Strategy
The initiative is being positioned as a core element of the President Trump Administration’s America First Global Health Strategy. According to the administration, ensuring partner countries can sustain health gains over time ultimately makes the United States “safer, stronger, and more prosperous,” while preserving decades of progress in global disease control.