The U.S.’s America First Global Health Strategy formalized a five-year agreement with Kenya, marking the first of many anticipated bilateral agreements with developing nations. Under this strategy, a co-investment model with Kenya has been established, allowing funding to flow directly from government to government, rather than through traditional channels such as USAID or nongovernmental organizations.

The America First Global Health Pact

On December 4, 2025, U.S. Secretary of State Marco Rubio and Kenyan President William Ruto signed the America First Global Health Strategy. Under the agreement, the U.S. will invest up to $1.6 billion, while Kenya will contribute $850 million to support critical public health initiatives, including HIV/AIDS, tuberculosis, malaria and maternal and child health. The framework aims to strengthen healthcare infrastructure in developing nations while enhancing diplomatic relations.

As the first country to sign, Kenya serves as a test case for a potential major shift in global health partnerships. The America First Global Health Strategy reflects a shift in the U.S.’s foreign aid ideology. After dismantling the USAID earlier this year, which resulted in significant cuts in funding for several global health programs, the current administration has sought out a framework it hopes will support state sovereignty and self-reliance.

Strengthening Africa’s HIV Response Through Direct Funding

At the 23rd International Conference on AIDs and STIs in Africa, UNAIDS executive director, Winne Byanyima, argued that health management has not been a priority in Africa, where funds are typically allocated toward debt repayment, as opposed to community health. Africa accounts for the majority of new HIV cases globally, with women representing 62% of infections. Economic disparities and lack of access to education are contributing factors.

It is reported that 46% of adolescent girls are not enrolled in school, exposing them to sexual and gender based violence. UNAIDS has welcomed this framework, as it aligns with its goal of significantly reducing HIV infections by 2030. The initiative aims for 95% of people with HIV to know their status, 95% of those diagnosed to receive treatment and 95% of those treated to achieve viral suppression.

Direct funding to the Kenyan government is expected to strengthen its ability to respond promptly to public health concerns and maintain control over its health priorities.

What Kenya Risks

Despite its potential, there has been backlash. The Consumer Federation of Kenya is seeking to dismantle the agreement, arguing that it violates the constitution as it pertains to concerns with health data privacy. The Consumer Federation of Kenya also argues that there isn’t sufficient oversight as to how sensitive health information would be transferred and used.

The Nairobi High Court has suspended parts of the agreement pending a full hearing. There have also been concerns of service disruption during the transitional phase from the NGO programs.

A New Development Era?

If Kenya’s experience produces positive health outcomes, the America First Global Health Strategy can serve as a blueprint for American partnerships with other nations in Africa. So far, Uganda and Rwanda have also recently signed agreements under this co-investment model. Whether this agreement marks a breakthrough in global health cooperation is yet to be determined.

However, Kenya’s outcome will likely influence agreements with other developing nations and the evolution of international development policy in the 21st century.

– Gloria Bwenge

Gloria is based in New York, NY, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Pixabay