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Designing Direct-to-Government Assistance: Three Case Studies in Global Health Financing
In September 2025, the US State Department released the America First Global Health Strategy, announcing a major shift in how the United States programs foreign assistance in one of its largest sectors, representing over $13 billion in FY 2024. Global health dollars, the strategy states, will now flow primarily to foreign governments, not to nongovernmental organizations (NGOs), as has been the case in recent decades. The Department has sought to advance this strategy by signing non-binding, multi-year memoranda of understanding (MOUs) with dozens of its largest aid recipients. While officials acknowledge that there will be real challenges to providing direct assistance in the near term, the explicit goal of these MOUs is to transition from donor-driven systems to partner government-led implementation.
Where the Trump Administration's Global Health Agreements Stand
The State Department has now signed more than 30 bilateral global health cooperation agreements, adding dozens of new deals with partner governments since our initial update and rundown of outstanding questions in December. And as the administration works to reorient the geographic focus of US assistance, the sweeping new agreements have reached the Western Hemisphere and the Indo-Pacific. Beyond signing additional agreements, the State Department published the official texts of five memoranda of understanding (MOUs) in response to a FOIA request, only to quietly disappear from the government's website. (Public Citizen maintains separate copies—along with other MOU-related documents from unofficial sources.)
U.S. Forging a Healthier Oceania Through Trump Administration's America First Global Health Strategy Through Bilateral Health Memorandum of Understanding with Papua New Guinea - U.S. Embassy & Consulates in China
United States Forging a Healthier Oceania Through Trump Administration’s America First Global Health Strategy Through Bilateral Health Memorandum of Understanding with Papua New Guinea Press Statement Thomas “Tommy” Pigott, Principal Deputy Spokesperson April 23, 2026 Yesterday the United States and Papua New Guinea signed a five-year bilateral Memorandum of Understanding (MOU) through the Trump Administration’s America First Global Health Strategy. The landmark health MOU focuses on effectively addressing emerging infectious diseases and ongoing outbreaks, building and maintaining surge-response capacities, and enabling Papua New Guinea’s government to independently manage new health threats before they spread internationally. Working with Congress, the United States intends to provide $15 million through December 2030 through the jointly decided health MOU, building on decades of progress in reducing HIV infections and transmissions in Papua New Guinea. The government of Papua New Guinea intends to allocate up to $3 million to disease control programs and strengthen health systems at the national and provincial levels. Up to $5 million under the health MOU will directly support global health security funding, advancing our shared commitment to health security in the region. Through the signing of this $18 million MOU, we are bolstering infectious disease prevention and response by leveraging cost-effective, nationally-driven approaches, with the goal of increasing Papua New Guinea’s health system self-sufficiency. America First Global Health Strategy Memoranda of Understanding (MOUs) signed so far represent more than $20.6 billion in new health funding, including more than $12.8 billion in U.S. assistance alongside $7.8 billion in co-investment from recipient countries, building on decades of progress fighting HIV/AIDS, malaria, tuberculosis, and other infectious diseases around the world. As of April 22, the State Department has signed 32 bilateral global health MOUs with Angola, Bolivia, Botswana, Burkina Faso, Burundi, Cambodia, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, the Dominican Republic, El Salvador, Eswatini, Ethiopia, Guatemala, Guinea, Honduras, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Niger, Nigeria, Panama, Papua New Guinea, the Philippines, Rwanda, Senegal, Sierra Leone, Tajikistan, and Uganda.
Forging Health Partnerships Under the Trump Administration’s America First Global Health Strategy in Honduras and Senegal - United States Department of State
The United States signed bilateral health cooperation Memoranda of Understanding (MOUs) with the Republic of Honduras and the Republic of Senegal, marking significant milestones in advancing the Trump Administration’s America First Global Health Strategy while strengthening our partnerships in the Western Hemisphere and Africa. In Honduras, the Department of State signed a five-year, $46.5 million […]
US Speeds Up Signing Of Bilateral Health Agreements, DRC Lawyers Challenge Minerals Deal
The United States has moved at speed to secure several new bilateral health Memoranda of Understanding (MOUs) in the past week, including, for the first time,
Pursuing Sustainable Health Outcomes Under the Trump Administration’s America First Global Health Strategy in the Republic of Guatemala, the Republic of Guinea, and the Republic of El Salvador - United States Department of State
Today, the United States signed bilateral health cooperation Memoranda of Understanding (MOUs) with the Republic of Guatemala, the Republic of Guinea, and the Republic of El Salvador, advancing the Trump Administration’s America First Global Health Strategy across two continents. These MOUs establish frameworks for sustainable, country-led health systems while strengthening disease detection and response capabilities […]
Bolstering Infectious Disease Outbreak Prevention and Response in Niger and the Dominican Republic Through the America First Global Health Strategy - United States Department of State
On February 26, the United States signed bilateral health cooperation Memoranda of Understanding (MOUs) with the Dominican Republic and the Republic of Niger, reinforcing U.S. leadership in global health while advancing country ownership under the Trump Administration’s America First Global Health Strategy. In the Dominican Republic, the United States signed a five-year bilateral health cooperation […]