By KT Reporter
Global civil society organisations have placed Uganda and neighbouring Kenya under scrutiny following their decision to sign new bilateral health funding agreements with the United States, warning that the deals could undermine national sovereignty and data protection.
Uganda, Kenya, Rwanda, and Liberia last week signed memoranda of understanding (MOUs) with the administration of former U.S. President Donald Trump.
The agreements provide five to ten years of health funding and technical support in exchange for co-financing, access to health data, pathogen specimens, and national health system information.
Civil society actors say the government-to-government financing model marks a significant shift in global health cooperation, moving away from multilateral frameworks that traditionally involve civil society participation and oversight.
This is largely under the America First Global Health Strategy, released on September 18, which outlines a vision to enhance U.S. safety, prosperity, and global health leadership while saving lives and preventing the spread of diseases globally.
The strategy transitions U.S. global health assistance to multi-year bilateral agreements that strengthen local health systems, reduce inefficiencies, and promote sustainability.
In a joint letter led by African public health and social justice networks, civil society groups urged President Yoweri Museveni and other African leaders to demand equity and protect sovereignty in bilateral health agreements with the United States.
They expressed concern that the MOUs grant the U.S. extensive access to national health data systems and pathogen samples without corresponding commitments on equitable benefit-sharing, technology transfer, fair pricing, or long-term public health system strengthening.
On December 10, 2025, the governments of Uganda and the United States signed a five-year, $2.3 billion bilateral health cooperation framework. According to a statement from the U.S. Embassy in Uganda, the MOU outlines a comprehensive vision to save lives, strengthen Uganda’s health system, and enhance global health security.
“The MOU advances the U.S.–Uganda bilateral relationship and supports Uganda to develop a resilient health system that prevents the spread of emerging and existing infectious diseases globally,” the statement reads. Under the agreement, the United States plans to support priority health programmes, including HIV/AIDS, tuberculosis, malaria, maternal and child health, polio eradication, global health security, disease surveillance, emergency preparedness, and human resources for health. Over the five years, the U.S.
Government plans to provide up to $1.7 billion, while the Government of Uganda has pledged to increase domestic health expenditure by more than $500 million, gradually assuming greater financial responsibility. Finance Minister Matia Kasaija described the agreement as a major step toward health sector self-reliance.
“This agreement represents a significant commitment by the United States and Uganda to co-invest in our shared global health priorities. We are making a shift toward promoting self-reliance through strong community health systems, clear performance metrics, and robust data systems that will prevent and stop outbreaks from threatening Uganda, the United States, and the world,” Kasaija said.
Uganda has long struggled with health financing, particularly for HIV/AIDS and tuberculosis, leading many to expect the new funding to be widely welcomed. However, civil society groups argue that the agreement raises human rights and equity concerns, especially regarding data ownership and sovereignty.
In Kenya, similar concerns sparked legal action, with activists warning that the MOU could allow U.S. access to personal medical records. The High Court subsequently ordered the suspension of the agreement. Kenya’s Cabinet Secretary for Health, Aden Duale, sought to reassure the public, saying the framework protects national sovereignty and data ownership.
“The partnership is designed to secure immense benefits for Kenyans by transitioning to a government-to-government funding model that enhances accountability and supports universal health coverage,” Duale said, adding that the agreement does not constitute an international treaty under international law.
AVAC, an international AIDS vaccine advocacy group, said the MOUs signal a reconstruction of U.S.-led global health investments, shifting away from multilateral models shaped by community input toward bilateral arrangements.
The organisation warned that this approach raises serious questions about transparency, equity, and privacy, with health data and biological samples increasingly treated as bargaining tools.
“African nations with larger economies, such as Kenya, may be better positioned to push back against problematic provisions, but many countries lack similar leverage,” AVAC said.
Civil society groups urged African governments to advance counter-proposals grounded in national law, regional strategies, and public accountability, rather than accept what they described as one-sided terms. “These agreements risk entrenching unequal power dynamics and compromising sovereignty,” said Aggrey Aluso, Executive Director of the Resilience Action Network Africa (RANA).
In response to growing debate, the U.S. Embassy in Kampala issued a detailed clarification outlining key aspects of the Uganda MOU. These include: Increased commitment by Uganda to procure most HIV, TB, and malaria commodities, training of the health workforce, and transition financing from U.S. support to the Government of Uganda funding.
It further said that the MoU provides for training and equipping 14,000 Community Health Extension Workers, with Uganda gradually assuming responsibility for their stipends.
Also, it provides for significant U.S. investment in health data and disease surveillance systems, including electronic medical records and interoperability.
The embassy noted that the United States is expected to remain the largest contributor to Uganda’s health sector throughout the MOU period, while Uganda pledged to increase domestic health funding by approximately $50 million annually, totaling over $500 million in five years.
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