U.S. Bilateral Health Agreements: Texts and Related Information
Following the dismantling of USAID and large-scale disruption to U.S. foreign assistance programs, the Trump administration is restructuring health aid according to its “America First Global Health Strategy.” Under the strategy, the Department of State is negotiating multi-year bilateral health funding agreements (memoranda of understanding, or, MOUs) with dozens of countries. The administration is negotiating these agreements on tight timelines, with limited transparency and minimal civil society engagement, despite their significant impact on how health systems and funding operate for years to come.
The State Department posted the main texts of several signed agreements, as well as some of the related “specimen sharing agreements” (but not the similarly related “data sharing agreements”) to its website.
PDFs of the agreements published by the Department of State are available in the table below. The table additionally includes agreements not published by the U.S. but posted by other sources.
An asterisk (*) indicates that the U.S. government made the text or other information public via its Case Act reporting page.
A caret (^) indicates that the U.S. government made the text public pursuant to Public Citizen’s Freedom of Information Act (FOIA) requests.
| Country | Agreement Date | Main Text | Data Sharing Agreement | Specimen Sharing Agreement |
|---|---|---|---|---|
| Kenya | Dec. 4, 2025 | PDF*^ | PDF (Health Policy Watch) | |
| Rwanda | Dec. 5, 2025 | PDF^ | Reported to Congress (text not disclosed)* | |
| Liberia | Dec. 9, 2025 | PDF^ | ||
| Lesotho | Dec. 10, 2025 | PDF^ | PDF* | |
| Uganda | Dec. 10, 2025 | PDF* | Reported to Congress (text not disclosed)* | |
| Eswatini | Dec. 12, 2025 | PDF^ | PDF* | |
| Mozambique | Dec. 15, 2025 | PDF*^ | PDF* | |
| Cameroon | Dec. 16, 2025 | PDF^ | PDF* | |
| Nigeria | Dec. 20, 2025 | PDF*^ | PDF* | |
| Sierra Leone | Dec. 22, 2025 | PDF^ | ||
| Botswana | Dec. 23, 2025 | PDF^ | ||
| Ethiopia | Dec. 23, 2025 | PDF*^ | Reported to Congress (text not disclosed)* | |
| Madagascar | Dec. 22, 2025 or Dec. 23, 2025 | PDF^ | ||
| Côte d'Ivoire | Dec. 30, 2025 | PDF^ | PDF* | |
| Malawi | Jan. 14, 2026 | PDF*^ | PDF* | |
| Burundi | Feb. 6, 2026 | PDF^ | ||
| Burkina Faso | Feb. 25, 2026 | |||
| Panama | Feb. 25, 2026 | |||
| Democratic Republic of the Congo | Feb. 26, 2026 | Reported to Congress (text not disclosed)* | ||
| Dominican Republic | Feb. 26, 2026 | |||
| Niger | Feb. 26, 2026 | |||
| El Salvador | Feb. 27, 2026 | |||
| Guatemala | Feb. 27, 2026 | |||
| Guinea | Feb. 27, 2026 | |||
| Honduras | Mar. 13, 2026 | |||
| Senegal | Mar. 13, 2026 | |||
| Angola | Mar. 19, 2026 | |||
| Cambodia | April 2, 2026 | |||
| Tajikistan | April 6, 2026 | |||
| Bolivia | April 17, 2026 | |||
| Papua New Guinea | April 22, 2026 | |||
| South Sudan | June 25, 2026 | PDF (draft) (Think Global Health) | ||
| Tanzania | July 1, 2026 | |||
| Tanzania | July 1, 2026 |
Source of MOU texts posted via the Case Act reporting page: here. Source of specimen sharing agreements and related information posted via Case Act reporting pages: here and here.
Source of country agreement dates: KFF or State Department press releases.
Public Citizen filed a lawsuit against the U.S. State Department for failing to produce records responsive to Freedom of Information Act requests for the health agreements and related information. Read the press release related to the suit here. The Washington Post covered the suit in its reporting on the Trump Administration’s secretive approach to global health assistance.
Additional documents related to the MOUs and the implementation of the America First Global Health Strategy (AFGHS)
- Template MOU (retrieved from PEPFAR Watch)
- Template MOU guidance (retrieved from PEPFAR Watch)
- Model Specimen Sharing Agreement (retrieved from Health Policy Watch)
- Model Data Sharing Agreement (retrieved from Emily Bass, Substack)
- MOU Implementation Plan Template (retrieved from Emily Bass, Substack, Jan 2026)
- MOU Implementation Plan Companion Tool (retrieved from Emily Bass, Substack, Jan 2026)
- MOU Implementation Process Overview (retrieved from Emily Bass, Substack, Jan 2026)
- AFGHS implementation documents (retrieved from Emily Bass, Substack, May 2026; also discussed here).