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 several of the related “specimen sharing agreements” (but not the similarly related “data sharing agreements”) to its website. It subsequently removed the MOUs that it had posted.
PDFs of the agreements published by the Department of State are available in the table below. The table below additionally includes agreements not published by the U.S. but posted by other sources.
| Country | Agreement Date | Text(s) published by State Department* | Other information disclosed by State Department** | Texts posted by other sources | |
|---|---|---|---|---|---|
| Kenya | Dec. 4, 2025 | MOU (PDF) | Data Sharing Agreement (Health Policy Watch) | ||
| Rwanda | Dec. 5, 2025 | Specimen Sharing Agreement reported to Congress (text not disclosed) | MOU (Emily Bass, Substack) | ||
| Liberia | Dec. 9, 2025 | MOU (Health Policy Watch) | |||
| Lesotho | Dec. 10, 2025 | Specimen Sharing Agreement (PDF) | |||
| Uganda | Dec. 10, 2025 | MOU (PDF) | Specimen Sharing Agreement reported to Congress (text not disclosed) | ||
| Eswatini | Dec. 12, 2025 | Specimen Sharing Agreement (PDF) | |||
| Mozambique | Dec. 15, 2025 | MOU (PDF) Specimen Sharing Agreement PDF | |||
| Cameroon | Dec. 16, 2025 | Specimen Sharing Agreement (PDF) | MOU (Think Global Health) | ||
| Nigeria | Dec. 20, 2025 | MOU (PDF) Specimen Sharing Agreement (PDF) | |||
| Sierra Leone | Dec. 22, 2025 | ||||
| Botswana | Dec. 23, 2025 | ||||
| Ethiopia | Dec. 23, 2025 | MOU (PDF) | Specimen Sharing Agreement reported to Congress (text not disclosed) | ||
| Madagascar | Dec. 22, 2025 or Dec. 23, 2025 | ||||
| Côte d'Ivoire | Dec. 30, 2025 | Specimen Sharing Agreement (PDF) | |||
| Malawi | Jan. 14, 2026 | Specimen Sharing Agreement reported to Congress (text not disclosed) | |||
| Burundi | Feb. 6, 2026 | ||||
| Burkina Faso | Feb. 25, 2026 | ||||
| Panama | Feb. 25, 2026 | ||||
| Democratic Republic of the Congo | Feb. 26, 2026 | Specimen Sharing Agreement 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 |
* Main agreement texts were originally published by the State Department here. Additional details regarding information reported to Congress were originally published here.
** Information regarding specimen sharing agreements and related information were published by the State Department 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).