US Global Health MOUs: A Country-by-Country Tracker (2026-2030)
The U.S. Government is reshaping its approach to global health, moving away from broad assistance programs toward bilateral agreements focused on long-term sustainability and mutual benefit. As of February 27, 2026, the U.S. Department of State has been signing Memorandums of Understanding (MOUs) with countries receiving U.S. Global health assistance, outlining five-year plans (2026-2030) for collaboration. This shift, detailed in the America First Global Health Strategy released in September 2025, aims to strengthen health systems in partner countries while prioritizing American interests and preventing the spread of infectious diseases.
These MOUs represent a significant change in how the U.S. Engages in global health. Traditionally, U.S. Assistance has often been delivered through a variety of channels, including multilateral organizations and non-governmental organizations. The new strategy emphasizes direct, country-to-country agreements, with a focus on transitioning programs from U.S. Funding to country ownership. A key component of this transition is a commitment from partner countries to increase their own domestic health spending over the next five years, effectively co-investing in their health systems.
Tracking the Agreements
A new tracker, maintained by KFF, provides an overview of the MOUs signed to date. The data is compiled from press releases issued by the State Department, U.S. Embassies, and partner country Ministries of Health, as well as the MOU documents themselves when publicly available. The tracker currently includes information on funding levels, program areas, and co-financing commitments.
As of this update, agreements have been signed with a growing number of countries, with varying levels of commitment and focus. The tracker highlights the diversity of program areas targeted, ranging from global health security and HIV/AIDS prevention to maternal and child health.
A Shift in Funding Priorities
The America First Global Health Strategy acknowledges that past U.S. Global health programs, while successful in saving lives and preventing outbreaks, have become inefficient and created a culture of dependency. According to the U.S. Embassy in Nigeria, less than 40% of health foreign assistance currently reaches frontline supplies and healthcare workers. Approximately 25% is used for commodities like diagnostics and drugs, and 15% for employing frontline healthcare workers, while a substantial 60% is spent on technical assistance, program management, and overhead costs. The strategy aims to address this imbalance by directing more resources to frontline workers and essential supplies.
The new MOUs reflect this shift. They emphasize the importance of 100% funding for frontline commodity purchases and healthcare workers during the agreement period. This commitment is intended to ensure that essential health services are maintained even as U.S. Assistance gradually decreases. The strategy also prioritizes data systems to monitor outbreaks and broader health outcomes, enabling countries to track progress and make informed decisions.
Focus on Global Health Security
A central pillar of the America First Global Health Strategy is strengthening global health security. The strategy explicitly states the goal of keeping Americans safe by supporting a global surveillance system capable of rapidly detecting infectious disease outbreaks. The U.S. Intends to work with local governments to respond promptly to outbreaks, surging resources when necessary to contain them and prevent them from reaching American shores.
Many of the MOUs signed to date include provisions for strengthening global health security, with a focus on outbreak preparedness and response. This includes investments in surveillance systems, laboratory capacity, and workforce training. The emphasis on global health security reflects the lessons learned from recent pandemics, including COVID-19, and the recognition that infectious diseases pose a significant threat to both national and international security.
Co-Financing and Country Ownership
The requirement for partner countries to increase their domestic health spending is a key element of the new strategy. This co-financing commitment is intended to ensure that countries take ownership of their health systems and are not solely reliant on U.S. Assistance. The U.S. Government believes that this approach will lead to more sustainable and resilient health systems in the long run.
The level of co-financing varies from country to country, depending on their economic capacity and existing health spending levels. However, all partner countries are expected to demonstrate a commitment to increasing their investment in health over the five-year period of the MOU. This commitment is seen as a sign of ownership and a prerequisite for continued U.S. Support.
What to Expect in the Coming Months
The signing of MOUs is an ongoing process, and the KFF tracker will continue to be updated as new agreements are reached. Implementation of the MOUs is slated to begin later in 2026, with a focus on transitioning programs to country ownership and strengthening health systems. The U.S. Government will be closely monitoring the progress of these agreements, and adjustments may be made as needed. The success of this new strategy will depend on the commitment of both the U.S. Government and partner countries to working together to achieve shared goals in global health.
