The US has been accused of “blatant exploitation” of a health funding deal with Zambia worth more than $1bn (£740m), amid warnings that the country is getting a raw deal from the Trump administration.
A leaked draft of a five-year memorandum of understanding (MOU) between the two countries, seen by The Guardian, reveals that Zambia can accept worse terms than health financing agreements the United States has reached with 16 other African countries.
The terms include a commitment to give Washington access to its health data for 10 years, far longer than other countries have negotiated. The Zambia deal also conditions any health funding on an even more covert deal that could open up the country’s mining industry to U.S. interests.
Asia Russell, director of the HIV advocacy organization Health Gap said: “These terms are far worse than other agreements. (The United States) is conditioning life-saving health services on the plundering of the country’s mineral wealth.
“It is blatant exploitation, which is immoral. It is also dangerous: when a rapacious administration treats health programs as currency, everyone suffers,” he said.
The Trump administration is pushing these bilateral global health agreements after dismantling most of the federal development agency, USAID.
The new strategy channels health financing directly to governments, rather than through aid organizations, while requiring greater investments from partner countries.
On Wednesday, Zimbabwe said it was suspending talks on a bilateral health deal with the United States over concerns about the sharing of sensitive health data.
In the case of Zambia, Washington is offering $1.012 billion in health financing in exchange for Lusaka’s commitment to hire 40,000 new health workers and contribute an additional $400 million in health services over five years, while improving health sector performance, according to the leaked draft. The country’s budget for health services in 2026 is approximately $1.3 billion.
If Zambia faltered on any of these fronts, Washington could terminate the agreement and withdraw its funds.
Julius Kachidza, chair of the Zambian Civil Society Self-Coordination Mechanism, supports much of what the MoU is trying to achieve, such as better services and increased domestic funding, but is concerned that if the country does not meet its stated terms, then the entire health system would be put at risk.
“I am a person living with HIV,” he said. “If Zambia’s HIV program is distorted, disrupted or derailed, I will be the first victim, along with hundreds of thousands of others.”
Civil society groups are pushing to modify the agreement. The memorandum of understanding includes a clause that the entire process will end if an agreement is not reached by April 1.
For advocates, their main demand is to remove any data-sharing requirements from the agreement.
Josiah Kalala, director of Chapter One Foundation, a human rights organisation, said: “This is essentially our Zambian government giving up the right to access the health data of its citizens to another country.”
Zambia is also preparing to provide Washington with information on any new or emerging pathogens within its borders over the next 25 years.
Other countries have committed to sharing data, but on less demanding terms. None of the publicly available MOUs include 25-year commitments to share pathogen data. Kenya limited the sharing of its health data to seven years, but still faces a legal challenge.
Kachidza said Zambian activists would also consider going to court over the deal.
In early December, the US embassy in Zambia confirmed that the health financing deal was contingent on “collaboration in the mining sector and clear business sector reforms” that would improve US economic access to the country.
The MOU also commits the Zambian government to holding monthly briefings with the U.S. embassy on trade and investment efforts between the two countries, with the goal of “expanding U.S. commercial investment in Zambia.”
Kachidza described the situation as “being held hostage.”
A U.S. State Department spokesperson declined to discuss the details of the MOU, but wrote in a statement: “The administration believes that U.S. foreign assistance should demonstrably advance U.S. national interests and use taxpayer dollars efficiently.”
On February 15, Zambian Health Minister Elijah Muchima denied that health funding was linked to mining concessions. “The conditions in that memorandum of understanding relate to how the money will be used,” he said on television.
“If there are other external conditions, I am personally not part of them,” he said. Zambian President Hakainde Hichilema fired Muchima three days later without explanation.
Activists fear Zambia is doomed to fail, although Oliver Kaonga, a Zambian health economist, said it might be possible for the government to meet new funding obligations. However, Zambia’s spending remains limited: more than a third of its 2026 budget will go to debt repayment. “The starting point would be: ‘can we mobilize resources better?’” he said.
The United States offers Zambia less health aid under the MOU than before. Washington had committed $367 million to Zambia for HIV services alone last year. Total health funding for 2026 is $320 million according to the draft MOU, which would cover programs such as disease surveillance and treatment of malaria, tuberculosis and HIV.
The total US commitment of $1.012 billion over five years is less than the $1.5 billion deal Muchima announced in November 2025. The US State Department, whose Office of Health Security and Global Diplomacy has been negotiating the agreements, did not respond to a request for clarification from The Guardian newspaper.
As its funding declines, Zambia is still expected to improve its performance goals, such as increasing the number of people enrolled in HIV treatment and reducing maternal mortality, or risk losing US support.
Kalala suspects that the Zambian government is pressing ahead with the deal despite the risks, in part because of its “grave concern about the sudden loss of funding for the health sector and the political fallout it could cause.”
Zambia’s Ministry of Health did not respond to requests for comment.
In Zambia, civil society groups finally secured a meeting with the Ministry of Health on February 3. But the two-hour briefing only addressed some components of the MOU, while several participants said officials warned them not to consider legal action over the data-sharing provisions. Officials declined to clarify whether the DGM funding was tied to economic concessions.
Advocates have presented a list of demands, along with the elimination of data sharing, including a position on the steering committee that will monitor progress.
Kalala is also spearheading a freedom of information request to make public the latest version of the MOU and the bilateral agreement.
“Once we have the agreement and the pact in sight, we can even see if we can challenge the constitutionality of some of the provisions,” he said. “We have to get it right from the beginning.”
