Zambia has suspended a proposed health funding agreement worth more than $1 billion with the United States, citing concerns that certain provisions in the draft framework do not align with its national interests.
The five-year deal was designed to channel over $1 billion in U.S. support toward HIV/AIDS and malaria treatment, maternal and child healthcare, and epidemic preparedness.
Under the terms of the draft, Zambia was also expected to contribute about $340 million in co-financing during the same period — a significant commitment at a time when the country is grappling with fiscal pressures.
Negotiations, which were expected to conclude in November 2025, reportedly stalled after revised drafts introduced a contentious clause.
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According to sources familiar with the discussions, the agreement suggested that funding could be withdrawn if Zambia and the United States failed to reach a separate “bilateral compact” by April 1.
That compact was said to be linked to a proposed mining partnership, sparking concerns that critical health funding could be tied to strategic resource access.
For a copper-rich nation increasingly central to global critical mineral supply chains, the optics of linking healthcare support to mining arrangements have raised eyebrows.
Analysts argue that the structure of the deal appeared to intertwine public health assistance with broader economic and geopolitical interests.
Local advocacy groups have also expressed unease.
Owen Mulenga of the Treatment, Advocacy and Literacy Campaign told Reuters that while Zambia needs U.S. support, transparency around the terms of engagement is essential.
He added that the government has not publicly clarified speculation about possible mining linkages within the agreement.
Asia Russell, executive director of Health GAP, a global HIV advocacy organization, warned that the arrangement risked prioritizing mining interests over life-saving health programmes for Zambians living with HIV.
President Hakainde Hichilema has previously signaled a broader rethink of Zambia’s dependence on foreign aid.
In October 2025, he described international aid reductions as “long overdue,” framing them as an opportunity for the country to take greater responsibility for its own development, despite the financial risks involved.
The United States disbursed approximately $598 million to Zambia’s health sector in the previous year, accounting for roughly one-third of the national health budget.
A large share of those funds supports HIV/AIDS treatment and essential maternal health services.
Earlier in 2025, Washington cut $50 million in medical assistance following reports of theft and resale of donated pharmaceuticals, further tightening the funding landscape.
Zambia’s decision reflects a broader continental trend. Several African governments are reassessing the structure and conditions attached to foreign assistance.
Zimbabwe recently withdrew from negotiations over a $350 million U.S. health funding deal, citing sovereignty concerns, particularly provisions requiring extended access to national health data.
Officials in Harare argued that such clauses could expose sensitive population-level information.
Meanwhile, in the Sahel, the United States has concluded a $147 million healthcare agreement with Burkina Faso.
That deal includes a $107 million domestic contribution from Burkina Faso, alongside investments in digitization and laboratory infrastructure, underscoring how co-financing is becoming a common feature of modern aid arrangements.
As debates over sovereignty, transparency, and strategic interests intensify, Zambia’s stance highlights the delicate balance African governments must strike between securing essential funding and safeguarding national priorities.
