Minerals for aid: Are new US health deals ‘exploiting’ African countries?

In late 2025 after the United States shocked the world by suspending global health aid and experts said it would lead to 700,000 more deaths, mostly of children, each year, Washington began proposing unusual bilateral health agreements to developing countries that have infuriated officials and health activists alike.

Critics said the deals, mostly made with African nations, smack of “exploitation” while at least two of the countries in dire need of health aid have pushed back against them.
In November, the US approached Zimbabwean authorities, promising more than $300m in funding in return for sensitive health data in negotiations that Harare felt were “lopsided” and promptly pulled out of, according to memos leaked in recent weeks.

About the same time, the US publicly announced $1bn in funding for neighbouring Zambia pending talks. However, Lusaka, too, called out “problematic” clauses in the US proposal that sought access to the country’s minerals and has since requested a review, according to statements from officials in early March.

Several other countries, though, such as Nigeria and Kenya, have gone on to sign the health pacts. The terms agreed remain unclear because the agreements have not been fully published.

Data or mineral demands in return for health aid are unprecedented in the history of the US, which is Africa’s largest health assistance provider. Policy experts said tying crucial funding to sensitive national assets could have negative consequences for African nations and also for the US itself.
“Supporting global health has clear benefits to the United States in terms of prevention of pandemics that can affect Americans too,” Sarang Shidore, Africa director at the US think tank Quincy Institute for Responsible Statecraft, told Al Jazeera.

“Linking such aid to payoffs in the extraction of critical minerals smacks of exploitative practices. Reform in the foreign aid sector is badly needed, but this is not the way to do it.”
Zambia pushes back against minerals-for-aid pact
African nations have long relied on US funding to foot many of their health bills. African countries received $5.4bn in US assistance in 2024, spent largely on humanitarian, health and disaster needs.

So when President Donald Trump’s administration abruptly cut funding in January 2025 and dismantled the US Agency for International Development (USAID), the impact reverberated around Africa and the globe. Boston University’s Impactcounter aid funding tracker revealed that the shocks from the cuts have since led to 518,428 child and 263,915 adult deaths from manageable diseases like HIV and tuberculosis. Close to 10 million new cases of malaria were also reported.

Washington has argued that the aid cuts suit its America First agenda, according to which foreign aid must directly serve US national interests. The stance backs long-held views from some economists that aid is often ineffective and causes overreliance.

Instead, Washington is now focused on government-to-government deals.

Details of what deals are being agreed to have just begun filtering out in recent weeks through leaks. The unusual secrecy surrounding the negotiations is itself a subject of controversy: Health NGOs and civil society groups in Africa said it leaves them out of crucial negotiations, making it harder to plan their programmes or track government funding.

The deals have typically required governments to take on an increasing share of their own health budgets in the next four to five years in a cofinancing arrangement.