The United States has signed a $480m public health aid agreement with Ivory Coast, marking the largest deal yet under President Donald Trump’s America First Global Health Strategy.
The accord, finalised in Abidjan on Tuesday, reflects Washington’s shift towards bilateral arrangements following deep cuts to the US Agency for International Development (USAID).
The Trump administration has argued that traditional foreign aid programmes have been inefficient, insisting that direct agreements with partner nations will ensure greater accountability and encourage eventual self-sufficiency.
“Today, our bilateral cooperation is entering a new phase. We are implementing the America First Global Health Strategy,” said US Ambassador Jessica Davis Ba at the signing ceremony.
She added that the new model aims to move “beyond the traditional aid approach toward a model focused on trade, innovation, and shared prosperity.”
Ivory Coast has pledged to contribute up to $292m in health funding by 2030, Prime Minister Robert Beugre Mambe confirmed. The deal is one of more than a dozen agreements signed under the new US strategy, but it stands out as the largest commitment to date.
The agreement comes amid widespread concern over the impact of USAID cuts earlier this year, which disrupted health services worldwide, particularly in Africa.
Experts warn that reduced funding could exacerbate the spread of HIV, weaken maternal and child healthcare, increase malaria cases, and hinder early detection of emerging infectious diseases.
While the bilateral deals are intended to address these gaps, analysts remain cautious. A recent report by the Center for Global Development highlighted both potential benefits and significant risks.
Senior analyst Jocilyn Estes and policy fellow Janeen Madan Keller noted that the strategy could reshape health priorities based on “transactional pressures” rather than medical needs.
They also raised questions about oversight and the sustainability of services if partner governments fail to meet their commitments.
“Operationalising a reconfigured approach to US global health assistance – particularly direct government assistance – at this scale and speed is unprecedented,” the report stated. “Each potential point of failure risks lives.”
The Ivory Coast deal underscores the Trump administration’s determination to redefine US foreign aid policy, prioritising bilateral partnerships over multilateral frameworks.
However, critics argue that the transactional nature of the agreements may undermine long-term public health gains, especially in regions where governance remains fragile.
As Washington continues to roll out its America First Global Health Strategy, the balance between efficiency, accountability, and humanitarian responsibility will remain under scrutiny.
Sources: Al Jazeera, Center for Global Development, Reuters, Associated Press
