Zambia and the United States signed a five-year health financing agreement in Lusaka on Thursday, ending months of public dispute over whether US aid was being tied to Zambian medical data and mineral access.
The US will provide about $1.5 billion under the deal, with Zambia also contributing. However, the two governments have given different figures for the combined package: the US State Department puts it at $2.49 billion, with the US contributing $1.52 billion and Zambia investing $975 million, while Zambian officials, including Health Minister Roma Chilengi, have described a total of roughly $3.6 billion covering 2026 to 2030. The discrepancy has not been publicly reconciled.
What changed before signing
Chilengi said clauses requiring Zambia to send biological specimens to the US had been removed, and that the agreement would not allow the sharing of individual patient records. "The Government will not be sharing any specimens with the United States because we removed all those aspects that raised concerns," he said.
Data exchange will be limited to information needed to monitor and evaluate US-funded programmes, the health minister said.
The final text also increased US funding by $504 million compared with the original draft, from $1.012 billion to approximately $1.516 billion, and reduced Zambia's co-financing requirements from $243 million to $154 million, according to Health GAP, a global health advocacy group which published both versions of the memorandum.
Minerals deal separated
The health agreement was decoupled from a separate critical minerals agreement that the US is still seeking to negotiate with Zambia, Africa's second-largest copper producer, which also holds significant lithium and cobalt deposits.
"What had been the position previously was that the two were coupled, and we as a government requested that we decouple the conversation on critical minerals on the one hand and the health MoU on the other," Foreign Minister Mulambo Haimbe told reporters. "This has been done."
US Embassy Chargé d'Affaires Mich Coker said the agreement was solely about health. "There is nothing at all in this agreement anywhere that speaks to critical minerals, that speaks to any commercial matter or commercial arrangement whatsoever," he said.
Civil society pressure
Civil society groups and activists had opposed the initial draft, campaigning against the linkage of health aid to mineral access and against data-sharing terms they described as coercive. The Chapter One Foundation warned the government risked "signing away" citizens' health data, and HIV advocates demanded the text be published.
Health GAP said "an inspiring, coordinated campaign of advocacy, pressure and outcry from Washington to Lusaka" had secured meaningful changes, including the removal of a clause that would have terminated health funding if a broader bilateral compact was not reached.
In May, Haimbe called the data terms a violation of privacy and "unconscionable". The then-US ambassador, Michael Gonzales, rejected that account as false.
A wider US push across Africa
The deal is part of the Trump administration's America First Global Health Strategy, pursued after the dismantling of the US Agency for International Development. The US has signed health data and specimen-sharing agreements with at least nine African nations, committing them to send data and specimens within five days of a request, according to agreements published by the State Department. The US says it can then share that material with up to 10 American non-governmental entities developing diagnostics and treatments.
Not all governments have accepted those terms. Zimbabwe rejected a deal in part over requirements to share sensitive health data, and the US ended its health assistance to Zimbabwe last month. Ghana and Namibia also refused to sign over concerns about data and specimen provisions.
Critics of the US aid cuts say they have disrupted health programmes, including the response to the Ebola outbreak in the Democratic Republic of Congo. The US denies its cuts have harmed efforts, describing the new arrangement as more "aligned and effective" and pointing to $270 million it has donated to tackle the epidemic.
What is confirmed, unknown and awaited
Confirmed: the memorandum was signed in Lusaka on Thursday; the US contribution is about $1.5 billion over five years; specimen-sharing and individual patient-data clauses were removed; and the minerals agreement will be negotiated separately.
Unknown: why the two governments cite different combined totals, and how the remaining funding will be allocated across HIV/AIDS, tuberculosis, malaria, maternal and child health, and disease surveillance.
Awaited: details of the separate critical minerals agreement, which Haimbe said is still being negotiated; the outcome of civil society requests for a role in implementing the health deal; and whether US lawmakers or Zambia's Constitutional Court will further scrutinise the pact.
Sources: Associated Press, Yahoo News, Health Policy Watch, Health GAP, Business Insider Africa, NewsDay