Editorial Note: Originally published on January 13, 2026, this resource will be updated as needed, most recently on September 11, 2026, to reflect additional developments.
On September 18, 2025, the U.S. government (USG) released its new America First Global Health Strategy, which details how the U.S. will engage in global health efforts moving forward. As part of this new strategy, the U.S. has announced that it will be establishing bilateral health cooperation agreements with countries that receive U.S. global health assistance. These agreements, or Memorandums of Understanding (MOUs), between the U.S. and partner countries represent five-year plans (for the period 2026-2030) outlining U.S. engagement in each country’s health efforts with the goal of “helping countries move toward more resilient and durable health systems.” Central to these plans is transitioning country programs from U.S. assistance to long-term country ownership, with a pledge from each partner country to increase its domestic health spending, or co-investment in health, over the next five years as the U.S. decreases its health assistance. The U.S. began signing these agreements in late 2025 and this process is ongoing. Implementation is slated for later this year.
This tracker provides an overview of the MOUs signed to date. Data are based on press releases issued by the State Department, U.S. embassies, and partner country Ministries of Health, as well as MOU documents (if publicly available). See Methods for more information. This tracker will be updated as agreements are signed and more data become available.
USG Global Health MOU Co-Financing Amount by Country
Number of countries with signed agreements: 34 countries
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Amount
Data as of July 1, 2026.
Global health MOU agreements for Bolivia, Botswana, Panama, and South Sudan are for a three-year period. *The Philippines did not sign an official MOU but rather a "Strategic Objective Agreement." While an overall funding amount is available, co-financing details are not yet publicly available.
KFF analysis of U.S. Department of State, U.S. embassy, and Ministries of Health press releases, and MOU documents.
Historical vs. Proposed 5-Year USG Global Health MOU Funding, Funding Change by Country
Number of countries with signed agreements: 34 countries
Total change (and percent change) in 5-year global health funding among countries with agreements: -$7.3 billion (-34%)
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Funding Amount
Funding Change
Percent Change
Data as of July 1, 2026.
Historical funding totals represent appropriated and planned amounts for FY21-23, and requested amounts for FY24-25 for the Global Health Programs (GHP) account. Represents U.S. funding only; does not include country co-investment funding. <br>*Global health MOU agreements for Bolivia, Botswana, Panama, and South Sudan are for a three-year period. For Botswana and South Sudan, prior funding represents planned global health funding for FY23-25. Due to limited data, Bolivia and Panama comparisons cannot be provided.<br>**The Philippines did not sign an official MOU but rather a "Strategic Objective Agreement." While an overall funding amount is available, co-financing details are not yet publicly available.
KFF analysis of U.S. Department of State, U.S. embassy, and Ministries of Health press releases, and MOU documents.
Historical vs. Proposed 5-Year USG Global Health MOU Funding, Percent Change by Country
Number of countries with signed agreements: 34 countries
Total change (and percent change) in 5-year global health funding among countries with agreements: -$7.3 billion (-34%)
Click on the buttons below to see data for
different charts:
Funding Amount
Funding Change
Percent Change
Data as of July 1, 2026.
Historical funding totals represent appropriated and planned amounts for FY21-23, and requested amounts for FY24-25 for the Global Health Programs (GHP) account. Represents U.S. funding only; does not include country co-investment funding. <br>*Global health MOU agreements for Bolivia, Botswana, Panama, and South Sudan are for a three-year period. For Botswana and South Sudan, prior funding represents planned global health funding for FY23-25. Due to limited data, Bolivia and Panama comparisons cannot be provided.<br>**The Philippines did not sign an official MOU but rather a "Strategic Objective Agreement." While an overall funding amount is available, co-financing details are not yet publicly available.
KFF analysis of U.S. Department of State, U.S. embassy, and Ministries of Health press releases, and MOU documents.
Methods
This tracker provides information on U.S. MOU bilateral global health agreements to date. Information is sourced from publicly available U.S. Department of State, U.S. embassies, and partner country Ministries of Health press release statements and MOU texts, and will be updated as more information becomes available and when additional agreements are signed. Currently, MOU text, which contains the most detailed information of these sources, is publicly available for only a limited number of countries; for these countries, data were sourced directly from these MOU documents. For countries with available MOU documents, overall totals are based on the sum of annual amounts presented in the text.
Program areas are captured using keyword searches; for global health security (GHS) specifically, country agreements were categorized as targeting GHS if they specifically mentioned GHS, or if they included descriptions of outbreak preparedness and response activities and containing health threats. Due to the limited nature of press release statements, this tracker may not comprehensively capture the global health program areas targeted in each country’s agreement.
Facts Only
* The U.S. government released the America First Global Health Strategy on September 18, 2025.
* The strategy establishes bilateral health cooperation agreements (MOUs) with countries receiving U.S. global health assistance.
* Most MOUs are five-year plans covering the period 2026-2030.
* Agreements for Bolivia, Botswana, Panama, and South Sudan are for a three-year period.
* Partner countries pledge to increase domestic health spending as U.S. assistance decreases.
* 34 countries have signed agreements as of July 1, 2026.
* Total 5-year global health funding among these 34 countries decreased by $7.3 billion, a 34% reduction.
* The Philippines signed a "Strategic Objective Agreement" rather than an official MOU.
* Data are sourced from the U.S. State Department, U.S. embassies, and partner country Ministries of Health.
* Implementation of these agreements is scheduled for late 2026.
Executive Summary
The U.S. government has shifted its approach to international health through the America First Global Health Strategy, transitioning from direct assistance to a model of bilateral cooperation and country ownership. This strategy utilizes five-year Memorandums of Understanding (MOUs) that require partner nations to increase their own domestic health investments in exchange for a scheduled reduction in U.S. funding. The primary objective is to create more resilient and durable health systems by reducing long-term dependency on American aid.
As of July 2026, 34 countries have entered these agreements, resulting in a projected 34% decrease in U.S. global health funding, totaling a $7.3 billion reduction. While most agreements follow a five-year trajectory, some nations are on shorter three-year terms. There is some uncertainty regarding specific co-financing details for certain partners, such as the Philippines, due to the use of different agreement formats and limited public documentation.
Full Take
The strongest version of this narrative is one of strategic sustainability: the U.S. is evolving from a donor to a partner, incentivizing sovereign nations to build their own infrastructure to avoid the "dependency trap" of perpetual foreign aid. This frames the $7.3 billion funding cut not as a withdrawal, but as a catalyst for domestic resilience.
This is SKEPTICAL MODE analysis. The narrative relies on the assumption that "country ownership" is a viable transition for all 34 nations regardless of their economic stability. The pattern here is a systemic shift in geopolitical priority, moving from a humanitarian-led global health model to a transactional, bilateral model. The implicit paradigm is that health security is a national responsibility rather than a global collective good.
The cost of this transition is borne by the partner countries; if domestic spending does not rise at the same rate as U.S. funding decreases, the result may be a net loss in healthcare delivery. The benefit accrues to the U.S. Treasury and aligns with a specific "America First" ideological framework.
Patterns detected: none
If this were a coordinated influence campaign, the playbook would involve masking a significant budget cut as a "capacity-building exercise" to preempt criticism from global health advocates. However, the provided data is presented as a tracker with methodology and specific figures, lacking the emotive urgency typical of such campaigns.
Bridge Questions:
1. What happens to health outcomes in countries where domestic co-investment fails to materialize?
2. How does the three-year timeline for specific countries differ in intent or risk from the five-year standard?
3. To what extent does "resilience" in these agreements refer to clinical health outcomes versus administrative autonomy?