Zambia has pushed back against parts of a proposed US$1 billion health funding agreement with the United States, saying elements of the deal do not align with the country’s national interests, the government has confirmed.
The agreement, which was due to be signed in November, would govern more than US$1 billion in US funding over five years to support programmes targeting HIV, malaria, maternal and child health, and disease outbreak preparedness.
It also requires Zambia to contribute about US$340 million in co-financing over the same period.
A spokesperson for Zambia’s Ministry of Health said the signing was delayed after revised drafts introduced a section the government found problematic, prompting Lusaka to request further changes. The spokesperson declined to disclose details of the disputed provisions.
The development comes amid growing concern from health advocates that the deal links health funding to broader geopolitical and commercial interests, including access to Zambia’s mineral sector. In December, the US publicly stated it was working with Zambia on a plan to unlock substantial grant funding in exchange for collaboration in mining and business-sector reforms.
Zambia is Africa’s second-largest copper producer after the Democratic Republic of Congo and holds significant reserves of cobalt, lithium, nickel, graphite, manganese and rare earth elements.
While the US State Department declined to comment on ongoing negotiations, it reiterated that American foreign assistance is designed to advance US national interests. Zambian authorities, however, insist the agreement is strictly health-focused.
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“The agreement has no relation whatsoever to minerals, mining or natural resources,” the Ministry of Health spokesperson said, adding that Zambia remains open to engagement only under terms that are mutually agreed and aligned with national priorities.
Despite these assurances, a draft of the agreement reviewed by journalists indicates that funding could be suspended if Zambia and the US fail to finalise a proposed bilateral compact by April 1. Multiple sources say the compact is tied to mining cooperation.
Health advocacy groups have also raised concerns over a proposed 10-year data-sharing arrangement, warning that it could disproportionately benefit the US and lacks transparency.
Owen Mulenga, an officer at Zambia’s Treatment, Advocacy and Literacy Campaign, said the secrecy surrounding the negotiations was troubling. He warned that health data would likely flow in one direction and called for greater openness.
International advocacy groups echoed those concerns, warning that the deal risks prioritising mining interests over the health needs of Zambians living with HIV.
The standoff reflects a broader shift in how the current US administration delivers global health funding, following cuts to aid programmes and a stated “America First” approach to foreign assistance.
Earlier this week, Zimbabwe withdrew from a similar US health funding agreement worth US$367 million, citing data privacy concerns.
Kenya’s more than US$1.6 billion deal remains suspended pending a court challenge, while countries such as Nigeria and Uganda have proceeded to sign comparable agreements.
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