Zambia has signed a five-year health financing agreement with the US, ending months of public dispute over whether the country was trading citizens’ medical data and mineral rights for aid.
Under the memorandum of understanding, signed in Lusaka on Thursday along with a data-sharing deal, the US will provide about $1.5bn (£1.1bn), with Zambia also contributing.
Civil society groups had criticised a leaked draft they said allowed too much data sharing, while activists seized on reports that health money was being linked to preferential access for US companies to minerals, which the then-US ambassador denied.
The deal comes after the US Agency for International Development (USAID) was cut.
US President Donald Trump had accused USAID of wasteful spending. After closing the agency last year, Washington has pursued similar deals with a number of African countries, arguing partner governments should take on more of the cost.
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Kenya, Tanzania and Uganda are among those that have signed. Ghana and Zimbabwe have rejected agreements over conditions about sharing data and specimens.
Officials say the revised text of Zambia’s new deal addresses concerns about privacy, intellectual property and benefit-sharing.
Health Minister Roma Chilengi said earlier this week that 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.
Data exchange, he said, would be limited to information needed to monitor and evaluate programmes funded under the deal.
A draft leaked earlier this year prompted civil society groups to warn that Zambia was accepting wider data-sharing terms than other African countries, including long-term access to pathogen information and specimens.
The Chapter One Foundation, a human rights group, said the government risked “signing away” citizens’ health data. HIV advocates, including the Treatment Advocacy and Literacy Campaign, said the flow of information would be one-way and demanded the text be published.
Opposition figures and activists also seized on reports that health money was being linked to preferential access for US companies to Zambia’s large reserves of copper and other critical minerals.
In May, Foreign Minister Mulambo Haimbe called the data terms a violation of privacy and “unconscionable”, and accused Washington of tying the package to minerals. Then-US ambassador, Michael Gonzales, rejected that account as false.
The row was sharpened by an earlier US suspension of drug funding after the embassy alleged theft of donated medicines, which the government disputed.
Zambia’s new deal replaces support that for years flowed largely through US programmes. The money is intended to support HIV/Aids, tuberculosis, malaria, maternal and child health, disease surveillance and wider health system work, including the recruitment of community health workers.
The US has described the arrangement as a shift from a donor-recipient model towards shared responsibility, with US funding expected to decline over the five years as Zambia increases domestic spending.
Officials have put the combined package covering 2026 to 2030 at roughly $3.6bn, though figures for the Zambian share have varied.
Shortly after taking office for the second time in January 2025, Trump ordered the closure of USAID, in the process decimating health programmes in some African countries that relied on American funding.
Critics say the move has impacted the speed of detecting the current ongoing Ebola outbreak in the Democratic Republic of Congo and the scale of the response, emphasising that the humanitarian agency was crucial to organising logistics, supplies and local outreach.
The US denies its cuts have harmed efforts, arguing that they are more “aligned and effective” under the new arrangement and pointing to the $270m it has donated to tackle the epidemic.
BBC