US health funding offer to Zambia: less money, more demands
A stalled US funding offer to Zambia made public this week reveals demands by Washington for access to minerals and data as funding is slashed, in terms criticised as exploitative.
President Donald Trump's administration has finalised secretive one-on-one health aid deals with around a dozen African countries after dismantling the USAID agency and curtailing the role of NGOs.
While countries like Rwanda, Uganda, Lesotho and Eswatini have signed on, Zimbabwe has rejected the offer and Kenya's agreement is suspended pending legal challenges.
The draft US-Zambia deal was leaked on Tuesday by international advocacy NGO Health Gap which said it was meant to have been signed in December.
It provides for $320 million of US funding this year to Zambia's health sector, according to the document. The amount is set to decrease annually to reach $112 million in 2030.
By way of comparison, Lusaka received more than $400 million in health sector aid from Washington in 2024, according to the website ForeignAssistance.gov.
The text also stipulates the offer would be suspended if an agreement on a separate and confidential "Bilateral Compact" was not finalised by April 1.
The US embassy in Lusaka said in December the overall plan, including the compact, "aims to unlock a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms."
Major copper producer
It "explicitly ties exploitation of mineral wealth" with health funding and via the compact, said Health Gap, which said it has been working with Zambian activists to fight the terms.
Zambia is Africa's second-largest copper producer, behind the Democratic Republic of Congo, and the eighth-largest in the world, according to the US Geological Survey (USGS).
Chinese companies have long dominated the copper sector, with major stakes in mines and smelters for the mineral that is essential for power grids, data centres and electric vehicles.
The US State Department did not directly confirm that the leaked memorandum was authentic but did not deny it either.
"We are not seeking anything at Zambia's expense or against Zambia's laws or interests, quite the opposite," a spokesman told AFP on Wednesday.
"These reforms are critical to ensure that the value of Zambia's mineral wealth flows to the Zambian people, and not predatory external actors."
The Zambian health ministry did not respond to AFP's requests for confirmation.
The five-year deal is for funding of HIV, tuberculosis, malaria and other health matters.
As in the deal with Kenya, the draft agreement stipulates that Zambia would share the health data of its citizens with the United States.
This included "physical specimens and related data, including genetic sequence data of detected pathogens with epidemic potential for either country", according to the leaked draft.
Zambia public health researcher Bupe Kabamba told AFP the sharing of people's health data was concerning.
It "may threaten privacy and national sovereignty. Poor management of health data exposes citizens to the risk of blackmail and discrimination," he said.
"Zambia still needs support. However, the support should be collaborative and symbiotic."
Health Gap said activists were also demanding a rejection of conditioning aid to to mining and the significant funding cut.
Zimbabwe pulled out of negotiations on a similar deal with the United States last month, saying the terms threatened its autonomy.
Kenya became the first country to sign a health aid deal with the United States in December but a court suspended it a week later over concerns about sharing personal data.
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