New bilateral health agreements signed by the United States with seven African countries could force governments to hand over sensitive patient data and monitor abortion provision, raising serious privacy and human rights concerns, according to a report by Human Rights Watch (HRW). The pacts, which condition lifesaving health assistance on a series of controversial terms, require partner nations to grant Washington surveillance access to their health systems and to comply with monitoring of the Helms Amendment – a US law that effectively bans foreign aid from being used to fund abortion services.
Human Rights Watch raises alarm over US health deals
The rights group’s report alleges that the agreements – signed with Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia and Uganda – give the US broad powers to access surveillance data and extractive rights to pathogen samples and associated data for pharmaceutical development. “After the sudden and devastating pullback from US assistance in 2025, governments are now being pressured to accept agreements with contingencies that jeopardise human rights,” said Julia Bleckner, a senior HRW health researcher.
The accords were negotiated after the dissolution of the US Agency for International Development (USAID), which eliminated more than 90 per cent of foreign aid contracts and cut approximately $60 billion in funding. The Trump administration’s “America First” Global Health Strategy shifted to direct government-to-government agreements, channelling funds to recipient countries while encouraging them to increase their own health spending. As of April 2026, the State Department had signed 32 such bilateral memoranda of understanding across Africa, Asia, Oceania and Latin America, representing over $20.6 billion in new health funding with co-investment from receiving nations.
Surveillance, extractive rights and the Helms Amendment
The agreements that have come into the public domain – either briefly posted to the State Department’s Freedom of Information Act Library before being removed, or leaked – contain conditions that HRW says threaten patient privacy and reproductive rights. In addition to granting the US access to national health data systems, some agreements allow unannounced inspections of health facilities to ensure compliance with the Helms Amendment, a 1973 law that has been interpreted as an outright ban on US foreign assistance funding abortion services, even in cases of rape, incest or when a pregnant person’s life is at risk.
“Governments negotiating health assistance agreements with the United States face difficult choices,” Ms Bleckner said. “They should be wary of terms asking them to sign away their populations’ rights and push for the inclusion of civil society representatives and multilateral global health organisations like the Global Fund in deliberations.”
The extractive provisions, which grant Washington rights to pathogen samples and associated data, raise concerns that the US could gain preferential access to diagnostics, vaccines and treatments developed from shared resources, undermining global efforts to establish equitable pathogen-access and benefit-sharing systems. HRW noted that safeguards for patient confidentiality are limited, particularly in countries with weak data protection laws.
Details of the 31 agreements signed overall have not been publicly disclosed by the US government. Agreements with Ethiopia, Kenya, Mozambique, Nigeria and Uganda were briefly available on the State Department’s FOIA library before being removed; those with Rwanda and Liberia were never officially released and only surfaced through leaks.
The pacts also represent a shift towards “country ownership”, with recipient governments committing to increase domestic health spending over five-year periods as US contributions decline. For example, the memorandum with Kenya commits the US to roughly $1.63 billion while Kenya increases its health spending by about $890 million. Nigeria’s deal involves $2.1 billion from the US and a $3 billion contribution from Nigeria. However, HRW noted that some countries, such as Liberia and Mozambique, expect overall declines in annual health spending despite higher domestic contributions, which could hinder their ability to meet health outcomes.
Broader fallout from aid cuts
The abrupt dismantling of USAID in early 2025 resulted in the cancellation of thousands of contracts and severe disruption to health programmes, supply chains and networks of community health workers worldwide. These cuts were compounded by heavy reductions in humanitarian aid from the UK and other Western nations. The UK’s development minister, Jenny Chapman, acknowledged this week that the response to the rapidly spreading Ebola outbreak in the Democratic Republic of Congo (DRC) had been undermined by foreign aid cuts, although she said the UK continues to spend “just short of £10 billion on international development each year”.
The current Ebola outbreak has seen confirmed cases hit almost 600 across three provinces in the DRC, with the virus also spreading to Uganda. Analysis by the US Centres for Disease Control has warned it could match the worst outbreak in history, which killed 11,000 people in West Africa between 2014 and 2016. The International Rescue Committee reported that nearly 60 per cent of its health facilities in the outbreak’s centre were forced to close due to funding cuts, leaving frontline agencies under-resourced and hampering early detection and containment. The outbreak has since escalated, with more than 900 suspected cases and over 220 deaths recorded by late May, according to figures cited in research by analysts tracking the crisis.
The wider impact of the global pullback on aid is projected to be catastrophic. A peer-reviewed study published in The Lancet estimates that aid cuts in 93 countries – including 38 in Sub-Saharan Africa – could lead to nearly 23 million additional deaths by 2030, including 5.4 million children under the age of five. Separate analyses project up to 22.6 million additional deaths in a severe defunding scenario, with significant increases in HIV infections, malaria cases, tuberculosis and polio. The cuts have also been linked to a significant increase in violence across several African nations and have harmed the global human rights movement, leading to halted investigations, reduced support for victims and the scaling back or closure of organisations that deter violations.
The State Department has been contacted for comment. A spokesperson previously said the department’s focus is on implementing lifesaving care in global health priority areas, including HIV/AIDS, tuberculosis, malaria, and maternal and child health – including through new, landmark bilateral global health memoranda of understanding.