America First Leaves Africa Reeling: US, Kenya Forge Bold New Path

Paul Riverbank, 12/5/2025US reshapes African health aid: Kenya secures funds, others face uncertainty, tough policy strings attached.

Instead of the sprawling, sometimes unwieldy US Agency for International Development projects, this fresh pact streamlines funding—$1.7 billion will flow from Washington, with Kenya contributing the remaining $850 million over the course of five years. Rubio, characteristically frank during the signing ceremony, framed this as a move to “strengthen US leadership” but underscored that the old model, riddled with what he called “dependency, ideology, inefficiency, and waste,” had run its course.

The abrupt dismantling of USAID, it must be said, left a trail of worries in its wake. Clinics shuttered with little warning, workers found themselves suddenly unpaid, and vital support for countless mothers, children, and HIV-positive patients evaporated overnight in places from South Africa to northern Nigeria. “Projects that had become the backbone of public health across much of the continent vanished almost instantly,” one health official in Ghana confided.

What sets this Kenya deal apart is not just its scale but its focus. Rather than an exhaustive portfolio of interventions, the new arrangement zeroes in on infectious diseases—a continued battle against HIV/AIDS, malaria, and tuberculosis. Especially notable is the elevation of faith-based organizations, now expected to take the lead in delivering frontline care, although all hospitals under Kenya’s national insurance remain eligible for support.

“It’s a real departure from what we’ve come to expect,” said Dr. Ouma Oluga, Kenya’s principal secretary for medical services. His relief was palpable—a sentiment echoed quietly by hospital directors who had feared further funding chaos.

But ideological lines remain. Of note, family planning resources will reach only those organizations whose policies align with current US stances on abortion—a restriction that is far from universally popular among Nairobi’s medical community. US envoys Jeremy Lewin and Brad Smith added that the partnership would not bar care for gay, transgender, or sex worker populations, attempting to forestall criticisms of exclusion.

The underlying message: Washington’s largesse comes with strings, and alignment with American policy is now something of a prerequisite. The “America First” lens dominates here; only countries viewed as reliable partners have been approached with similar proposals so far. For those like Nigeria or South Africa—both major regional powers—the absence of a fresh accord is telling. US officials quietly cite “policy differences,” but the subtext is difficult to miss.

For South Africa especially, the loss has been acute. The sheer scale of the challenge is hard to overstate: with the highest number of people living with HIV globally, the nation once counted on nearly $400 million annually from US sources, a fifth of its HIV-fighting budget. UNAIDS and local advocacy groups laid out dire forecasts in recent months, warning that gains of the last two decades could rapidly unravel. Washington did restore some aid, notably a $115 million injection into South Africa’s HIV response, but the uncertainty has left its mark.

Nigeria’s situation, if anything, reflects an even starker reality. Built up with four billion dollars of US support over the past half-decade, its national health infrastructure had always teetered on the edge. When the funding tide turned, clinics and schools in remote states saw services dry up almost overnight, exacerbating pressure on an under-resourced system.

Rubio defended the new approach, arguing these consolidations will make American dollars work harder and reach further—a point echoed in some corners of Kenya’s health bureaucracy but met with suspicion elsewhere. The United States has signaled that more such agreements may follow before the year’s end, though success hinges on how closely future recipients mirror Washington’s own position.

Ruto, for his part, framed the deal as a chance to not only shore up health outcomes domestically but to bolster Kenya’s global leadership—including its controversial troop deployment to Haiti, noted by several journalists in Nairobi as a not-so-subtle nod to broader regional ambitions.

On the ground across Africa, the mood is uneasy. Supporters hold out hope that targeting investments more precisely will result in lasting benefits and greater local autonomy. Critics, meanwhile, warn that the most vulnerable—the rural poor, young mothers, and millions living with HIV—risk being swept aside as priorities shift.

For now, the corridors of power in Washington and African capitals are alive with debate and negotiation. Whether these new partnerships can deliver on their promises, and at what cost, remains to be seen. As one seasoned Kenyan doctor remarked, “It’s a new chapter, but we don’t yet know who’s writing the ending.”

When word broke last week of a new $2.5 billion health partnership between the US and Kenya, reactions across the global health community ranged from cautious optimism to open skepticism. The deal, brokered in Nairobi by Kenyan President William Ruto and US Secretary of State Marco Rubio, wasn’t simply another bilateral pledge—it marked an unmistakable turn in America’s strategy for foreign health aid, following the sudden shuttering of USAID’s longstanding African programs earlier this year.Instead of the sprawling, sometimes unwieldy US Agency for International Development projects, this fresh pact streamlines funding—$1.7 billion will flow from Washington, with Kenya contributing the remaining $850 million over the course of five years. Rubio, characteristically frank during the signing ceremony, framed this as a move to “strengthen US leadership” but underscored that the old model, riddled with what he called “dependency, ideology, inefficiency, and waste,” had run its course.The abrupt dismantling of USAID, it must be said, left a trail of worries in its wake. Clinics shuttered with little warning, workers found themselves suddenly unpaid, and vital support for countless mothers, children, and HIV-positive patients evaporated overnight in places from South Africa to northern Nigeria. “Projects that had become the backbone of public health across much of the continent vanished almost instantly,” one health official in Ghana confided.What sets this Kenya deal apart is not just its scale but its focus. Rather than an exhaustive portfolio of interventions, the new arrangement zeroes in on infectious diseases—a continued battle against HIV/AIDS, malaria, and tuberculosis. Especially notable is the elevation of faith-based organizations, now expected to take the lead in delivering frontline care, although all hospitals under Kenya’s national insurance remain eligible for support.“It’s a real departure from what we’ve come to expect,” said Dr. Ouma Oluga, Kenya’s principal secretary for medical services. His relief was palpable—a sentiment echoed quietly by hospital directors who had feared further funding chaos.But ideological lines remain. Of note, family planning resources will reach only those organizations whose policies align with current US stances on abortion—a restriction that is far from universally popular among Nairobi’s medical community. US envoys Jeremy Lewin and Brad Smith added that the partnership would not bar care for gay, transgender, or sex worker populations, attempting to forestall criticisms of exclusion.The underlying message: Washington’s largesse comes with strings, and alignment with American policy is now something of a prerequisite. The “America First” lens dominates here; only countries viewed as reliable partners have been approached with similar proposals so far. For those like Nigeria or South Africa—both major regional powers—the absence of a fresh accord is telling. US officials quietly cite “policy differences,” but the subtext is difficult to miss.For South Africa especially, the loss has been acute. The sheer scale of the challenge is hard to overstate: with the highest number of people living with HIV globally, the nation once counted on nearly $400 million annually from US sources, a fifth of its HIV-fighting budget. UNAIDS and local advocacy groups laid out dire forecasts in recent months, warning that gains of the last two decades could rapidly unravel. Washington did restore some aid, notably a $115 million injection into South Africa’s HIV response, but the uncertainty has left its mark.Nigeria’s situation, if anything, reflects an even starker reality. Built up with four billion dollars of US support over the past half-decade, its national health infrastructure had always teetered on the edge. When the funding tide turned, clinics and schools in remote states saw services dry up almost overnight, exacerbating pressure on an under-resourced system.Rubio defended the new approach, arguing these consolidations will make American dollars work harder and reach further—a point echoed in some corners of Kenya’s health bureaucracy but met with suspicion elsewhere. The United States has signaled that more such agreements may follow before the year’s end, though success hinges on how closely future recipients mirror Washington’s own position.Ruto, for his part, framed the deal as a chance to not only shore up health outcomes domestically but to bolster Kenya’s global leadership—including its controversial troop deployment to Haiti, noted by several journalists in Nairobi as a not-so-subtle nod to broader regional ambitions.On the ground across Africa, the mood is uneasy. Supporters hold out hope that targeting investments more precisely will result in lasting benefits and greater local autonomy. Critics, meanwhile, warn that the most vulnerable—the rural poor, young mothers, and millions living with HIV—risk being swept aside as priorities shift.For now, the corridors of power in Washington and African capitals are alive with debate and negotiation. Whether these new partnerships can deliver on their promises, and at what cost, remains to be seen. As one seasoned Kenyan doctor remarked, “It’s a new chapter, but we don’t yet know who’s writing the ending.”