The administration of US President Donald Trump has signed an agreement providing $480 million in public health aid to Ivory Coast.
The agreement, signed Tuesday in Abidjan, the capital of the West African country, is the latest turning point in the Trump administration’s “America First” global health strategy.
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The plan envisions entering into bilateral agreements with dozens of countries to receive U.S. health aid following the administration’s elimination of the U.S. Agency for International Development (USAID).
The Trump administration has maintained that U.S. foreign aid policy is ineffective and unnecessary, saying bilateral agreements would create more accountability, oversight and, ultimately, self-sufficiency.
Experts have questioned the effectiveness of this approach and sounded the alarm about its transactional nature.
At the signing ceremony Tuesday, U.S. Ambassador to Ivory Coast Jessica Davis Ba said the U.S. government was moving “beyond the traditional approach to aid to a model focused on trade, innovation and shared prosperity.”
“Today, our bilateral cooperation enters a new phase. We are implementing the America First global health strategy,” the ambassador said.
As part of the agreement, Ivory Coast has committed to ultimately providing up to $292 million in health financing by 2030, Ivorian Prime Minister Robert Beugre Mambe said.
The deal is the largest of more than a dozen other agreements reached so far by the Trump administration under the new strategy.
Cuts to USAID
Significant USAID budget cuts earlier this year disrupted public health services around the world, with Africa particularly hard hit.
This has raised concerns about the potential increase in the spread of HIV on the continent, declining maternal and child health care, increased cases of malaria and reduced early detection of new infectious diseases.
While the Ivory Coast deal and other new bilateral agreements seek to address these issues, public health experts are wary of the administration’s approach.
An analysis earlier this month by the Center for Global Development indicates that the new strategy presents several potentially beneficial changes to the delivery of health assistance abroad.
However, these changes “carry enormous risks to service delivery and hard-won public health gains,” wrote senior analyst Jocilyn Estes and policy researcher Janeen Madan Keller.
The pair identified several potential areas of risk, including public health priorities that could be shaped by “transactional pressures,” questions about surveillance, and a lack of clarity on how services will be protected if a partner country is unable to meet its commitments.
Experts further question what the strategy would mean for aid in areas where there is no “credible or stable government.”
“Implementing a reconfigured approach to U.S. global health assistance – particularly direct government assistance – at such scale and speed is unprecedented,” they wrote, adding that “every point of potential failure puts lives at risk.”
