In late May, about two weeks after an Ebola outbreak was confirmed in the Democratic Republic of the Congo (DRC), the U.S. government announced plans to establish a quarantine facility in Kenya for Americans exposed to the virus.
Days later, a high court in the East African country blocked the move, following a petition filed by governance watchdogs citing concerns ranging from sparse public information on the bilateral partnership to potential health risks for locals.
“The public has not received sufficient clarity on the agreement, the facility’s legal basis, administrative criteria, operating protocol, community safety, and even the liability arrangements, including the pathways for implementing the workforce,” George Obhai, a Kenyan public health mentor, told Amjambo Africa.
But despite pushback, Kenya’s President William Ruto told citizens that the 50-bed facility at the Laikipia Air Base, about 200 kilometers from Nairobi, the country’s capital, was “the right thing to do.”
In accepting to host the facility, the United States committed about Kes1.7 billion ($13.5 million) to Kenya for the Ebola response.
“It is for the good of Kenyans because we lack adequate resources and comprehensive capacity needed to tackle the Ebola virus. However, the secrecy around the deal has damaged public trust,” Obhai, who also works as a strategic policy advisor with the Intergovernmental Authority on Development (IGAD), said.
Still, hundreds of Kenyans have protested and challenged the preparedness partnership, revealing how strained U.S.-Africa health partnerships have become in recent times.
“Strategic partnerships”
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For decades, the United States has been Africa’s largest donor country for health interventions implemented by the U.S. Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR).
Between 2001 and 2025, the United States contributed more than $204 billion in global health assistance, with Africa benefitting largely. This contribution helped reduce the prevalence of diseases such as malaria, HIV/AIDS, and tuberculosis, as well as maternal and newborn deaths across the continent.
But weeks after Trump took office for a second term, he significantly curtailed USAID operations and moved to reduce or restructure major health assistance programs, including PEPFAR.
In Africa, the shift has been accompanied by controversial health agreements that critics say require countries to provide access to strategic resources, including minerals, and share health data in exchange for funding and technical support. About 18 countries, including Ethiopia, Nigeria, and Kenya, have signed these agreements.
“Health diplomacy has become one of the central pillars of contemporary U.S.-Africa relations. It is increasingly being integrated into broader strategic partnerships,” Emmanuel Muthama, an international relations and diplomacy expert, told Amjambo Africa.
He said Africa remains strategically important to the United States for reasons including Nigeria’s oil, Kenya’s role as a security hub, and Ethiopia’s hosting of the African Union headquarters, making health assistance one way to secure those interests.
Still, some countries, including Zimbabwe, Ghana, and Zambia, have rejected these deals. “It’s about national interests,” Muthama said. “Countries that have accepted these deals believe that the benefits outweigh the costs, while those rejecting them believe there may be potential risks such as sovereignty, security, or political legitimacy.”
Even as some countries negotiate new terms, others are losing support altogether. Trump recently announced that the United States will end PEPFAR funding and programs in South Africa, a country with one of the highest HIV burdens globally. South Africa’s government responded by stating that plans for self-reliance have long been in the pipeline, allowing the country to cater to its population outside of foreign assistance.
Contested future
According to Muthama, whether these new arrangements strengthen African health systems or deepen suspicion will depend on how they are designed and implemented.
Muthama argued that U.S.-Africa health relations are moving away from the traditional donor-recipient model that defined much of the post-Cold War era toward a more strategic partnership in which both sides expect tangible returns.
He also explained that African countries now have options following recent alliances with countries like China and Russia, weakening U.S. leverage as the primary health partner.
Over the next decade, he said, the relationship between Africa and the United States could take one of three paths: genuine partnership, strategic competition, or growing mistrust.
The most optimistic scenario would see greater investment in local manufacturing, technology transfer, capacity building, and stronger African ownership of health systems. “It’s going to be determined by whether both sides can build relationships based on mutual respect, shared responsibility, and genuine partnership,” he said.
But mistrust, according to him, could deepen if agreements are perceived as unequal, opaque, or primarily serving external interests.
For now, debates over Kenya’s proposed Ebola facility and broader health agreements suggest that African governments and citizens are no longer willing to accept health cooperation without scrutiny. The era of aid may be fading, but what replaces it remains contested.
