The United States is reshaping its approach to global health, moving toward bilateral agreements designed to foster greater self-reliance among partner nations. A new KFF tracker provides a detailed overview of these Memorandums of Understanding (MOUs), launched as part of the America First Global Health Strategy released in September 2025. These agreements, central to the Biden administration’s vision for global health security, aim to transition programs from direct U.S. Assistance to sustainable, country-led health systems.
The core principle underpinning these MOUs is shared responsibility. Each agreement, covering the period from 2026 to 2030, outlines a five-year plan for U.S. Engagement in a partner country’s health sector. Crucially, these plans are contingent on a commitment from each nation to increase its own domestic health spending – a “co-investment” in health – as U.S. Assistance gradually decreases. The strategy, as outlined by the State Department, prioritizes American interests while simultaneously aiming to “save millions of lives around the world” and build more resilient health infrastructure globally.
A Shift in U.S. Global Health Engagement
The move toward bilateral MOUs represents a significant shift in U.S. Global health policy. Traditionally, U.S. Assistance has often been channeled through multilateral organizations. The new strategy emphasizes direct engagement with partner countries, tailoring programs to specific national needs and priorities. This approach, officials say, will lead to more effective and sustainable health outcomes. The U.S. Began signing these agreements in late 2025, with implementation slated for later this year.
The KFF tracker, updated as of February 26, 2026, provides a comprehensive overview of the MOUs signed to date. The data are compiled from press releases issued by the State Department, U.S. Embassies, and partner country Ministries of Health, as well as from the MOU documents themselves when publicly available. The tracker details the funding commitments, co-financing arrangements, and program areas targeted in each agreement.
Key Trends in MOU Agreements
Analysis of the KFF tracker data reveals several key trends. Funding levels vary significantly by country, reflecting differing needs and priorities. The agreements prioritize a range of program areas, including global health security, maternal and child health, and infectious disease control. A consistent theme across all agreements is the emphasis on strengthening health systems – improving infrastructure, training healthcare workers, and enhancing data collection and analysis capabilities.
Co-financing is a central component of the new strategy. Partner countries are expected to contribute financially to their own health programs, demonstrating a commitment to long-term sustainability. The level of co-financing varies, but the expectation is that it will increase over the five-year period of the MOU. This approach aims to reduce reliance on U.S. Assistance and empower countries to take ownership of their health priorities.
Challenges and Considerations
While the new strategy holds promise, several challenges remain. The success of the MOUs will depend on the willingness and ability of partner countries to meet their co-financing commitments. Economic instability or political upheaval could hinder their ability to do so. The limited availability of MOU text for many countries makes it difficult to fully assess the details of each agreement. The KFF tracker notes that data are primarily based on press releases, which may not capture the full scope of program areas targeted in each country.
The tracker’s methodology relies on keyword searches to categorize program areas, and acknowledges that this approach may not be exhaustive. For example, global health security (GHS) is categorized if the agreement specifically mentions GHS or includes descriptions of outbreak preparedness and response activities. The State Department’s America First Global Health Strategy emphasizes the importance of preventing and responding to infectious disease outbreaks, a priority reflected in many of the MOU agreements.
The KFF tracker will continue to be updated as new agreements are signed and more data become available, providing a valuable resource for policymakers, researchers, and stakeholders interested in the evolving landscape of U.S. Global health engagement. The next major checkpoint will be the full implementation of these agreements later in 2026, and subsequent monitoring of co-financing commitments and program outcomes.
What are your thoughts on the new America First Global Health Strategy? Share your comments below.
