US-Nigeria health deal offers huge prospects but concerns remain

On 19 December 2025, Nigeria and the United States signed a five-year, $5.1 billion Memorandum of Understanding (MoU) for health cooperation aimed at strengthening Nigeria’s health system, improving disease control, and increasing domestic health financing.

The agreement, which will run from April 2026 to December 2030, combines nearly $2.1 billion in United States grant funding with an estimated $3 billion in Nigerian government investment.

Both governments describe it as a shift toward a more resilient, self-reliant and accountable health system for Nigeria.

Nigeria’s Coordinating Minister of Health and Social Welfare, Muhammad Pate, said the MoU represents a major step in safeguarding the health of Nigerians while strengthening national resilience.

“This partnership underscores our determination to build a health system that can prevent, detect, and respond to health threats, while expanding access to affordable, quality care for all Nigerians,” Mr Pate said. “It also reflects our firm commitment to domestic investment, accountability, and long-term sustainability.”

However, beyond its ambitious funding commitments, the MoU has also sparked debate, particularly over its religious framing, transparency, and what it ultimately means for Nigeria’s health sovereignty.

A shift in US health assistance

The new deal comes at a time when the US under President Donald Trump is reshaping its global health assistance programmes, following the dissolution of key aid vehicles such as USAID, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative.

In a statement announcing the Nigeria MoU, the US government said the five-year MoU is part of efforts to advance the America First Global Health Strategy, aimed at supporting resilient, self-reliant, and durable health systems while promoting accountability and shared responsibility.

It added that the agreement represents the largest co-investment made by any country under the new strategy, underscoring “Nigeria’s commitment to greater national ownership of its health system.”

Under the MoU, the United States said it will continue to support disease surveillance and outbreak response, laboratory systems, health commodities, frontline healthcare workers and health data systems.

The focus areas include HIV/AIDS, tuberculosis, malaria, polio, and maternal and child health. The country has one of the highest maternal and child mortality rates globally and accounts for about 30 per cent of the global malaria burden.

“US assistance under the MOU will expand access to affordable, preventive and curative services for HIV/AIDS, tuberculosis (TB), malaria, polio, and maternal and child health, strengthening health outcomes across Nigeria,” it noted.

What the agreement includes

According to the statement from Nigeria’s Federal Ministry of Health and Social Welfare, the MoU will enhance collaboration on the early detection, prevention and control of emerging, re-emerging and existing infectious diseases, including HIV/AIDS and tuberculosis.

Under the agreement, both countries will work together to strengthen disease surveillance and outbreak response, improve laboratory systems and biosafety procedures, support frontline healthcare workers, strengthen health data systems, ensure access to essential health commodities, and provide strategic investment and technical assistance across the health sector.

The MoU also aligns with Nigeria’s ongoing health reforms, including the Nigeria Health Sector Renewal Investment Initiative and the Health Sector Renewal Compact signed in 2023 by President Bola Tinubu and all 36 state governors.

Why the support matters for Nigeria

Nigeria’s health indicators remain among the worst globally, despite decades of donor-supported programmes.

A 2023 World Health Organisation (WHO) report titled ‘Improving maternal and newborn health and survival and reducing stillbirths’ showed that Nigeria accounts for the second-highest number of maternal deaths worldwide.

The United Nations Economic Commission for Africa estimates that one in every seven maternal deaths globally occurs in Nigeria — more than 50,000 women annually. Most of these deaths are caused by preventable and treatable conditions such as severe bleeding, infections, hypertensive disorders and delayed access to care.

Malaria remains another major burden. In 2024, Mr Pate noted that Nigeria bears about 30 per cent of the global malaria burden, with an estimated 68 million cases and 190,000 deaths recorded in 2021 alone.

Nigeria’s primary healthcare system is also constrained by chronic underfunding, infrastructure gaps and unequal access, particularly in rural and underserved communities.

Support under the MoU could help strengthen these weak points if effectively implemented and sustained.

Religious framing and public concern

Despite its potential benefits, the agreement has sparked controversy. The African Democratic Congress (ADC), one of Nigeria’s main opposition parties, recently raised concerns about the religious framing of the US support, warning that it could deepen divisions in Nigeria’s fragile social landscape.

The opposition party cited the US government’s statement that the MoU places “a strong emphasis on Christian faith-based healthcare providers,” with about $200 million in dedicated support for Christian clinics and hospitals.

Nigeria’s 200 million-plus population is estimated to be almost evenly made up of Christians and Muslims.

According to the US, Nigeria’s more than 900 Christian faith-based health facilities serve over 30 per cent of the population, often in areas where public healthcare facilities are limited.

However, the ADC argued that this religious emphasis was absent from Nigeria’s official explanation of the agreement. It called on the Nigerian government to publish the full MoU to address concerns about transparency, sovereignty and constitutional compliance.

The debate comes amid heightened international scrutiny of religious violence in Nigeria. In October 2025, President Trump designated Nigeria ‘a Country of Particular Concern’, citing religious freedom violations, especially against Christians.

Nigerian authorities have repeatedly rejected claims that violence targets Christians alone, describing insecurity as a complex crisis driven by ethnicity, banditry and broader security failures affecting all communities.

Caution on transparency and sovereignty

In an analysis published by Nigeria Health Watch, its Managing Director, Vivianne Ihekweazu, urged caution in interpreting the MoU’s promises and implications.

Mrs Ihekweazu noted that an MoU is a formal statement of intent, not a legally binding agreement. In the United States, actual funding will still require appropriation by Congress, while Nigeria’s co-financing commitments must be approved through future budget cycles.

“This reality introduces significant uncertainty into any multi-year agreement,” she wrote, pointing to Nigeria’s long-standing failure to meet the Abuja Declaration target of allocating 15 per cent of national budgets to health.

She also raised concerns about transparency, noting that the full signed MoU has not been made public. She argued that publishing the agreement would build public trust and allow Nigerians to better assess its implications.

She highlighted particular concern about provisions related to health data sharing. A circulated summary of the MoU refers to negotiations on regulated data-sharing arrangements, raising questions about data ownership, privacy and national control.

Similar clauses in other African countries have sparked debate, especially where agreements included references to long-term sharing of pathogen samples or access to national databases.

“Until the final signed MoU between Nigeria and the United States is made public, it is not possible to fully understand the commitments made or their implications for Nigeria’s sovereignty,” she noted.

Opportunity and risk

The US–Nigeria health agreement presents a clear opportunity for Nigeria, but it also raises important questions about transparency, funding commitments, sovereignty and long-term independence.

If fully implemented, the deal could help Nigeria strengthen disease surveillance, improve access to essential medicines, support frontline health workers and expand primary healthcare services, especially in underserved areas. The commitment to increased domestic health financing could also reduce long-term dependence on foreign aid.

However, concerns remain about transparency and implementation. The full text of the MoU has not been made public, making it difficult to assess all the obligations and conditions attached to the agreement.

Beyond funding promises, the success of the agreement will depend on how well it is implemented, how resources are shared, and whether commitments on both sides are honoured over the next five years.

For Nigeria, the real test will be whether the partnership delivers stronger, more reliable healthcare for ordinary citizens and ultimately helps build a health system capable of standing on its own long after the agreement ends.