US Faces "Shameless Exploitation" Allegations Over Controversial Zambian Health Financing Agreement
The United States government is confronting serious accusations of "shameless exploitation" regarding a proposed health financing agreement with Zambia valued at over $1 billion. A leaked draft memorandum of understanding reveals concerning terms that include mandatory performance targets, extensive data-sharing requirements spanning a decade, and potential access to Zambia's valuable mining concessions.
Revealing Terms of the Bilateral Health Agreement
According to the leaked five-year memorandum obtained by journalists, Zambia appears to be accepting significantly worse conditions than those negotiated with sixteen other African nations. The agreement would require Zambia to provide Washington with access to comprehensive health data for an unprecedented ten-year period, far exceeding the terms accepted by other countries. More alarmingly, the health financing appears contingent upon additional arrangements that could open Zambia's mining industry to American commercial interests.
Asia Russell, director of the HIV advocacy organization Health Gap, condemned the proposed terms, stating: "These conditions represent a substantial deterioration compared to other international agreements. The United States is essentially making life-saving health services conditional upon access to Zambia's mineral wealth. This constitutes shameless exploitation that is both immoral and dangerous. When health programs become bargaining chips for a rapacious administration, everyone ultimately suffers."
Background and Strategic Shift in US Health Financing
This bilateral approach follows the Trump administration's dismantling of substantial portions of the United States Agency for International Development. The new strategy channels health financing directly to foreign governments rather than through traditional aid organizations, while simultaneously requiring increased financial commitments from partner nations.
Under the proposed agreement, Washington would offer $1.012 billion in health funding in exchange for Zambia's commitment to hire 40,000 new healthcare workers and contribute an additional $400 million toward health services over five years. Zambia must also demonstrate measurable improvements in health sector performance. The country's total health budget for 2026 stands at approximately $1.3 billion, making these additional commitments particularly challenging.
Risks and Consequences for Zambia's Health System
Julius Kachidza, chair of Zambia's Civil Society Self-coordinating Mechanism, expressed support for certain aspects of the memorandum, including improved services and increased domestic financing. However, he voiced serious concerns about the potential consequences if Zambia fails to meet the stringent terms. "As someone living with HIV, I recognize that if Zambia's HIV program becomes disrupted or derailed, I would be among the first casualties, along with hundreds of thousands of other vulnerable individuals," Kachidza explained.
The agreement includes provisions allowing Washington to terminate funding if Zambia falters on any performance metrics, potentially jeopardizing the entire national health system. Civil society organizations are urgently pressing for amendments before the April 1 deadline for finalizing the agreement.
Data Sharing and Mining Concessions Raise Alarm
Beyond the performance requirements, the data-sharing provisions have generated particular concern among Zambian activists. Josiah Kalala, director of the Chapter One Foundation human rights organization, warned: "This essentially represents our Zambian government signing away the right to access health data of its citizens to another sovereign nation."
Zambia would also commit to providing Washington with information about any new or emerging pathogens within its borders for an extraordinary twenty-five-year period. While other countries have agreed to data sharing, none have accepted such lengthy commitments. Kenya, for instance, limited its data sharing to seven years and still faces legal challenges regarding those provisions.
Economic Conditions and Political Fallout
In early December, the US embassy in Zambia confirmed that the health financing agreement was contingent upon "collaboration in the mining sector and clear business-sector reforms" that would improve American economic access to the country. The memorandum further commits the Zambian government to monthly briefings with US embassy officials regarding trade and investment efforts, with the explicit goal of expanding American commercial investment in Zambia.
Kachidza described this situation as feeling "like being held hostage" by the agreement's terms. Despite these concerns, Zambia's former health minister, Elijah Muchima, publicly denied that health financing was linked to mining concessions in a February television appearance. Muchima was dismissed from his position just three days later without official explanation.
Financial Realities and Advocacy Efforts
Activists fear Zambia is being set up for failure, though some experts believe the government might potentially meet the new funding obligations. Oliver Kaonga, a Zambian health economist, noted that Zambia's spending remains severely constrained, with more than one-third of its 2026 budget allocated to debt repayments. "The fundamental question becomes whether Zambia can mobilize resources more effectively," Kaonga observed.
Notably, the United States is actually offering Zambia less health aid under this memorandum than in previous years. Washington committed $367 million to Zambia for HIV services alone last year, while the total health funding for 2026 under the draft memorandum would be just $320 million, covering multiple programs including disease surveillance and treatment for malaria, tuberculosis, and HIV.
Civil Society Response and Legal Considerations
Zambian civil society groups secured a meeting with the health ministry in early February, but the two-hour briefing addressed only select components of the memorandum. Multiple participants reported that officials warned against considering legal action regarding the data-sharing provisions and refused to clarify whether the funding was tied to economic concessions.
Advocates have presented a comprehensive list of demands, including removal of data-sharing requirements and representation on the steering committee that will monitor progress. Kalala is spearheading an access-to-information request to obtain the latest versions of both the memorandum and the bilateral agreement. "Once we review the complete agreement, we can assess whether we can challenge the constitutionality of specific provisions," Kalala stated. "We must ensure we get this right from the beginning."
The US State Department declined to discuss specific details of the memorandum but issued a statement asserting: "The administration believes that American foreign assistance must demonstrably advance American national interests and use taxpayers' dollars efficiently." As negotiations continue, Zambian activists remain prepared to pursue legal challenges if the concerning provisions remain unchanged.
