By Joseph Dumbula
Malawi is among 18 countries that will face a health funding cut by the United States of America until 2030. This follows plans to cut its health funding by 59% of pre-2025 levels by 2030, according to a Public Citizen and Partners In Health analysis of the bilateral agreements the US has signed with these countries.
The bilateral Memorandums of Understanding (MOUs) were signed as part of the ‘America First Global Health Strategy’ adopted by the Trump administration in 2025, and are intended to rapidly wean countries off US aid by 2030.
The reduction amounts to a cut of some $2 billion to US aid dispensed before 2025, according to Public Citizen, which analyzed the MOUs – some of which it initially obtained via a Freedom of Information Act (FOIA) lawsuit against the Trump administration.
Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%).
All MOUs require countries to make substantial co-financing commitments. These are for activities identified as priorities by the US, and do not necessarily align with the countries’ priorities. For example, the US wants all countries to improve their ability to identify disease outbreaks, so it requires substantial investment in epidemiologists and data capturers. But many recipient countries may prefer to prioritise employing health workers.
In 11 out of the 18 countries, the co-financing commitments fail to cover the US cuts over five years compared to pre-2025 government funding.
“Countries may also struggle to meet these funding expectations,” says the analysis. “For example, Malawi would have to mobilize new funding equal to 56% of the country’s total health expenditure to meet its annualized co-financing commitment.
If Ethiopia, Kenya, Mozambique, Cameroon, and Malawi fail to meet co-financing commitments, the US will reduce its funding by $1 for every $1 shortfall.
Uganda and Côte d’Ivoire face a 2:1 reduction. However, no penalties are specified in the MOUs with Rwanda, Liberia, Lesotho, Eswatini, Sierra Leone, Madagascar, Burundi, Botswana, and South Sudan.
