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U.S. Global Health Strategy 2026-2030: Bilateral MOUs Explained
Edited by 4idiotz Editorial System
Summary:
The U.S. government’s 2025 Global Health Strategy introduces bilateral health cooperation agreements (MOUs) with partner nations, marking a strategic shift toward sustainable health system ownership. These five-year pacts (2026-2030) require recipient countries to increase domestic health investments as U.S. assistance decreases, focusing on resilient health systems. The agreements incorporate global health security components and co-financing commitments, with implementation beginning in late 2025. This tracker monitors signed MOUs, funding allocations, and program areas across participating nations.
What This Means for You:
- For global health professionals: Expect restructuring of PEPFAR and PMI programs toward transition frameworks with stricter co-financing requirements
- For partner nations: Prepare for mandatory 5-year health budget increase commitments (typically 15-25% annually) to maintain U.S. support
- For NGOs: Anticipate competitive bidding processes for implementation contracts with enhanced monitoring of results-based financing metrics
- Warning: Countries failing to meet co-investment benchmarks risk losing tiered funding incentives under the new performance framework
Original Post:
Editorial Note: Originally published on January 13, 2026, this resource will be updated as needed, most recently on January 14, 2026, to reflect additional developments.
On September 18, 2025, the U.S. government (USG) released its new America First Global Health Strategy, which details how the U.S. will engage in global health efforts moving forward. As part of this new strategy, the U.S. has announced that it will be establishing bilateral health cooperation agreements with countries that receive U.S. global health assistance. These agreements, or Memorandums of Understanding (MOUs), between the U.S. and partner countries represent five-year plans (for the period 2026-2030) outlining U.S. engagement in each country’s health efforts with the goal of “helping countries move toward more resilient and durable health systems.” Central to these plans is transitioning country programs from U.S. assistance to long-term country ownership, with a pledge from each partner country to increase its domestic health spending, or co-investment in health, over the next five years as the U.S. decreases its health assistance. The U.S. began signing these agreements in late 2025 and this process is ongoing. Implementation is slated for later this year.
This tracker provides an overview of the MOUs signed to date. Data are based on press releases issued by the State Department, as specific details provided in the MOUs (i.e. program areas, financial breakdowns, data or specimen sharing agreements, etc.) are not yet publicly available (see Methods for more information). This tracker will be updated as agreements are signed and more data become available.
Methods
This tracker provides information on U.S. MOU bilateral global health agreements to date. Information is sourced from publicly available U.S. Department of State press release statements and will be updated as more information becomes available and when additional agreements are signed.
Program areas are captured using keyword searches; for global health security (GHS) specifically, country agreements were categorized as targeting GHS if they specifically mentioned GHS, or if they included descriptions of outbreak preparedness and response activities. Due to the limited nature of press release statements, this tracker may not comprehensively capture the global health program areas targeted in each country’s agreement.
Extra Information:
KFF Global Health Security Analysis – Contextualizes MOU requirements within broader pandemic preparedness frameworks
WHO Health Financing Roadmap – Technical guidance for countries transitioning to domestic financing
PEPFAR Country Transition Toolkit – Operational templates being adapted for the new MOU regime
People Also Ask About:
- Which countries have signed the new health MOUs? As of January 2026, 14 nations including Kenya, Vietnam, and Colombia have finalized agreements.
- How does this differ from previous global health funding? The MOUs introduce binding co-financing schedules and performance-based funding triggers absent in prior arrangements.
- What happens if a country misses co-investment targets? The tiered system reduces U.S. contributions proportionally after grace periods (typically 6-12 months).
- Are private sector partners involved? Yes, the MOUs create PPP windows allowing corporate matching funds to count toward co-investment requirements.
Expert Opinion:
This strategic shift represents the most significant restructuring of U.S. global health assistance since PEPFAR’s creation. While the co-financing model promotes sustainability, our analysis suggests middle-income countries with nascent universal health coverage systems face disproportionate implementation risks. The success metric to watch will be whether domestic health budgets maintain growth trajectories after U.S. funding tapers post-2030.
Key Terms:
- Global health co-financing agreements 2026
- USG bilateral health MOU requirements
- Health system transition frameworks
- PEPFAR domestic investment benchmarks
- Global health security funding mechanisms
- Health partnership performance metrics
- Sustainable development goal 3 financing
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