Late last year Zimbabwe rejected the United States’ “trade for aid” terms for a health assistance deal, and now Ghana has done the same, also turning down US terms for bilateral health assistance, particularly the requirement to share sensitive health data, reports Health Policy Watch.
Zimbabwe’s refusal, notably, related to the demand to share pathogen data without any “corresponding guarantee of access to any medical innovations – such as vaccines, diagnostics, or treatments – that might result from that shared data”, according to government spokesperson Nick Mangwana.
And in Zambia, the government had until 30 April to decide on whether to avail its minerals – primarily copper, cobalt and lithium – to US companies in exchange for $1bn in health assistance, but that deadline has passed without any deal, reports Reuters.
The US has criticised Zambia, saying repeated outreach from Washington had been ignored. Outgoing US ambassador Michael Gonzales said the failure to finalise the memorandum of understanding (MOU) had left funding continuing on an ad hoc basis, without a coherent implementation plan for programmes covering HIV, malaria, maternal and child health and disease preparedness.
US aid supported antiretroviral treatment for an estimated 1.3m Zambians, and in the wake of disruptions since President Donald Trump assumed office last January, some local hospitals are seeing a surge in Aids cases.
In December, the US announced Zambia had committed to a plan to unlock “a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms that will drive economic growth and commercial investment that benefits both the United States and Zambia”.
But this has never materialised amid renewed US pressure on Zambia to open its mineral wealth to the US.
In South Africa, the loss of US funding has “damaged critical health services, dismantled HIV prevention programmes, and disrupted world-class South Africa-US research collaboration,” according to a report published by Physicians for Human Rights (PHR), Advocates for the Prevention of HIV in South Africa (APHA), and Emthonjeni Counselling and Training.
‘Trade over aid’
The terms of the Memorandums of Understanding (MOU) that the US is seeking with key countries, as part of its “America First Global Health Strategy” (AFGHSD), are overwhelmingly transactional.
Last week, the US entrenched this approach at the launch of its ‘Trade over Aid’ initiative at the New York Stock Exchange, asserting that the free market is the “surest route to economic prosperity”
Ghana is Africa’s largest gold producer. It is unclear whether the US tried to use its aid offer to extract minerals, as it has in other countries.
However, this is unlikely to have gone down well, as Ghana is clamping down on foreign mining operations. In the past few weeks, the country’s Minerals Commission has given three international firms until the end of the year to transfer their gold mining operations to locals.
Ghanaian President John Mahama is also championing the “Accra Reset”, launched last year to encourage African countries to invest more of their domestic budgets in their health and depend less on aid.
At the same time, Ghana is heavily indebted and recently held off paying newly recruited nurses as it lacked the finances.
The US held off signing an MOU with the DRC on 5 December, when it signed deals with Rwanda and Kenya on the sidelines of a peace accord between the DRC and Rwanda, allegedly the sponsor of the M23 rebels waging war inside the DRC.
Instead, the US and DRC first signed a “strategic partnership agreement” to “promote secure, reliable, and mutually beneficial critical mineral flows for commercial and defence purposes”, according to the US State Department. The health MOU followed on 26 February.
The DRC is one of the world’s most important sources of rare earth minerals, but China has dominated the purchasing and processing of its minerals. After the agreement, the DRC offered US investors stakes in state-owned mineral assets. In late March, a US company, Virtus, bought a cobalt mine.
Recently, it emerged that the DRC has offered mining opportunities to US companies in Rubaya, currently held by M23 rebels, indicating that the US would need to play a role in maintaining peace if it wants access to rare minerals. This week, the DRC announced the formation of a $100m initiative to establish “mining guards” to secure mines, with investment from the US and the United Arab Emirates.
However, lawyers in the DRC have challenged the MOU in court, while part of Kenya’s MOU has been suspended by a High Court in the face of an ongoing court challenge.
See more from MedicalBrief archives:
Expert urges caution on Africa-US health agreements
Zimbabwe rejects $350m US health deal
Washington launches billion-dollar health pacts in Africa – with provisos