Ghana Withdraws as U.S. Signs Landmark Health MOUs with Sierra Leone and Other African Nations

In April 2026, Ghana withdrew from a five-year, $109 million health agreement with the United States, citing concerns about the loss of regulatory control and the requirement to share sensitive health data in violation of Ghana's data protection laws.

A Ghanaian official noted that granting access to citizens' data without safeguards raised health equity and constitutional concerns, and questioned the purpose of sharing such data with the United States.

Zambia and Zimbabwe have faced similar challenges regarding health data sharing. 

In December 2025, the United States signed four new global health Memorandums of Understanding (MOUs) with several African countries, including Sierra Leone.

According to the U.S. Department of State, these agreements aim to strengthen U.S. leadership in combating infectious diseases and reduce reliance by foreign countries on U.S. taxpayers.

According to the press statement, the United States will provide over $30 million in 2026 to Sierra Leone to enhance disease surveillance, laboratory capacity, health workforce, and data systems, while Sierra Leone increases its financial contributions.

By 2030, Sierra Leone is expected to assume most commodity, workforce, and laboratory costs, reducing the long-term U.S. commitment.

The agreement targets a 75% reduction in malaria deaths, improved HIV diagnosis and treatment rates, integration of health workers into the national payroll, and the establishment of a national outbreak surveillance system meeting the 7-1-7 standard. (More than $173 million total: $129 million in U.S. assistance, over $44 million in recipient co-investment.)

Across the four MOUs, totaling nearly $2.3 billion, the United States has committed almost $1.4 billion, with recipient countries co-investing over $900 million.

In Ethiopia, the United States signed a bilateral global health cooperation MOU valued at $1.466 billion, including $1.016 billion in U.S. investment and $450 million from the Ethiopian government.

Priority areas include HIV/AIDS, tuberculosis, malaria, polio eradication, maternal and child health, and infectious disease preparedness and response.

The agreement is designed to sustain progress from over $5 billion in U.S. health assistance to Ethiopia over the past two decades, ensuring continuity of essential health services under Ethiopian leadership. (More than $1.466 billion total: $1.016 billion in U.S. assistance, $450 million in recipient co-investment.)

In Botswana, the United States and the Government of Botswana entered a bilateral agreement to increase Botswana's ownership of HIV clinical and community service delivery.

The United States will provide $106 million in targeted assistance, while Botswana will contribute over $380 million.

The MOU supports self-reliance, workforce reform, and sustained control of the HIV epidemic beyond the 95-95-95 targets.

It will also modernize electronic medical records and disease surveillance systems, potentially leveraging American satellite-based technologies to enhance outbreak preparedness and advance U.S. technological leadership. (More than $487 million total: $106 million in U.S. assistance, $381 million in recipient co-investment.)

In June 2026, Sierra Leone's Institute for Legal Research and Advocacy for Justice (ILRAJ) issued an open letter requesting that the health minister publicly release the memorandum of understanding on health cooperation.

The five-year bilateral agreement, part of the U.S. government's America First Global Health Strategy, commits significant Sierra Leonean public funds and requires increased national investment, with the expectation that Sierra Leone will assume most of the costs, workforce, and laboratory expenses by 2030.

ILRAJ raised concerns about transparency and emphasized the public's right to know the terms governing the health sector over the next five years.

Sierra Leonean newspapers report that the health ministry is expanding its PreSTrack maternal health platform, which currently monitors 11,000 pregnant women, by integrating the localized "Kuma" voice-to-text system.

This allows rural health workers to document clinical metrics in their native dialects, removing barriers created by English-only software. The finance ministry is also implementing custom artificial intelligence modules in its central financial management systems to automate and improve macro fiscal planning.

Additionally, an intelligent document assistant has been developed to answer citizen queries on public portals using official government documents, ensuring accuracy and preventing misinformation.

Sierra Leone has positioned itself as an AI innovation hub, leading the deployment of custom, low-data, and voice-first AI models to advance education, healthcare, and finance.

The digital transformation office has highlighted results from a guided learning model developed with Google DeepMind and Fab Ai, which enabled junior secondary students to achieve math learning gains equivalent to nearly two years of standard progress.