Leaked MOU shows deep funding cuts, strict conditions on workforce, data sharing
By Bunmi Yekini
Health activists on Tuesday accused the United States of leveraging life-saving health funding to gain access to Zambia’s mineral resources, after publishing a draft bilateral agreement that has been under negotiation for months.
The draft Memorandum of Understanding (MOU), covering five years of U.S. support for HIV, tuberculosis, malaria and other health programmes, has not been signed despite an initial December 2025 target, and is now drawing sharp criticism over its terms.
Activists say the document links funding to a separate “Bilateral Compact” tied to Zambia’s mineral wealth, a condition they describe as unprecedented in explicit written form.
The controversy intensified following a report by The New York Times that officials in the State Department had considered escalating pressure, including withholding HIV prevention and treatment funding if negotiations remain stalled. U.S. Secretary of State Marco Rubio is said to be weighing tougher measures, according to the report.
The draft agreement outlines a 53% reduction in funding compared with 2024 levels, amounting to $1.012 billion over five years, significantly lower than an earlier U.S. pledge of $1.5 billion, activists said.
They also raised concerns about what they described as unrealistic obligations placed on Zambia, including a requirement to hire 40,000 additional health workers by 2030, a 50% increase in the country’s existing workforce. Failure to meet the target could trigger funding cuts or termination of the agreement.
Further provisions include reduced U.S. contributions for medical commodities, long-term requirements for Zambia to share pathogen samples and data for up to 25 years, and limited roles for civil society groups in programme oversight.
“These are some of the harshest terms we have seen in any bilateral health agreement,” one activist group said in a statement, warning the cuts could undermine efforts to control HIV and other diseases.
Julius Kachidza, a civil society leader in Zambia, said the proposed funding reduction would be “apocalyptic,” particularly for people living with HIV.
Despite the criticism, the draft MOU includes support for expanding access to pre-exposure prophylaxis (PrEP) through community-based and private-sector channels, a move activists acknowledged as a positive step toward improving HIV prevention.
Campaigners are now calling for the removal of any link between health funding and mining deals, a reversal of proposed budget cuts, and greater inclusion of civil society in oversight mechanisms.
Negotiations between Zambia and the United States remain ongoing.