A proposed billion-dollar health financing agreement between the United States and Zambia is drawing sharp criticism from civil society groups, who warn the terms amount to exploitation and pose significant risks to the country’s public health system and sovereignty.
A leaked draft of the five-year memorandum of understanding reveals the $1.012 billion in US health funding is contingent upon Zambia meeting stringent conditions. These include hiring 40,000 new health workers, contributing an additional $400 million of its own funds to health services, and achieving specific performance targets. Failure on any front could lead Washington to terminate the agreement and withdraw its support.
Beyond the financial commitments, the draft terms mandate extensive data sharing with the United States. Zambia would be required to provide access to national health data for a decade and share information on any new or emerging pathogens within its borders for an unprecedented 25-year period. Critics argue this surrenders control over sensitive citizen data to a foreign power.
“The Zambian government is essentially signing away the right to access the health data of its citizens to another country,” said Josiah Kalala, director of the Chapter One Foundation, a human rights organization.
The most controversial aspect, however, may be the reported link to Zambia’s mining sector. While Zambian officials have publicly denied health funding is tied to economic concessions, a US embassy statement in December confirmed the agreement was contingent on “collaboration in the mining sector and clear business-sector reforms” to improve US economic access. The MOU also commits Zambia to monthly briefings with the US embassy aimed at “expanding US commercial investment.”
Health advocates condemn this linkage. “Conditioning life-saving health services on plundering the mineral wealth of the country is shameless exploitation,” said Asia Russell, director of the HIV advocacy group Health Gap. “When health programmes are treated like a bargaining chip, everyone suffers.”
For Zambians dependent on these health services, the stakes are personal. “I’m a person living with HIV,” said Julius Kachidza, chair of a civil society coordinating mechanism. “If the HIV programme in Zambia is disrupted, I’ll be the first casualty, as well as hundreds of thousands of other people.”
Civil society groups are mobilizing to amend the agreement before a reported April 1 deadline. Their primary demands include stripping out the data-sharing requirements and ensuring no health funding is conditional upon mining or trade concessions. They are also seeking a seat on the committee that would monitor the deal’s progress and have filed access-to-information requests to obtain the latest versions of the documents, with an eye toward potential legal challenges.
The Zambian government faces a difficult position. With over a third of its 2026 budget allocated to debt repayments, the sudden loss of US health funding could cause severe political and social fallout. However, analysts note the proposed five-year US commitment is lower than previous funding levels and comes with far greater strings attached.
As negotiations continue behind closed doors, activists warn that a bad deal could mortgage the country’s future. “We have to get it right at the beginning,” Kalala stated. The coming weeks will determine whether Zambia’s health system secures vital support or becomes entangled in an agreement critics describe as being “held hostage.”
