Protecting health systems and rights in the ‘America First’ era: why we must act now
The recent shift in US global health policy has introduced significant changes to international health financing and strategic priorities. The US remains the largest bilateral donor, but its new "America First Global Health Strategy" now explicitly ties health investments to US geopolitical and commercial interests. Thematic priorities, especially HIV, remain stable but multilateral funding is deprioritized, favoring direct government agreements, private sector partnerships, and faith-based organizations. Several countries are excluded from negotiations due to political or commercial disagreements, included former large beneficiaries. For those still included, the new bilateral health agreements include strict conditionalities, especially regarding data sharing and co-financing.
A major concern is the expanded Mexico City Policy (Global Gag Rule), which now restricts funding not only for abortion-related activities but also for projects promoting diversity, inclusion, and so-called "gender ideology." This policy affects all non-military US assistance, creating a chilling effect across the ecosystem of sexual and reproductive health and rights (SRHR). National health strategies in partner countries may be rewritten to align with US priorities, often at the expense of existing commitments to SRHR. The lack of transparency in negotiations and the exclusion of civil society and technical experts from decision-making processes further exacerbate risks.
Advocacy and information-sharing are urgently (a matter of weeks) needed to mitigate negative impacts and preserve national health priorities. There is a narrow window for influencing implementation plans following the signing of bilateral agreements, and practical strategies include advocating for health system strengthening and safeguarding domestic co-financing for local priorities. The situation demands coordinated action and vigilance from all stakeholders to ensure that essential health services and rights are not undermined by external conditionalities and shifting donor agendas.
Meeting this moment requires a whole ecosystem response, that brings together civil society organizations, technical experts, academia, governments, bilateral partners, and diplomatic missions in coordinated action and shared vigilance, to ensure that essential health services and rights are not undermined by external conditionalities.
The Enabel health team
Enabel is the bilateral Belgian Agency for International Cooperation
For mote details we refer to the following presentations and tools:
US_Compacts___G2G_and_their_pote...
us_compacts_advocacy_toolkit.pdf
Global_Health_funding_-_Enabel_C...
