Which countries received the most foreign aid for healthcare from the Trump administration?
Executive summary
Available reporting shows the Trump administration’s biggest announced health-aid commitments were concentrated in a set of new bilateral “compacts” with African governments—an initial tranche of agreements that the State Department framed as an $11.1 billion, five‑year pledge tied to disease programs and national health system reforms [1]. At the same time, independent trackers report the U.S. remained the single largest global health donor overall (about $8.3 billion per year in bilateral health assistance in the recent donor period), but public, auditable data on precisely which countries actually received the most disbursed health dollars under the administration is incomplete [2] [3].
1. The headline recipients on paper: African MOUs and the $11.1 billion package
The clearest “top‑recipient” signals come from the State Department’s roll‑out of bilateral health memoranda of understanding that Secretary Rubio signed with a series of sub‑Saharan African countries; reporting says 15 agreements have been signed so far and $11.1 billion in U.S. commitments over five years was announced to back those compacts, with the State Department aiming to expand to roughly 50 countries [1] [4]. Specific countries highlighted in U.S. press materials and analysis include Kenya (the first compact), Rwanda, Mozambique and Zambia—each named in State Department documents or coverage describing program priorities like HIV/AIDS, malaria, TB and maternal and child health [4] [1] [5].
2. Scale and context: U.S. global health funding versus announced new strategy
Kaiser Family Foundation analysis places U.S. bilateral health assistance at roughly $8.3 billion per year across the recent donor period and identifies the U.S. as the single largest health donor, with total U.S. global health funding around $12.4 billion in FY2025 when multilateral and research lines are included [2] [6]. The administration presented its “America First Global Health Strategy” and those MOUs as a re‑direction—not a simple reduction—of that money into country partnerships and domestic co‑investment, even as KFF and others warned the administration’s budget requests proposed substantial cuts to established global health lines [6] [7].
3. What reporters and data portals do not show: actual disbursements by country
Public reporting and government press releases list commitments and the names of partner countries but do not provide a comprehensive, line‑by‑line accounting of disbursed health aid per country under the new approach, and ForeignAssistance.gov remains the central but not always granular source for verifying country‑level flows [3] [5]. Analysts at the Center for Global Development and other observers note important operational unknowns—how much of the $11.1 billion is contractual, how much is conditional on country performance, and how quickly funds will be transferred—leaving an evidentiary gap about which specific countries “received the most” in cash terms [5].
4. The political and commercial logic behind the recipient list
Reporting makes plain that recipient selection and the scale of pledges reflect strategic and commercial priorities as well as health needs: diplomats tied compacts to trade and investment openings (for example, linking a Zambia agreement to mining access), and State Department materials emphasize shifting procurement and health‑worker funding toward host governments and private‑sector partnerships [1] [4]. Critics and independent analysts warn these incentives can skew program design and mask an agenda to prioritize U.S. strategic leverage and business interests alongside, or even above, strictly humanitarian health outcomes [1] [8].
5. Competing narratives: continuity with disease programs versus a disruptive freeze
Supporters portray the compacts as a rapid, country‑led approach that preserves key disease programs (PEPFAR, commodities, frontline workers) while driving “country ownership,” but watchdogs and aid organizations argue the administration’s earlier foreign‑aid freeze, dissolution of USAID functions and canceled awards created service disruptions that undercut continuity—making it unclear whether pledged amounts will translate into sustained, highest‑value flows to the countries named [9] [6] [10]. Independent commentators also note the Global Fund and multilateral channels remain critical backstops even as the U.S. retools bilateral programming [9].
Bottom line answer
Based on official State Department announcements and contemporaneous reporting, the countries singled out as the largest intended recipients of the Trump administration’s new health‑aid push are those African partners named in the initial MOUs—notably Kenya, Rwanda, Mozambique, Zambia and several other sub‑Saharan states—with an aggregate headline pledge of $11.1 billion over five years for those agreements [1] [4]. However, independent donor tracking shows the U.S. as the largest global health donor overall (about $8.3 billion per year in bilateral health assistance), and publicly accessible, audited data on actual, country‑level disbursements under the administration’s reconfigured programs remain incomplete, so definitive rankings of “which countries received the most” in real dollars cannot be confirmed from the available sources [2] [3] [5].