The America First Global Health Strategy presents bilateral, time-bound financing compacts as a pathway toward greater country ownership. Under these arrangements, African governments co-finance health programs with the United States and gradually assume financial responsibility as American funding declines. Yet this episode asks a fundamental question: can countries genuinely own health systems when they bear responsibility for sustaining them but lack the corresponding authority over technology, data, procurement, and the political conditions attached to funding?
Nelson Aghogho Evaborhene, a PhD fellow in Global Health Governance at Roskilde University, examines how these agreements may reproduce dependency under the language of ownership. The conversation considers Nigeria’s $3 billion compact and its religious conditionalities, as well as the South African experience of funding being withdrawn for political reasons despite strong program performance. It also explores how bilateral agreements may fragment the continental institutions African countries have been building.
This episode of the Global Health Unfiltered podcast offers an important distinction between domestic financing and genuine health sovereignty. It argues that assuming a larger share of program costs does not necessarily give governments greater control and that even fully domestically financed health systems remain vulnerable when countries cannot produce the technologies and other essential inputs on which those systems depend.
Check out the podcast here: Paying more and Owning less with Nelson Aghogho Evaborhene