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…