Submission ID 130752
| Issue/Objective | Historically, US-Africa health engagement has been anchored in humanitarian logics and multilateral cooperation. However, the 2025 America First Global Health Strategy (AFGHS) marks a decisive normative and operational shift. The global health assistance is strategically reframed as an instrument of U.S. national security, economic competitiveness, and geopolitical influence. This study interrogates how this shift from humanitarianism to strategic transactionalism reshapes power relations, governance, and sovereignty within African health systems and what it means for health system strengthening. |
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| Methodology/Approach | This research utilises a Multi-scalar Critical Discursive Institutionalist (MCDI) Policy Analysis approach. This deconstructs the 2025 AFGHS and associated bilateral frameworks with African countries by examining the intersection of policy narratives with institutional shifts in funding, procurement, and operation. The MCDI approach maps these policy shifts against emerging geopolitical realities. Emerging implementation debates and African policy responses are incorporated to contextualise implications for Africa's health systems. |
| Results | The analysis reveals a structural reorientation of U.S. global health engagement away from solidarity-based assistance toward performance-conditioned, bilateral, and commercially aligned partnerships. Africa is positioned simultaneously as a biosecurity frontier, a geopolitical arena, and an emerging health market. Key implications for African health systems include: (1) constrained policy autonomy through data-sharing requirements, surveillance integration, and funding conditionalities; (2) intensified external influence over national priority-setting and budgeting via co-investment benchmarks and audit mechanisms; (3) risks of premature donor withdrawal under the discourse of "self-reliance," potentially undermining service continuity; and (4) deepening technological and pharmaceutical dependence through procurement structures favouring external innovation over local production. While efficiency gains are possible, these are accompanied by heightened sovereignty and equity concerns. |
| Discussion/Conclusion | This study, therefore, proposes an Afrocentric counter-framework for global health engagement grounded in five principles: (i) sovereignty, through national ownership of data, surveillance, and priority-setting; (ii) equity, by addressing structural global inequalities; (iii) mutual accountability, centring African publics rather than external donors; (iv) sustainability, based on realistic fiscal transitions and regional production capacities; and (v) decolonial power relations, moving from "donor-recipient" models to "technology-transfer partnerships". Such a framework repositioning global health as a cooperative public good, rather than a transactional tool, is essential for resilient, and people-centred African health systems. |
| Presenters and Affiliations | Kingsley Ogunne Department of Political Science, University Of Ibadan Kingsley Ogunne Department of Political Science, University Of Ibadan |
