America First Global Health Strategy – Bilateral Agreements on Global Health Cooperation

As outlined in the America First Global Health Strategy, the United States will sign multi-year Bilateral Agreements on Global Health Cooperation with dozens of countries receiving U.S. health assistance in the coming weeks. These landmark agreements will advance a comprehensive and shared vision directly between the United States and recipient country governments for continued future cooperation on global health issues. The agreements will also maximize the impact of our global health assistance and strengthen our bilateral relationships while simultaneously saving millions of lives, stopping the spread of diseases globally, and helping countries move toward more resilient and durable health systems.

These bilateral global health agreements will continue to build on decades of global health investment by fully transitioning U.S. technical assistance and other key functions, including financial responsibility, to countries currently receiving U.S. health assistance.

A key component of each bilateral agreement will be staying committed to the ambitious goals that we have set over the past decades for combatting the spread of HIV/AIDS, tuberculosis, malaria, and polio, while prioritizing maternal and child health, disease surveillance, and infectious disease outbreak preparedness. Our guiding principles in these agreements will include streamlining performance monitoring, reducing non-frontline investment by integrating U.S., programming within a country's broader health system, mobilizing the private sector and faith-based organizations, and requiring increased co-investment from receipt countries for healthcare workers and commodities.

Each agreement will contain important and innovative provisions that facilitate long-term sustainability such as:

• Commodities: The procurement of commodities will be transitioned from the U.S. government to partner governments gradually over the established period of the agreement. The United States has committed to covering 100 percent of frontline healthcare workers and commodities for the next fiscal year and will work with countries to co-invest in these efforts over time.
• Frontline Health Workers: Frontline health workers currently funded by the U.S. government will be mapped to the cadres of health workers that can be employed by partner governments, and those cadres of health workers will be transitioned to the partner government payroll over a multi-year period as jointly agreed to.
• Data Systems: Funding will support the scale up of partner governments' health data systems to ensure key programmatic data for HIV/AIDS, TB, malaria, polio, and disease outbreaks can be tracked at scale long-term.
• Co-Investment: Partner governments will increase their domestic health expenditures over the agreement period, a critical step in ensuring partner governments have the resources they need to sustain their health response long-term without support from the U.S. government.
• Performance Incentives and Transition Assistance: U.S. government financial support will be linked to countries' ability to meet or exceed key health metrics with financial incentives for countries who exceed those metrics.

Since 2001, the United States has invested more than $204 billion to bolster other governments' health sectors, supporting programs that have saved lives, strengthened health systems, and improved global health cooperation. Through these new bilateral health cooperation agreements, we preserve what works in our health foreign assistance programs while rapidly fixing what is broken. This is another example of the Trump Administration's America First Global Health Strategy ensuring America is safer, stronger, and more prosperous.

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