A US push to sign multi-year bilateral health cooperation agreements with dozens of African nations has been overshadowed by privacy concerns after a Kenyan court temporarily restrained the government from sharing “any medical, epidemiological or sensitive personal health data,” deepening scrutiny of similar pacts recently signed with Liberia, Uganda and others.
The injunction followed a petition by the Consumers Federation of Kenya alleging that the $1.6 billion health cooperation framework signed with the United States “exposes citizens to lasting privacy violations, stigma and potential misuse of their information” and was negotiated in an “opaque and constitutionally improper” manner.
The High Court order stopped Kenyan authorities from implementing the data-sharing elements of the pact while the matter is considered.
The dispute comes as the Trump administration’s America First Global Health Strategy moves forward with a series of bilateral memoranda of understanding.
Under those agreements the United States has outlined multi-year commitments, including a five-year Memorandum of Understanding with Liberia in which the US intends to provide up to $125 million in health assistance and Liberia agree to increase domestic health spending by nearly $51 million — a combined $176 million package the State Department says is intended to accelerate Liberia’s move toward self-reliance.
Other recent deals include a $1.7 billion financing pact with Uganda and $232 million earmarked for Lesotho over five years, according to US government statements.
The US fact sheet on the program says the agreements aim to transition procurement, technical assistance and other functions from US programs to partner governments over time while maintaining commitments to combat HIV/AIDS, tuberculosis, malaria and polio and to strengthen maternal and child health, surveillance and outbreak preparedness.
Critics and civil-society groups, however, warn the agreements risk trading sovereignty and privacy for more limited assistance.
Almost 50 civil-society organizations in Africa have urged governments to insist on equity and sovereignty in the negotiations. “These deals ask countries to trade their power and a little of their dignity for less support than Trump took away early this year,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines Program told Bloomberg.
Kenyan officials pushed back on the specific allegation that personal medical records would be handed to the United States. Ouma Oluga, Kenya’s principal secretary for medical services, said personal medical records would not be shared with the US and that the funding would be used to track diseases such as HIV/AIDS, tuberculosis, polio and malaria and to help roll out a national electronic medical-records system.
The US State Department has described the bilateral agreements as a way to “maximize the impact” of global health assistance and to move partner countries toward “long-term sustainability,” with provisions including gradual transition of commodity procurement from the US to partner governments, mapping and transition of frontline health workers to partner payrolls, investments in health data systems, increased co-investment by recipient governments and performance-linked financial incentives.
Key components of the US bilateral health cooperation deals (as described by the US government)
– Commodities: Gradual transition of procurement responsibility for health commodities from the US government to partner governments, with the US covering 100 percent of frontline healthcare workers and commodities for the next fiscal year and co-investment planned thereafter.
– Frontline health workers: Mapping of US-funded frontline cadres to partner-government employment categories and phased transition of those workers to the partner payroll over the agreement period.
– Data systems: Funding to scale up partner governments’ health data systems to enable long-term tracking of programmatic data for HIV/AIDS, TB, malaria, polio and outbreak response.
– Co-investment: Commitments by partner governments to increase domestic health expenditures during the agreement period to support sustainability.
Performance incentives and transition assistance: Linking US financial support to countries’ achievement of key health metrics, with incentives for exceeding targets and assistance during transition.
The Kenyan court action highlights the potential flashpoints as Washington presses ahead with the strategy. Legal challenges focused on privacy and procedural transparency could slow or alter implementation in countries where civil-society scrutiny is high.
US officials say additional bilateral agreements will be signed in the coming weeks.
How the Kenyan ruling and broader privacy concerns will affect those negotiations and the pace of data-related activities in partner countries remains unclear as governments, donors and civil society seek clearer safeguards and greater transparency.
