In this week’s Health News Roundup, the U.S. is tightening health aid through bilateral agreements tied to co-financing and measurable targets, while South Africa remains excluded amid diplomatic tensions. In the Central African Republic, overlapping health and humanitarian crises have pushed the healthcare system to the brink of collapse. Elsewhere on the continent, key stories include chronic underinvestment in sub-Saharan clinical trials, a resurgence of cholera, and Kenya’s industrial pivot in partnership with the WHO. The DRC is prioritizing cancer prevention, Togo has launched a new telecom-health partnership, and Ethiopia’s Marburg outbreak appears to be stabilizing.

The United States is accelerating the rollout of a new, more restrictive bilateral health aid model in Africa, built around co-financing, measurable targets, and sanctions for non-performance.

Following Kenya, Rwanda, and Uganda, four additional countries were brought into the scheme in late December 2025. Madagascar, Sierra Leone, Botswana, and Ethiopia signed memorandums of understanding totalling approximately $2.3 billion over five years. Under this approach, the United States is committing $1.4 billion, while partner countries are expected to mobilize more than $900 million in domestic resources.

This shift marks a clear departure from traditional multilateral aid channels. Assistance is now negotiated on a government-to-government basis, with strict timelines and performance indicators. In Madagascar, the funds arrive amid a budget contraction in which health spending’s share of the 2026 budget fell to 5.4%, well below the 15% target set by the Abuja Declaration. According to Washington, the objective is to reduce structural dependence after more than $175 billion invested in international health aid since 2001. Implicitly, the model entails a relative reduction in the U.S. financial effort and increased pressure on national capacities.

In Nigeria, the U.S.–Nigerian health agreement introduces an unprecedented religious component. Over five years, the United States will allocate $2 billion, while Nigeria will mobilize $2.9 billion of its own resources to strengthen its health system. The agreement, negotiated alongside reforms aimed at protecting Christian populations from violence, includes dedicated funding for Christian health facilities. The U.S. State Department has explicitly linked this aid to Nigeria’s efforts to combat extremist religious violence targeting vulnerable Christian communities, and Washington reserves the right to suspend or terminate programs deemed inconsistent with American national interests.

South Africa excluded from new U.S. health aid amid diplomatic tensions

South Africa remains outside the new American health aid system despite having one of the world’s highest HIV prevalence rates. The country has lost $400 million in annual U.S. funding following diplomatic tensions with Washington.

Unlike nine other African nations, South Africa has not signed a memorandum of understanding under the new bilateral model. Diplomatic relations appear to be conditioning access to funding. While the U.S. State Department insists that the health agreements are not linked to migration cooperation, particularly on the return of deported migrants, the timing raises questions. Several countries that agreed to cooperate with Washington on migration matters secured health agreements, while South Africa remains in a diplomatic freeze.

Kenya: WHO partnership anchors industrial strategy

Kenya is deepening its partnership with the World Health Organization, with a focus on technology transfer and local production. On the sidelines of the second WHO Global Summit on Traditional Medicine, held from December 17 to 19, 2025, in India, Health Minister Aden Duale reaffirmed the country’s ambition to reduce dependence on imported health products.

Recent reforms have attracted 13 new pharmaceutical manufacturers, supported by streamlined regulatory timelines and reduced fees. Kenya is also aiming to reach WHO regulatory maturity level 3 by 2026. National institutions, including the Pharmacy and Poisons Board, the Kenya Biovax Institute, and KEMRI, are mobilizing to strengthen production capacity, emergency preparedness, and the negotiation of more balanced global agreements.

Central African Republic: a health system facing enormous challenges

In the Central African Republic, only 32% of health facilities are fully operational, while 25% are partially functional and 43% remain non-operational, according to a recent WHO report.

The country is facing a multifaceted health crisis: a maternal mortality rate of 829 per 100,000 live births, among the highest globally; life expectancy of 54 years; and acute malnutrition affecting 7.4% of children under five. Violence against health facilities has increased, with 44 incidents documented in 2023 by Insecurity Insight. The country regularly experiences outbreaks of measles, malaria, cholera, and hepatitis E.

Of the 3.2 million people requiring humanitarian assistance, 2.1 million need urgent health interventions. Persistent armed conflict, compounded by climate-related impacts, continues to disrupt access to care. The 2025 response plan remains severely underfunded, undermining efforts to contain epidemics and deliver basic services.

Medical research: sub-Saharan Africa remains underused for clinical trials

Globally, fewer than 56% of clinical trials meet their recruitment targets, and only 20% are completed on time. Sub-Saharan Africa nonetheless represents a largely untapped pool of capacity. To date, just 1.1% of global clinical trials are conducted in the region, despite strong on-the-ground performance. African research networks report consent rates above 80% and retention rates ranging from 85% to 96%.

Over the past two decades, investments—primarily in HIV, tuberculosis, and COVID-19—have helped establish nearly 5,000 potential research sites, staffed by personnel trained in good clinical practices. A recent decline in donor funding is freeing up capacity at a time when non-communicable diseases are rising. Hypertension, diabetes, cancers, and chronic respiratory diseases are increasing, driven by urbanization and population ageing. The genetic diversity of African populations remains a key asset for oncology and precision medicine. Persistent barriers, including limited digital medical records and regulatory delays, are gradually being addressed through the expansion of the African Medicines Agency.

Cholera resurges across Africa in 2025

Africa is experiencing a concerning resurgence of cholera in 2025. According to Africa CDC, more than 310,000 cases have been reported since January, with approximately 3,000 deaths across 25 countries. Five countries account for nearly 88% of cases, while Sudan, the Democratic Republic of Congo, South Sudan, and Angola record the highest number of fatalities.

Africa CDC has established a continental task force to integrate governance, infrastructure, and public services. The agency stresses that medical responses alone are insufficient without sustained investment in water and sanitation. Globally, cholera causes up to four million cases and more than 140,000 deaths annually. In Africa, recurring outbreaks continue to strain health systems and slow economic development.

Togo: telecoms support healthcare professionals

In Togo, the National Order of Physicians and Yas Business, a subsidiary of telecom operator Yas, have signed a two-year partnership to improve doctors’ access to tailored communication solutions.

The agreement offers preferential telecom packages to registered physicians to modernize work tools and ensure service continuity during the digital transformation of the health sector. It also provides a framework for promoting reliable connectivity solutions essential for care coordination and medical data management. For the operator, the partnership targets a strategic institutional audience; for the Order, it represents a lever to improve members’ working conditions. Over the longer term, the cooperation aims to enhance care quality and the overall efficiency of Togo’s health system.

DRC: raising internal awareness to prevent cancer

In Kinshasa, the WHO office in the Democratic Republic of Congo organized a breast and prostate cancer screening workshop for its staff this week, promoting early detection in a country where access to specialized care remains limited.

Participants received practical training in self-examination and basic screening techniques, alongside on-site testing. According to WHO data, the African region recorded more than 900,000 new cancer cases in 2022 and over 580,000 deaths. Without strengthened action, cancer mortality could rise by more than 70% by 2040. In the DRC, key risk factors include smoking, alcohol consumption, pollution, and sedentary lifestyles. Specialists emphasize that early detection remains the most effective way to improve survival. By starting with its own staff, the WHO aims to lead by example and reinforce a culture of prevention.

Ethiopia contains Marburg virus outbreak

Health authorities in Ethiopia have confirmed the stabilization of the country’s first Marburg virus outbreak, according to Outbreak News Today. As of December 21, 2025, no new cases had been reported for more than a week.

The cumulative toll stands at 14 confirmed cases, including nine deaths and five recoveries. Nearly 2,500 laboratory tests have been conducted, reflecting enhanced surveillance. The response has relied on early detection, contact tracing, strengthened prevention measures, and community engagement, in line with international protocols. While vaccines and candidate treatments are in development, none have yet been licensed. Experts say the strict application of response measures helped contain the outbreak, limiting its health and social impact.

Zimbabwe launches National Public Health Institute

Zimbabwe officially launched its National Institute of Public Health in October 2025. The semi-autonomous body centralizes surveillance, laboratory services, emergency preparedness, and research, with technical support from the WHO and funding from the European Union.

Governance is overseen by a committee chaired by the Minister of Health, signaling strong political backing. An exchange visit with Zambia’s National Public Health Institute enabled Zimbabwe to draw on regional best practices. By consolidating previously fragmented functions, the institute aims to improve data quality, strengthen intersectoral coordination, enhance crisis preparedness, and support progress toward universal health coverage.

Ayi Renaud Dossavi