The Trump administration has entered into bilateral agreements with countries hit by deep cuts in U.S. foreign aid.
Published December 30, 2025
US President Donald Trump’s administration has signed an agreement pledging $480 million in public health aid to Ivory Coast.
The agreement, signed Tuesday in the West African nation’s capital Abidjan, is the latest development in the Trump administration’s America First global health strategy.
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The plan envisions signing bilateral agreements with dozens of countries to receive U.S. medical assistance following the administration’s dismantling of the U.S. Agency for International Development (USAID).
The Trump administration has argued that U.S. foreign aid policy is inefficient and wasteful, and said bilateral agreements would increase accountability and oversight and ultimately lead to self-sufficiency.
Experts have questioned the effectiveness of this approach and warned of its transactional nature.
At Tuesday’s signing ceremony, U.S. Ambassador to Ivory Coast Jessica Davis Barr said the U.S. government is moving “beyond traditional aid approaches and toward a model that focuses on trade, innovation, and shared prosperity.”
“Today, we are entering a new phase in our bilateral cooperation. We are implementing our America First global health strategy,” the ambassador said.
As part of the agreement, Ivory Coast has committed to ultimately provide up to $292 million in health funding by 2030, Ivory Coast Prime Minister Robert Bouglé Mambé said.
The agreement is the largest of more than a dozen agreements reached so far under the new strategy by the Trump administration.
Reductions to USAID
Deep cuts to USAID earlier this year have disrupted public health services around the world, with Africa particularly hard hit.
This has raised concerns about a potential increase in the spread of HIV on the continent, a decline in maternal and child health care, a surge in malaria cases and a decline in early detection of new infections.
The Ivory Coast Agreement and other new bilateral agreements seek to address these areas, but public health experts are cautious about the administration’s approach.
An analysis conducted by the Center for Global Development earlier this month said the new strategy outlines several potentially beneficial changes to the provision of foreign medical assistance.
But these changes “pose significant risks to service delivery and hard-won public health gains,” wrote senior analyst Jocelyn Estes and policy fellow Janine Madan Keller.
They identified several potential areas of risk, including public health priorities that may be shaped by “trade pressures,” questions around oversight, and uncertainty about how services will be protected if partner countries fail to meet their commitments.
Experts also questioned what the strategy would mean for aid to regions without “credible or stable governments.”
“Operating at this scale and speed with U.S. global health assistance, especially a reconfigured approach to direct government assistance, is unprecedented,” it said, adding that “each potential point of failure is putting lives at risk.”
