US to track health data and increase surveillance under $2bn deal with Nigeria

The United States State Department has disclosed that the $2 billion agreement signed with Nigeria includes provisions for data monitoring and enhanced health surveillance to enable rapid responses to disease outbreaks.

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This was outlined in America First Global Health Strategy document, a memorandum of understanding signed with at least 20 African countries, including Nigeria. Although the individual country agreements have not been made public, the broader document offers insight into the expectations placed on participating nations.

The deal, which runs for five years from April 2026 to December 2030, was signed between Nigeria and the US last December. Under the agreement, the US government will provide nearly $2 billion in grant funding, while Nigeria will mobilise close to $3 billion for health sector development over the same period.

When the pact was announced, emphasis was placed on the funding supporting Christian faith-based healthcare providers. However, concerns later emerged about potential encroachments on Nigeria’s health sovereignty.

In the health strategy document, the US said it would partner with recipient countries to develop a streamlined and robust performance monitoring system capable of tracking data in four areas: service delivery, epidemiology, supply chains, and co-investment.

Nigeria’s Ministry of Health noted that both countries intend to negotiate a “regulated data-sharing arrangement to exchange information on the long-term performance of the MoU, in compliance with applicable laws governing data protection, privacy, ownership, access rights, and hosting requirements.” The ministry did not provide details on what kind of data would be shared.

An earlier circulating version of the MoU included stronger language on direct access to national databases and made several references to sharing pathogens and pathogen sequence data with the US for 25 years. The US could then share specimens and data with up to ten “non-U.S. Government U.S. entities” capable of developing diagnostics or other medical countermeasures. This requirement was reportedly contained in agreements with Nigeria, Rwanda, Ethiopia, Uganda, and Mozambique. If countries fail to provide these resources, they could lose all funding included in the agreement.

In March, the New York Times reported that the US MoU with Zambia depended on the Southern African country providing more access to its critical minerals. Citing a state department memo, the NYT said the US considered withholding lifesaving HIV assistance as a negotiating tactic to pressure the Zambian government. That deal was valued at $1 billion.

According to Human Rights Watch, the agreements with Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia, and Uganda also required partner governments to give the US broad access to data and information to monitor compliance with the Helms Amendment, a US law that prohibits foreign assistance from being used to pay for abortion as a method of family planning or to motivate or coerce abortion.

Failure to provide this access can result in “changes to planned assistance and/or discontinuation of the agreement,” the HRW report said. That means non-compliant countries could lose anywhere from $124 million over five years in the case of Liberia to $1.8 billion in the case of Nigeria for HIV, TB, malaria, maternal and child health, laboratory systems, clinical commodities, and health workforce support that populations depend on for life-sustaining care. The agreement with Uganda goes as far as allowing US officials to conduct unannounced spot checks at health facilities and clinics.