The collapse of a proposed US$367 million bilateral health agreement between Zimbabwe and the United States this week triggered alarm among medical experts and civil society groups, who warned that millions of citizens could be exposed to life-threatening risks in the absence of a resolution of the spat.
Health campaigners said the aborted deal, intended to fund programmes targeting HIV and Aids, tuberculosis, malaria, maternal and child health and disease outbreak preparedness, would have provided a critical lifeline to a health system already stretched to breaking point.
The fallout exploded dramatically after negotiations collapsed over Harare’s concerns about proposed conditions, including sharing sensitive health data.
Washington subsequently moved to wind down its assistance on Tuesday.
But without rapid alternative funding, the country faces an explosive rise in infection rates, treatment disruptions, drug resistance and worsening mortality, campaigners warned.
“The … health of millions of Zimbabweans is at stake,” Itai Rusike, executive director at the Community Working Group on Health (CWGH), said as he called upon both governments to return to the negotiating table.
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A deal would have delivered life-saving assistance valued at over US$300 million over five years under Washington’s America First Global Health Strategy.
“Zimbabwe has been heavily reliant on external support provided by donors to fund programmes in the health sector and for humanitarian assistance,” Rusike warned.
“Without funds being rapidly mobilised to fill the gap left by the US withdrawal…the health of millions of Zimbabweans is at stake with the failure to prevent new infections for HIV and Aids, TB and malaria, and the threat of drug resistance developing because of disrupted treatment will have far-reaching consequences,” he added.
Campaigners warned that the southern African country’s fragile public health system — already constrained by chronic underfunding — could struggle to cope.
“It is going to be a struggle for the ordinary person, unless there is sufficient domestic resource mobilisation for the health sector to cover the gap,” the CWGH boss said.
He said Zimbabwe must urgently increase health spending and develop independent funding mechanisms to reduce reliance on donors.
“We still believe these negotiations can be revisited with compromises from both ends,” he said. “At the end of the day, it comes down to protecting the interests of our people.”
Johannes Marisa, president of the Medical and Dental Private Practitioners Association of Zimbabwe, told the Zimbabwe Independent the rejection of funding would be potentially devastating.
“I am not privy to the real reasons for rejecting the deal except that it undermined sovereignty, which is merely a political reason,” Marisa said.
“Unless there are some unknown reasons, rejecting such a significant capital injection is detrimental to our health delivery system. There is already government underfunding. There is massive exodus of critical staff on top of poor stocks of medicines. The country is limping in terms of health matters.”
The controversy comes as Treasury tabled a ZiG30,4 billion allocation for health in the 2026 National Budget. The government said this figure represented 15% of total expenditure, meeting the benchmark set under the African Union’s Abuja Declaration.
It commits African governments to allocate at least 15% of their national budgets to health. But in an earlier analysis of the budget, the CWGH said the headline figure masked structural weaknesses.
Experts said primary healthcare services and frontline facilities remained underfunded.
CWGH also warned that despite the Abuja target being “met on paper”, the real impact is constrained because almost half of the health budget is absorbed by employment costs.
Stanley Takaona, president of the Zimbabwe HIV/Aids Activists Union, urged both sides to avoid politicising humanitarian support.
“I think we should urge parties not to politicise humanitarian funding,” Takaona said. “I feel Zimbabwe is a sovereign country, it has got a right to reject if there are strings attached. It is very safe to receive funding with no strings attached for sustainability because once there is conflict and that funding will be cut off, then we are also left in danger.”
But as Washington closed the door on the lifeline, officials in Harare defended their stance. Government spokesperson Nick Mangwana said the deal constituted an “unequal exchange”, particularly regarding data sharing.
“At its core, the arrangement was asymmetrical,” Mangwana said.
“Zimbabwe was being asked to share its biological resources and data over an extended period, with no corresponding guarantee of access to any medical innovations — such as vaccines, diagnostics, or treatments — that might result from that shared data.
“When financial assistance is contingent upon concessions that touch upon national security, data sovereignty, or access to strategic resources, it fundamentally alters the nature of the relationship from one of partnership to one of unequal exchange. This we cannot accept.”
Late last year, a Kenyan court suspended a health funding agreement that the government had signed with the US, pending the hearing of a case filed by a consumer protection group citing concerns over the safety of citizens’ health data.
“This growing continental reflection should not be misconstrued as anti-American sentiment,” Mangwana said this week.
Following the breakdown in talks, the US embassy announced it would begin phasing out assistance.