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The America First Global Health Strategy promises something African health advocates have demanded for decades: ownership. Through time-bound bilateral compacts, countries co-finance health programs with the US, gradually taking over as American funding tapers. By year five, they're supposed to own and sustain these systems themselves.

But what if ownership without authority is just dependency with a new face?

In this episode, we sit down with Nelson Aghogho Evaborhene, PhD fellow in Global Health Governance at Roskilde University, to unpack how these compacts actually work. Nelson has written several major analyses of the AFGH, and his conclusion is stark: these agreements transfer responsibility to African governments without transferring commensurate control over technology, data, procurement, or even the political conditions under which funding continues.

We explore Nigeria's $3 billion compact and its religious conditionalities, the South Africa precedent where funding was cut for political reasons despite strong performance, how bilateralism fragments the continental institutions Africa has been building, and why—even with full domestic financing—health systems remain vulnerable to collapse if they can't produce what they need.

Reading: Nelson's articles

Rebalancing Risk and Responsibility Under the America First Global Health Strategy

The America First Global Health Strategy and the Dilemma of Pan-Africanism

America First and the Fragmentation of Global Health: How Africa can Reimagine Its Agency

Protecting global health in the era of the America First Strategy

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2025 was the year the comfortable illusions of global health shattered. The U.S. withdrawal from WHO, the dismantling of USAID, and controversial bilateral agreements exposed uncomfortable truths about power, dependency, and who really benefits from "global health partnerships."

In this special year-end episode, we hear from global health leaders across the world reflecting on what 2025 revealed and where we're heading in 2026.

Featuring perspectives from:

• Dr. Luchuo Bain on why this is "the end of global health as we knew it—and the opening we needed."
• Dr. Seye Abimbola on being "surprised by how surprised people have been" about global health as foreign policy
• Dr. Boghuma Titanji on reimagining sustainable health financing after devastating aid cuts
• Dr. Madhu Pai on why we can't save global health without saving democracy
• Dr. Mohamed Aburawi on moving from intention to infrastructure
• Sitawa Wafula on AI's unregulated role in mental health care

We examine the human toll of USAID cuts, the sovereignty concerns around bilateral agreements, and the glimmers of agency emerging as countries like Nigeria and South Africa step up with domestic funding.

This isn't just a year in review; it's a reckoning with what global health has been and what it must become.

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This is a continuation of our previous episode with Emilie Koum Besson discussing the various forms of aid dependency. In this episode, we focus on the relationship between aid and dependency as well as pragmatic solutions.

To support us, consider becoming a paid subscriber on Patreon or making a one-time donation via PayPal.

Subscribe to our weekly newsletter: globalhealthunfiltered.com

Follow us on X (@unfiltered_gh), LinkedIn, Instagram, and TikTok.