Tanzania’s decision to keep outbreak specimens under its own control has exposed a question millions of Africans still cannot answer about the health agreements their governments have already signed with the United States.
Development Diaries reports that Tanzania signed its bilateral agreement under the America First Global Health Strategy (AFGHS) on 01 July, 2026, with Health Minister Mohammed Mchengerwa announcing in Dar es Salaam that his country deliberately refused to sign any specimen-sharing arrangement, insisting that biological samples collected during disease outbreaks would be tested, stored and governed on Tanzanian soil.
His disclosure came as the US State Department confirmed that 34 African countries had signed AFGHS agreements totaling more than 24 billion dollars in combined commitments, although the full texts of most of those agreements have not been made public.
Tanzania’s announcement exposed a transparency gap, with citizens in Nigeria, Mozambique and many of the other signatory countries still unable to tell whether their governments secured similar safeguards because most of the agreements remain unpublished.
The AFGHS replaces the traditional USAID-led health assistance model with direct government-to-government partnerships. Under the arrangement, the United States commits funding to African governments in exchange for investments in disease surveillance, laboratory systems, public health financing and broader health sector cooperation.
Tanzania’s five-year framework combines 3.1 billion dollars in investment, including 1.3 billion dollars from the United States and 1.8 billion dollars from Tanzania. Kenya signed a 2.5 billion-dollar agreement months earlier. Those investments are substantial, but agreements that determine how countries collect, store and share health information also determine who controls one of Africa’s most valuable public resources.
Kenya’s experience illustrates why those details deserve public attention. An analysis by the Carnegie Endowment for International Peace found that Kenya’s agreement contains no binding commitments on benefit sharing or technology transfer linked to Kenyan genomic data and provides no enforceable safeguards preventing that data from being shared with other datasets once it leaves Kenya’s control.
That raises the possibility that health and pathogen data collected from Kenyan citizens could be used for pharmaceutical research, biotechnology development or artificial intelligence training without Kenya exercising meaningful control over how the information is subsequently used.
The concerns proved serious enough to reach the courts. A legal challenge argued that aspects of Kenya’s agreement violated constitutional privacy protections, the country’s Data Protection Act and the Digital Health Act, prompting the court to suspend part of the arrangement while the case continues.
Zambia reportedly rejected proposals linking health cooperation to mineral access, while Zimbabwe declined to participate altogether over concerns about data sovereignty.
The bigger question is what happened in the other 32 countries. Tanzania secured written protection for biological samples, while Kenya’s agreement is already facing a legal challenge. Citizens in the remaining signatory countries still do not know what protections, if any, their governments negotiated because most of the agreements remain unpublished.
A Human Rights Watch (HRW) review of several AFGHS agreements offers part of the answer, as it found that some agreements require participating governments to provide the United States with access to health data and other information needed to conduct compliance audits at laboratories, health facilities and public health programmes, while continued assistance may depend on meeting those obligations.
That creates a relationship in which foreign oversight extends into national public health systems, even though citizens in many participating countries have never seen the agreements defining those obligations.
The greater governance problem is the absence of public scrutiny. Ministries of health and attorneys general negotiated agreements affecting national disease surveillance systems, laboratory networks and health data governance without publishing the full documents for independent review.
Many national parliaments did not publicly examine the agreements before they were signed, leaving citizens unable to determine how information generated through their own public health systems may be collected, shared or protected.
The lack of transparency also weakens accountability. The US State Department announced more than 24 billion dollars in health commitments across Africa while withholding the full text of most agreements from public scrutiny.
African governments accepted arrangements with long-term implications for public health governance without ensuring that citizens, lawmakers and independent experts could examine the obligations they created. A programme reshaping health systems across 34 countries has therefore advanced with remarkably little democratic oversight.
This is fundamentally a rights issue, and countries across Africa have enacted data protection laws recognising citizens’ rights to know how their personal information is collected, stored and shared.
Health records are among the most sensitive categories of personal data governments possess, and agreements that affect those rights should not remain inaccessible to the very people whose information they govern.
Women and girls have particular reason to demand transparency because they account for a significant share of users of maternal healthcare, reproductive health services, HIV programmes and child health services that now fall within these partnerships.
Their medical records contain some of the most sensitive information held by governments. The transition from NGO-managed programmes to government-led systems also affects thousands of community health workers, most of whom are women, raising important questions about whether they will move into government employment under fair and secure conditions.
African citizens should formally request the full text of their country’s AFGHS agreement from their Ministry of Health, parliament and national data protection authority, while the African Union Commission should publish a comparative review identifying which countries secured protections for biological samples, limits on foreign data audits and benefit-sharing guarantees, and which countries did not.
Citizens cannot make informed decisions about agreements they have never been allowed to read, especially when those agreements determine how Africa’s health data will be governed for years to come.
