Why Ghana turned down a $109 million health aid from the Trump administration

Fresh details have emerged explaining Ghana’s decision to reject a $109 million health aid package proposed under the United States’ “America First Global Health Strategy,” offering deeper insight into concerns over national sovereignty, data protection, legal jurisdiction, and regulatory independence.

The initiative, introduced under the administration of Donald Trump, is designed to shift global health responsibility toward lower-income countries, encouraging them to take greater ownership in combating diseases such as HIV/AIDS, malaria, tuberculosis, and polio. The policy framework also aims to transition partner countries from long-term aid dependence toward self-sufficiency.

According to multiple sources familiar with the negotiations, discussions began in November 2025 when the U.S. chargé d’affaires presented Ghana’s Ministry of Health with a draft Memorandum of Understanding (MoU). The document reportedly came with a request for Ghana to sign within one week. However, Ghanaian officials raised concerns, noting that the agreement had been drafted unilaterally without input from Ghanaian authorities, and requested a more collaborative negotiation process.

The U.S. side, however, declined to reopen discussions and continued to push for immediate signature. The chargé d’affaires is said to have insisted he was acting on “instructions from the top,” while also indicating that several other countries had already signed similar agreements. Despite sustained pressure, Ghanaian officials resisted signing and instead sought revisions to key provisions.

One of the most contentious issues involved health data governance. Under the proposed agreement, Ghana would have been required to share citizens’ health records with the United States for a period of 25 years—far beyond the five-year duration of the aid programme itself. Officials raised concerns that the U.S. would have broad discretion over how the data could be used, including potential sharing with American pharmaceutical companies for research and commercial product development. This raised significant ethical, legal, and privacy concerns within Ghana’s health sector.

Another major concern centred on pharmaceutical regulation. The MoU reportedly contained provisions that would allow medicines approved by the U.S. Food and Drug Administration (FDA) to enter the Ghanaian market without undergoing local approval processes. This would have effectively bypassed the authority of the Food and Drugs Authority (FDA Ghana), which is legally mandated to independently evaluate and certify all medicines before distribution in the country. Health officials warned that such a clause could undermine patient safety and weaken Ghana’s regulatory sovereignty.

Legal concerns also arose from a clause stipulating that the agreement would be governed under U.S. law. This meant that any disputes would be interpreted and adjudicated within the American legal system, significantly limiting Ghana’s jurisdiction and control over enforcement or dispute resolution.

In addition to sovereignty and legal issues, the financial structure of the agreement was also heavily scrutinized. While the U.S. pledged $109 million over five years, Ghana was required to contribute $70 million in counterpart funding. However, the U.S. contribution was conditional on congressional approval and available funding, while Ghana’s financial commitment was binding. Failure by Ghana to meet its obligation could have led to termination of the entire agreement, creating what officials described as an uneven and high-risk arrangement.

Following internal review, the Ministry of Health escalated the matter to Cabinet. The Attorney-General subsequently advised against signing the agreement, and Cabinet ultimately approved its full rejection.

Ghana’s decision reflects broader tensions emerging around the implementation of the “America First Global Health Strategy.” As of this week, the United States Department of State has signed 32 agreements under the initiative, amounting to a combined $20.6 billion—$12.8 billion from the U.S. and $7.8 billion from partner countries.

However, similar concerns have begun to surface in other countries. Reports suggest negotiations have faced setbacks in places such as Zimbabwe, while Kenya’s agreement has also attracted legal scrutiny from civil society organizations over comparable concerns involving sovereignty and governance.

For Ghanaian authorities, the rejection was not a dismissal of international health assistance, but a decision grounded in principle. Officials maintain that while external support for public health programmes remains important, it must not come at the expense of national control over data, law, and regulatory systems. The government ultimately concluded that the long-term risks embedded in the agreement outweighed its short-term financial benefits.