What's happened
On December 4, 2025, the US and Kenya signed a $2.5 billion, five-year health agreement replacing previous USAID programs dismantled earlier this year. Kenya will increase domestic health spending by $850 million. Meanwhile, US-South Africa relations remain strained after the US boycotted the recent G20 summit in Johannesburg, citing unsubstantiated claims of white farmer persecution and refusing to recognize South Africa's G20 presidency transfer.
What's behind the headline?
US-Kenya Health Agreement: A Strategic Shift
The new $2.5 billion US-Kenya health compact marks a significant pivot from multilateral aid via NGOs to direct government-to-government partnerships. This aligns with the Trump administration's 'America First Global Health Strategy,' aiming to reduce dependency and inefficiency in foreign aid. Kenya's commitment to increase domestic health spending by $850 million signals a push toward sustainability and local ownership of health programs.
Impact on African Health Systems
The dismantling of USAID disrupted critical programs combating HIV/AIDS, malaria, and tuberculosis, risking setbacks in public health gains. The Kenya agreement attempts to mitigate this by integrating faith-based and private providers into the national health insurance system, ensuring broad access. However, political tensions with populous nations like Nigeria and South Africa, excluded from similar deals due to political differences, may fragment regional health efforts.
US-South Africa Diplomatic Rift
The US boycott of the Johannesburg G20 summit and Trump's unsubstantiated claims of 'white genocide' against Afrikaners have deepened diplomatic tensions. South Africa's rejection of these allegations and insistence on its sovereign G20 membership underscore a clash over respect and recognition. The US decision to halt payments and exclude South Africa from the 2026 G20 summit in Miami further strains relations, potentially impacting multilateral cooperation on global economic and health issues.
Forecast and Consequences
The US-Kenya deal will likely serve as a model for future bilateral health agreements, emphasizing American strategic interests and local accountability. However, the exclusion of key African players like South Africa and Nigeria risks undermining continental cohesion in health and diplomatic arenas. The ongoing US-South Africa dispute may hamper collaboration on broader global challenges, including economic recovery and pandemic preparedness, at a critical juncture for multilateralism.
What the papers say
The New York Post and AP News report on the signing of the $2.5 billion US-Kenya health agreement, highlighting the replacement of USAID programs and Kenya's increased domestic health spending. Reuters' Simon Lewis details the shift from NGO-led aid to government partnerships, quoting Secretary Rubio's criticism of the 'NGO industrial complex.' All Africa emphasizes Kenya's commitment to health system sustainability and the innovative provisions in the agreement.
Conversely, multiple sources including Reuters, The New York Times, and Al Jazeera cover the diplomatic fallout between the US and South Africa. Reuters notes the US boycott of the Johannesburg G20 summit and Trump's allegations of 'white genocide,' which South African President Ramaphosa vehemently denies. The New York Times highlights Trump's refusal to recognize the G20 presidency transfer and his announcement to halt payments to South Africa. Al Jazeera and The Independent provide context on South Africa's rejection of these claims and its commitment to multilateralism despite US absence.
These contrasting narratives illustrate a US foreign policy increasingly focused on bilateralism and American interests, while straining traditional alliances and multilateral forums in Africa.
How we got here
The Trump administration dismantled USAID in 2025, disrupting longstanding US health aid programs in Africa. The new US 'America First Global Health Strategy' emphasizes bilateral agreements with countries like Kenya to promote self-reliance. Concurrently, US-South Africa relations soured over Trump's allegations of 'white genocide' and refusal to attend the 2025 G20 summit hosted by South Africa.
Go deeper
- What are the key provisions of the US-Kenya health agreement?
- Why did the US boycott the South Africa-hosted G20 summit?
- How is South Africa responding to US allegations and exclusion from the G20?
Common question
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Why Are US and South Africa Relations So Strained Now?
Recent tensions between the US and South Africa have made headlines, mainly due to disagreements over human rights allegations and diplomatic recognition. Many are wondering what sparked this conflict and what it means for global diplomacy. Below, we explore the key questions about this diplomatic dispute and what could happen next.
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Why Are Countries Fighting Over G20 Recognition?
Diplomatic disputes over G20 recognition can seem confusing, but they often stem from deeper issues of sovereignty, human rights, and international influence. Recent tensions between the US and South Africa highlight how disagreements over leadership and human rights narratives can escalate into diplomatic conflicts. Understanding these disputes helps clarify the broader implications for global relations and markets. Below, we explore common questions about international disputes and their impact on the world stage.
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Why Did the US Boycott the G20 Summit Over South Africa?
The recent G20 summit in Johannesburg saw a surprising absence: the United States. This move was driven by serious allegations and diplomatic tensions surrounding South Africa's presidency. Many are asking, what exactly led to the US's decision to skip the summit? How does this impact global diplomacy? And what does it mean for future international cooperation? Below, we explore the key questions and provide clear answers about this diplomatic dispute.
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What’s Really Going On in Today’s Major News Stories?
With so many headlines shaping our world, it’s easy to feel overwhelmed. From political crackdowns to international disputes and security threats, understanding the bigger picture helps make sense of the chaos. Below, we explore key questions about today’s top stories and what they mean for the global landscape.
More on these topics
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South Africa, officially the Republic of South Africa, is the southernmost country in Africa. With over 59 million people, it is the world's 24th-most populous nation and covers an area of 1,221,037 square kilometres.
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Matamela Cyril Ramaphosa is a South African politician and the fifth and current President of South Africa. Previously an anti-apartheid activist, trade union leader and businessman, Ramaphosa served as the Deputy President of South Africa from 2014 to 20
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The G20 is an international forum for the governments and central bank governors from 19 countries and the European Union. Founded in 1999 with the aim to discuss policy pertaining to the promotion of international financial stability, the G20 has expande
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Donald John Trump is an American politician, media personality, and businessman who served as the 45th president of the United States from 2017 to 2021.
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The United States of America, commonly known as the United States or America, is a country mostly located in central North America, between Canada and Mexico.
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Marco Antonio Rubio is an American attorney and politician currently serving as the senior United States Senator from Florida. A Republican, Rubio previously served as Speaker of the Florida House of Representatives.
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Kenya, officially the Republic of Kenya, is a country in Eastern Africa. At 580,367 square kilometres, Kenya is the world's 48th largest country by total area. With a population of more than 47.6 million people, Kenya is the 29th most populous country.
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William Kipchirchir Samoei Arap Ruto CGH is a Kenyan politician who is serving as the fifth and current president of Kenya since 13 September 2022. Prior to becoming president, he served as the first elected deputy president of Kenya from 2013 to 2022.
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Johannesburg, informally known as Jozi, Joburg, or "The City of Gold", is the largest city in South Africa and one of the 50 largest urban areas in the world.