How America First Bilateral Agreements Will Reshape Global Health Grant Opportunities

Hook: The Quiet Rise of Domestic Investment in Global Public Health

On April 7, 2026, the Kaiser Family Foundation (KFF) updated its tracker on America First bilateral global health agreements, marking a turning point in the funding dynamic for U.S.-supported global health programs. Under the America First Global Health Strategy, launched in September 2025, new five-year Memorandums of Understanding (MOUs) with partner countries lay the groundwork for a gradual transition: U.S. funding will decrease, while recipient nations are required to ramp up their own health spending. This policy shift is already underway, with several MOUs signed and more expected in 2026.

Context: A Paradigm Shift for U.S. Global Health Support

The America First Global Health Strategy represents a wholesale rethinking of U.S. engagement abroad. Earlier U.S. global health programs, such as PEPFAR and the Global Health Security Agenda, succeeded largely due to substantial, sustained American investment. The new approach flips that script: recipient countries must commit to increasing their own health budgets as a condition for continued—but reduced—U.S. assistance.

MOUs under this strategy have been (and continue to be) signed with countries spanning multiple continents, with the U.S. State Department and embassies providing sporadic updates. However, the full texts of most agreements aren’t publicly available, and details about the precise obligations, funding amounts, or specific program areas are often limited. The key through-line: U.S. resources are explicitly beginning to phase down as nations are pushed to fill the gap.

This shift is designed to promote country ownership and sustainability, a long-standing development goal. But the ambitious pace and scale of phasedown make it a watershed moment—both for grant seekers and for at-risk communities dependent on current U.S.-funded interventions.

Impact: What U.S. Funding Phase-Down Means for Grant Seekers

Researchers in global health will need to be especially vigilant. Projects that rely on U.S. bilateral funding in affected countries may see grant sizes decrease, face new local partnership requirements, or find eligibility criteria changing as funding streams are reoriented. The competitive landscape may intensify as local governments—now with increased responsibility—prefer proposals that align with their own budgetary priorities or demonstrate strong co-investment from local actors.

Nonprofits and NGOs operating on the ground should expect to adapt. As U.S. support tapers, host-country ministries might tighten oversight or demand demonstrable returns on investment. It’s likely that proposals demonstrating a clear path to sustainability, or those leveraging blended finance (public, private, philanthropic) will be favored. Organizations should also expect more scrutiny over indirect costs or overhead rates.

Small businesses and social enterprises working in health services or supply chains may also face downstream impacts. Opportunities may arise from local governments increasing procurement or tendering, but donor competition may increase and U.S. dollars may be less available for piloting or scaling new solutions.

For all sectors, the phasedown does not mean an immediate funding cliff. Rather, the transition period (2026-2030) offers some lead time. However, those who ignore the trend risk being left behind.

Action: Steps to Take Now

1. Track local policy developments. MOUs are often public, but details remain sparse—stay in active dialogue with local Ministries of Health and U.S. embassy contacts, and monitor the KFF Tracker for updates.

2. Engage local partners early. Begin building or strengthening relationships with in-country stakeholders who are now positioned as budget holders and strategic decision-makers.

3. Reposition proposals. Make sustainability a core selling point and demonstrate commitment to local ownership. Highlight prospects for scaling, local hiring, or capacity building.

4. Diversify funding streams. Explore alternative donors, private sector co-investment, and regional development banks—especially for projects serving vulnerable or high-need populations.

Outlook: The Next Phase of Global Health Funding

The full effects of this strategy will reveal themselves over the next two to three years, as implementation ramps up and early outcomes emerge from the first cohort of MOUs. Be prepared for evolving guidelines, expanded reporting obligations, and, potentially, revised country priorities. If partner nations fail to meet their obligations for increased domestic spending, further U.S. reductions (or program wind-downs) could follow.

Stay tuned for further updates: The KFF tracker and direct government channels will remain your best sources for timely, authoritative information.

Granted AI can help you navigate shifting priorities and identify new, diversified funding opportunities for global health work.