Ghana has rejected a proposed health compact with the United States that would have provided an estimated $109 million in US health funding over five years, with President John Dramani Mahama saying the agreement raised serious concerns over health data, financing obligations, and Ghana’s regulatory authority.

The decision places Ghana among a few African countries that have pushed back against new US health agreements introduced as Washington restructures its foreign assistance following the dismantling of USAID. Zimbabwe has also rejected a similar agreement, while Zambia has raised concerns over provisions in its negotiations with the United States.

Ghana raises concerns over health data

Speaking at the Council on Foreign Relations in New York on September 25, Mahama said the proposed compact was presented to Ghana as a replacement for health funding previously provided through USAID.

He said Ghana’s Ministry of Health reviewed the document before preparing a Cabinet Information Paper.

“Ghana is a sovereign nation, and we have our own processes. We are a democratic country,” Mahama said.

According to the President, the Cabinet identified several provisions that raised concerns, particularly those relating to Ghana’s health information.

“One, it says that we shall give the United States our pathogen profile,” he said, adding that the agreement also required Ghana to provide medical records.

“It also says we should give our medical records. I mean, who takes another country’s medical records? And so that was strange.”

Concerns over health-data sharing have been central to resistance to the new US health agreements in several African countries.

No FDA inspection

Mahama also raised concerns about the treatment of medicines and other medical products supplied under the proposed arrangement.

He said Ghana would have been required to contribute funding to the program while, according to his account of the compact, the country’s Food and Drugs Authority would not have been able to inspect medicines or other medical products entering Ghana under the program.

“And then it also says that any medications or any medical products that shall be brought into our country, our Food and Drugs Administration has absolutely no right to inspect,” Mahama said.

“I mean, it was humiliating.”

Ghanaian officials had previously cited concerns about the proposed handling of sensitive health information as a reason for rejecting the agreement. Reporting on the negotiations also indicated that the proposed arrangement would have required additional investment from Ghana alongside the US contribution.

Cabinet rejected the agreement

Mahama said the proposal was rejected after the Health Ministry presented its assessment to the Cabinet.

He described the decision as unusually swift.

“It was the compact that was thrown out in record time in our Cabinet. I’ve never seen anything thrown out as fast as that.”

He said the government subsequently instructed the Health Minister to communicate Ghana’s position to the US ambassador.

“And so, of course, we rejected it. And we asked the health minister to inform the US ambassador that we didn’t need it. We’ll manage ourselves.”

The proposed agreement would have provided Ghana with about $109 million in US health assistance over five years. The negotiations had begun in late 2025.

A wider concern over health sovereignty

Ghana’s decision comes as the United States seeks to shift its approach to global health cooperation. The new US strategy places greater emphasis on recipient countries taking responsibility for financing and delivering health programs, while Washington reduces its traditional aid commitments.

Kenya became the first African country to sign the agreement which was challenged in court, followed by similar arrangements with Rwanda, Liberia, Uganda, Lesotho and Eswatini, among other countries. Ravi Ram from the People’s Health Movement (PHM) East and South Africa, told BreakThrough News in December 2025, that  “Bilateral agreements between the US and Kenya and other African countries are meant to limit the ability of any one ‘partner’ country to challenge the terms of implementing the agreement, due to the unequal power relations.”

The concerns among health activists and concerned Africans is the ability of African states to determine their own health priorities, regulate medicines, control sensitive health information, and collectively negotiate the terms of international health cooperation.

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