On February 26, the United States signed bilateral health cooperation Memoranda of Understanding (MOUs) with the Dominican Republic and the Republic of Niger, reinforcing U.S. leadership in global health while advancing country ownership under the Trump Administration’s America First Global Health Strategy.

In the Dominican Republic, the United States signed a five-year bilateral health cooperation MOU. Under the MOU, working with Congress, the Department of State intends to provide up to $46.7 million to support the Dominican Republic’s efforts to combat HIV/AIDS and other health threats. The Government of the Dominican Republic commits to increasing its own domestic health expenditures by $14.1 million over the course of the five-year MOU.

The $60.8 million MOU with the Dominican Republic includes over $6 million in global health security funding to establish a 7-1-7 surveillance system capable of detecting infectious disease outbreaks within seven days, notifying the U.S. government within one day, and initiating response within seven days. By 2028, the Dominican Republic will assume full responsibility for all health commodities, frontline healthcare workers, and laboratory systems, with U.S. support focused on surveillance and new health innovations.

In Niger, the United States signed a five-year, $179.3 million bilateral health cooperation MOU. Under the MOU, working with Congress, the Department of State intends to provide up to $107.4 million to support Niger’s efforts to combat malaria, strengthen maternal and child health, and bolster disease surveillance and outbreak response. The Government of Niger commits to increasing its own domestic health expenditures by $71.9 million over the course of the five-year MOU.

The MOU with the Republic of Niger includes $5 million in global health security funding and work to establish a comprehensive digital health ecosystem, including an integrated suite of six health information systems covering electronic medical records, laboratory management, pharmacy management, surveillance and outbreak response, commodity inventory, and a national data warehouse.

These MOUs, together worth over $240 million in U.S. taxpayer dollars and recipient nation co-investments, protects Americans by strengthening infectious disease surveillance and response systems in the Dominican Republic and Niger, essential for detecting and containing infectious disease outbreaks before they reach U.S. shores. By requiring substantial co-investment from both countries and transitioning them toward national ownership, these MOUs deliver greater value for American taxpayers while maintaining critical health security partnerships.

America First Global Health Strategy Memoranda of Understanding (MOUs) signed so far represent nearly $20 billion in new health funding including more than $12.4 billion in U.S. assistance alongside $7.6 billion in co-investment from recipient countries, building on decades of progress in improving health security and fighting HIV/AIDS, malaria, tuberculosis, and other infectious diseases around the world. As of February 27, the State Department has signed 21 bilateral global health MOUs with Botswana, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, the Dominican Republic, Eswatini, Ethiopia, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Niger, Nigeria, Panama, Rwanda, Sierra Leone, and Uganda.