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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At the end of August, at the Silverbird Cinema in the Accra Mall in Ghana, two Israeli feature films were screened alongside Ghanaian student productions. 

For the second year running, the seats for this Israeli film festival were empty. Ordinary Ghanaians declined the Israeli Embassy’s films, and a peaceful demonstration outside held placards for Palestine and against the continued killing of civilians in Gaza.

There is another screen Ghanaians must refuse to look away from, protestors asserted. The screens on which we have watched Gaza reduced to rubble, families displaced again and again, hospitals and schools destroyed, and children carried from the wreckage of a war that, despite the ceasefire announced in October 2025, has not stopped killing them.

However, something else walked through the doors of the film festival: schoolchildren. In uniform. On a Sunday.

Students from Achimota School and Accra Girls Senior High School, two of Ghana’s most prominent public secondary schools, were brought into an embassy-sponsored event at the center of a serious political controversy. Those of us who were there saw them. We have photographs and videos. The question Ghana must now answer is not about cinema. It is about who sent our children, and why.

The 2025 Israeli Film Festival

Last year, the Embassy staged a week-long Israeli Film Festival at the same venue and called it an exercise in “dialogue and mutual understanding.” Nearly 400 Ghanaian organizations, student movements, trade unions, faith communities, civil-society groups, signed one statement calling for a boycott. Protesters gathered outside. Sponsors pulled out. The Embassy still declared the event a success.

The veteran editor Kwesi Pratt Jnr., who joined the picket, recalled what that “success” looked like a year ago for the “Alhaji and Alhaji” program:

“This is the first time in my life that I’ve seen 400 organizations come together to sign one statement calling for a boycott of the film festival. I joined the picket at the Silverbird Cinema, and a few, very, very few, prominent Ghanaians, including Afenyo-Markin, attended in spite of the protest. But it was a fiasco. The room was empty. Ghanaians rejected the film festival completely.”

So the Embassy returned smaller: two Israeli films on a single Sunday, free entry, free popcorn, raffle prizes, and an invitation aimed squarely at young people. When adults again refused to fill the room, uniformed students appeared. If Ghanaian adults will not lend legitimacy to this event, should Ghanaian children be made to supply it?

The timing makes it harder to dismiss as a routine outing.

President John Dramani Mahama has publicly described what is happening in Gaza as genocide. The Israeli Ambassador to Ghana has publicly rejected that position and defended his government’s conduct. He is entitled to make his case, but he is a guest of a sovereign state, not the author of its policy.

Against that backdrop, the presence of uniformed students inside an embassy program, days after this very public disagreement, demands an accounting. Pratt put the question bluntly:

“At the time that the ambassador was attacking our president, some authorities in our secondary schools decided to side with [the embassy]. What judgment was exercised by the school authorities when they agreed to bus their students to this film festival? What were they expecting? What checks did they do on the quality of the films?”

Those are the right questions, and they are not rhetorical. They have not yet been answered and there has been no investigation.

What the students deserve

None of this is an accusation against the children. They may have had little understanding of the political purpose around the event. The responsibility belongs to the adults who placed them there.

Ghana rejected the Israeli film festival not because cinema or cultural exchange is evil. Not because Israeli artists have no right to make films. The rejection is not an attack on Jewish people. Antisemitism is hatred and must also be rejected. 

The problem is that this festival is not an example of artists meeting freely across borders. It is an Israeli Embassy-backed initiative staged while the Palestinian people continue to pay with their lives. Amid the killing of civilians and the destruction of Palestinian life, the use of state diplomacy to manufacture an appearance of normality while those questions remain unresolved is nothing less than political soft power.

Ghanaian children are not diplomatic props, and Ghanaian schools must never become extensions of a foreign embassy. Teach them, yes. Teach them the Holocaust, the Nakba, occupation and international law, and give them the evidence to think critically. That is education. Busing uniformed children into a controversial embassy function, and letting their presence become evidence of Ghanaian acceptance, is the opposite.

That is why the demand is simple, and now directed at the Ministry of Education and the Ghana Education Service: did you know? If yes, explain. If not, investigate. And if any official bypassed procedure or abused authority to place schoolchildren inside a foreign government’s public-relations exercise, hold them accountable.

Ghana’s revolutionary legacy

There is a longer tradition at stake. Ghana is the country from which Kwame Nkrumah declared that our independence was meaningless unless linked with the total liberation of Africa. Africa understands what cultural normalization is for: domination has rarely arrived only with rifles. It seeks respectability, the reception, the festival, the partnership, until oppression becomes a disagreement to be discussed politely while business continues.

Palestine poses that old question to the African conscience once more. And a small part of the answer is being written by who walks into a cinema in Accra Mall, and who is made to walk in.

For the second year, the empty seats have spoken. Now Ghana’s own institutions must speak. Our children deserve education, not enlistment. And a sovereign state deserves to decide, in the light of its own conscience, what its schools lend themselves to.

Stay away. Let the empty seats speak, for the Palestinian child who will never again enter a classroom, and for the proposition that human life is worth more than diplomatic image-building.

The enlargement of BRICS presents Africa with a wider field of economic possibilities by bringing the continent into closer relationship with some of the world’s largest markets, important sources of development finance and countries possessing substantial capabilities in manufacturing, energy, infrastructure, pharmaceuticals, agriculture, and advanced technologies. At a time when international economic relations are becoming increasingly fragmented, this wider range of relationships gives African countries greater room for maneuver.

But a wider choice of trading partners, financiers, and technological partners will mean considerably less if Africa continues to export raw materials, import sophisticated technologies, and occupy the lower reaches of global value chains, because the destination of our commodities may become more diversified without fundamentally altering our position in the international division of labor. It is not the direction of extraction that has ever been the problem, but its structure.

20 years of BRICS

This should therefore be the central African question about BRICS as it enters its third decade: how do we use this changing configuration of economic relationships to build productive power on the continent? The measure of Africa’s engagement with BRICS cannot simply be the increase in trade, investment or infrastructure finance, but must increasingly be whether these relationships enable African economies to convert their minerals, energy resources, labor, knowledge and expanding continental market into greater productive, technological and institutional capability.

Africa’s experience gives this question particular historical significance. The continent has been deeply integrated into the world economy for centuries, but largely through an economic structure in which minerals and agricultural commodities traveled enormous distances while much of the processing, manufacturing, technology, and financial value associated with them accumulated elsewhere. That structure remains recognizable in economies that export crude oil while importing refined petroleum products, export mineral ores while importing machinery and manufactured components and export agricultural commodities while importing processed goods derived from the same productive base.

Barriers to development

The post-colonial challenge has therefore never been to trade more but to build the productive capabilities that allow African economies to retain more value from what they produce. Yet this has become more difficult as several economies have experienced premature deindustrialization before manufacturing reached the scale needed to absorb large numbers of workers and sustain productivity growth. Domestic firms are frequently small, supplier networks remain shallow, and the relationship between universities, technical institutions and industry is often weak. Infrastructure still too often reflects the historical logic of moving commodities from sites of extraction to ports rather than connecting African centers of production.

Read more: The International Monetary Fund’s Africa policy is underdevelopment

The African Continental Free Trade Area creates the possibility of changing the scale at which we approach some of these problems. A continental market can support forms of industrial specialization that smaller national markets cannot, but the agreement will acquire its full developmental significance only when African firms possess the productive capacity to supply that market. Lowering tariffs creates trade opportunities; it does not by itself produce the firms, electricity, logistics, finance, skills and technical standards required to take advantage of those opportunities.

The emergence of BRICS creates new possibilities within this African project, but it does not guarantee the outcome. Consider the minerals required for the global energy transition. African countries possess significant deposits of manganese, platinum-group metals, cobalt, lithium, and other minerals required for batteries, electric mobility, renewable-energy systems and the wider low-carbon economy. Several BRICS economies already represent substantial sources of demand for these minerals, and their industrial and technological ambitions are likely to further increase that demand. The question is whether it can be structured to support African processing, refining and manufacturing rather than simply accelerating the export of unprocessed ore. For South Africa, this means asking whether its mineral endowments, established industrial base, scientific institutions and engineering capabilities can support new activities in batteries, fuel cells, electric mobility, and renewable-energy equipment. Elsewhere on the continent, mineral extraction can be progressively connected to refining, processing, component manufacturing, engineering services, and technical skills.

Regional integration consequently must become as much an industrial project as a trade project. A viable African battery value chain need not be reproduced inside the borders of a single country. Minerals extracted in one economy can be processed in another, components can be manufactured where industrial capabilities already exist, with assembly occurring close to sufficiently large markets. The strategic objective should be to connect these capabilities across the continent so that regional integration progressively expands the number of African firms, workers, and economies participating in higher-value activities. Regional institutions have recognized this opening. Both SADC and SACU have recently developed strategies to leverage their members’ critical mineral endowments for industrial development rather than raw export, embedding the beneficiation agenda within regional frameworks rather than leaving it to individual countries to negotiate alone. The question for BRICS partners is whether their infrastructure finance can connect regional production rather than reinforcing the extractive economic geography that routes everything to ports.

The experience of Indonesia is instructive in this respect. By restricting the export of unprocessed nickel ore, Indonesia used its resource endowment as an instrument of industrial policy, compelling downstream investment in domestic refining and processing and generating a measurable expansion of manufacturing activity around the minerals sector. The conditions in Indonesia differ from those across African mineral-producing economies, and no single approach transfers without adaptation, but the underlying logic, that a country with significant mineral endowments can use its position in global supply chains to anchor productive capability rather than to service demand, is directly relevant to the African debate. SADC and SACU frameworks enable the collective pursuit of that logic rather than individually, which considerably strengthens the negotiating position of member states.

Read more: For Africa to have digital sovereignty, it must control data and AI technology

A vehicle for regional integration and development

BRICS cooperation can be brought directly into this developmental space. Its members collectively possess capabilities that African economies require industrial finance, advanced manufacturing, energy technologies, digital systems, agricultural technologies, pharmaceuticals, logistics expertise and large consumer markets. The strategic African objective should therefore be to use these relationships to close specific productive gaps, rather than to approach BRICS principally as another destination for commodities. The test of each partnership is whether it leaves firms stronger, engineers more capable, supplier networks deeper, and regulatory institutions better equipped than before.

This requires developmental statecraft, understood not as a rhetorical commitment to the state’s role in development but as the organized capacity of public institutions to identify productive opportunities, direct finance towards them, negotiate technology partnerships on terms that leave capabilities behind, coordinate the different policy instruments that productive transformation requires, and sustain that effort through the inevitable difficulties of implementation. State capability, in this sense, is the operational form of sovereignty in practice. A government may possess all the formal attributes of sovereign authority whilst systematically lacking the institutional capacity to negotiate effectively with international capital, enforce agreements, direct finance towards developmental ends or build the regulatory knowledge that separates a beneficial technology partnership from another form of dependency.

The infrastructure and technology challenges illustrate the practical implications. Much of Africa’s transport network still reflects an extractive economic geography. The next generation of infrastructure must connect African economies and link transport corridors to processing facilities, industrial parks, energy systems, universities, cities, and regional markets rather than simply moving commodities more efficiently to ports. When an African country acquires sophisticated technology, the relevant question is what remains after the transaction: whether our engineers understand it, whether our universities can teach and improve it, whether domestic firms can enter its supply chains and whether we can progressively adapt it to local circumstances. The developmental value of technology partnerships lies ultimately in the capabilities they leave behind, and state capability is what determines whether those conditions are written into agreements and enforced when partners resist them.

Finance is an equally pressing matter in the African context. Large infrastructure projects can attract BRICS capital, but smaller domestic manufacturers and regional suppliers frequently lack the patient finance required to expand production, meet technical standards, and enter value chains. BRICS financing mechanisms, including the New Development Bank, could make a particularly consequential African contribution by complementing large infrastructure investment with financing for productive enterprises, supplier networks, and industrial projects.

Africa and BRICS

For Africa, these possibilities will not materialize automatically. The continent possesses many of the minerals upon which emerging industries will depend, the youngest population of any continent, enormous renewable-energy potential and a continental market whose importance will grow considerably during this century. But history provides ample evidence that endowments do not, by themselves, produce development, and the responsibilities that follow from this understanding fall primarily on African states rather than on any external partner. BRICS cannot perform these functions on Africa’s behalf, nor should it. What it can do is enlarge the range of instruments available to countries pursuing productive transformation.

Africa, therefore, confronts BRICS with both an opportunity and a test: the opportunity is a wider range of markets, finance, technologies, industrial partners, and development experiences, while the test is whether the continent uses this greater room for maneuver to change its productive structure or merely to diversify the destinations to which its commodities are exported. BRICS can enlarge Africa’s field of possibilities, but it cannot determine what Africa builds within it. The changing international order can give Africa greater room to act, while productive power will determine what we can do with that room.

Busani Ngcaweni is Director of the Centre for Public Policy and African Studies at the Johannesburg Business School, University of Johannesburg.

This article was produced by Globetrotter.