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.

A proposed R114 million wall along Cape Town’s N2 has sparked protests, with residents and civil society groups accusing the city of investing in a barrier that could deepen the divide between poorer communities and surrounding suburbs.

Residents marched on September 25 to oppose the N2 Edge project, a planned 9-kilometer wall development that the city says is aimed at improving safety and security along the highway.

But protesters say that the wall risks reproducing the spatial divisions created under apartheid, saying public money should instead be spent on housing, public services and opportunities for communities that have been pushed to the margins.

Movement for CARE, which was among those involved in organizing the protests, had criticized the project, saying;

“Instead of investing in dignified housing, safe neighborhoods, quality public services, and opportunities for communities that have been pushed to the margins for generations, the city wants to invest millions in a barrier that deepens exclusion and reinforces the geography of apartheid.”

The organization said from the beginning when the news about the proposal was announced, that Cape Town does not need more walls but rather affordable housing close to work and economic opportunities, as well as greater investment in communities.

“We need investment in communities, not their isolation. We need a city that brings people together instead of driving them further apart,” it said.

The Movement for CARE described the proposed structure as an “Apartheid Wall,” arguing that the first step towards justice is refusing to normalize and hide existing inequalities.

City defends the R114 million project

The City of Cape Town has defended the project as a safety intervention. In January, Cape Town Mayor Geordin Hill-Lewis said the city’s adjustment budget had committed “R114m to the N2 Edge project.”

The investment “will make a positive difference to the safety of every motorist along that stretch, and reduce pedestrian fatalities,” Hill-Lewis said.

He said the project would repair safety barriers and introduce other safety improvements for communities along the N2.

Hill-Lewis also said that a small number of “criminal elements” were affecting the safety of hundreds of thousands of daily N2 users.

According to the mayor, the N2 Edge project would be accompanied by increased highway patrols, with more than 40 new Metro police officers deployed to the N2, supported by CCTV cameras, automatic number plate recognition and digital coordination for rapid response.

Despite the widespread backlash, the city maintains it will continue with the project.

Abahlali baseMjondolo backs the protest

Abahlali baseMjondolo also supported the protests, saying in a post that the project would deepen racial and economic divisions in the city.

“The City of Cape Town continues to entrench neo-apartheid laws in post-apartheid South Africa by building a wall that segregates and hides the poor from the rich along the N2,” the organization said.

Adding that the project shows that the Democratic Alliance-led City does not recognize the needs of poor communities, particularly Black communities.

Read more: “A declaration of war against the poor”: AbM leads resistance against South Africa’s anti-occupation bill

The organization said it supported the struggles of residents in Khayelitsha, Langa, Dunoon, Gugulethu and Mitchells Plain who continue to face what it described as segregation and racism.

The protests have raised questions over whether the R114 million allocated to the N2 Edge project represents the right priority for Cape Town. With the protesters arguing that public resources should instead be directed towards reducing inequality, improving services and providing better housing and opportunities for communities living along the N2, instead of separating communities and concealing poverty.