President John Dramani Mahama says the health compact the United States offered Ghana to replace USAID funding was humiliating, and that his cabinet rejected it faster than anything he has seen in office. He gave that account at the Council on Foreign Relations in New York on Friday, 25 September 2026, at an event billed as a conversation with the President.
He also traced the origins of the Accra Reset, the continental initiative he launched last year, directly to the American aid withdrawal that preceded the compact. The two decisions form a single argument that Ghana would rather find the money itself than accept conditions it considers an affront to its sovereignty.
Four Provisions That Sank It
President Mahama said the Ministry of Health studied the document and prepared a cabinet information paper, which flagged several provisions.
The first was a requirement that Ghana hand over its pathogen profile, the record of diseases endemic in the country. The second was a demand for medical records. “Who takes another country’s medical records?” he asked.
The third required Ghana to commit a set amount of its own money as counterpart funding. The fourth stipulated that medications and medical products brought into the country under the programme would not be subject to inspection by the Food and Drugs Authority, the regulator established under the Public Health Act to certify what enters the Ghanaian market.
Thrown Out In Record Time
“It was humiliating,” he said. The cabinet’s response, in his telling, was 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 Minister of Health was then directed to inform the American ambassador that Ghana did not need the arrangement and would manage on its own. The President dismissed the sum involved as a pittance, describing it as a hundred and something million dollars.
The decision was taken at the end of April, after negotiations that began in November 2025 and grew steadily more pressured. Washington had set 24 April as the deadline to conclude, and Accra concluded it could not accept what was on the table.
The Hole USAID Left
The compact was designed to replace assistance that had already gone. President Mahama put the withdrawal at 174 million dollars for Ghana, money that had been flowing mainly into education and health.
The health component alone came to about 74 million dollars a year, and he detailed where it went. It funded medical research and testing laboratories for HIV and AIDS, and the PEPFAR programme, administered through USAID, supplied antiretroviral drugs.
American government figures put total foreign assistance to Ghana at 219 million dollars in 2024, of which 96 million was specifically for health, in the year before the cuts. Whichever figure is used, the shortfall had to be covered from a budget already passed.
From Shortfall To Accra Reset
That gap is what produced the initiative President Mahama has spent the past year promoting. He said former President Olusegun Obasanjo and others approached him arguing that Africa needed to think again about health sovereignty and break what he called the dependency syndrome.
The reasoning drew on the pandemic. African countries were last in the queue for COVID-19 vaccines because the major producers are all in the West, he said, and the consensus is that another pandemic is a matter of when rather than if.
The objective he set out is to produce more medicines and vaccines on the continent and to spend more on health outcomes, which he described as a central factor in African development. That argument became the health sovereignty report his High-Level Panel launched in New York on Monday.
Ghana Is Not Alone
The compact Ghana refused belongs to a wider American programme. The America First Global Health Strategy, introduced after USAID was dismantled, has produced bilateral deals with close to two dozen African countries, asking poorer nations to take on a larger share of the fight against HIV, malaria, tuberculosis and polio before transitioning away from aid.
Ghana was not the first to walk away over data. The executive director of Ghana’s Data Protection Commission, Arnold Kavaarpuo, said the scope of data access requested went far beyond what would typically be required for the stated purpose, and Africa CDC Director-General Jean Kaseya has voiced concerns about data and pathogen sharing in the agreements generally.
What Refusal Costs
Rejecting the compact leaves the funding gap where it was, which is the part of the story President Mahama’s framing moves past quickly. Antiretrovirals, laboratory testing and medical research still need paying for, and health sovereignty is a programme measured in years rather than budget cycles.
That is the wager Ghana has made. The country has traded a hundred and something million dollars for control over its own pathogen data, its medical records and its regulator’s authority to inspect what crosses the border, and President Mahama now takes that argument into the African Union chairmanship in January, where he will ask other governments facing the same offer to reach the same conclusion.
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