Malawi is under pressure to decide whether to accept a five-year $740 million (K1.3 trillion) health financing deal with the United States. The deal, which must be concluded by December 31, 2025, promises much-needed funds for the country's health sector, but it comes with serious risks to privacy, data sovereignty, and transparency.
Under the proposed arrangement, the US would directly inject funds into Malawi's government health systems rather than through civil society organisations. Supporters argue that this could speed up funding, improve health service delivery, and strengthen government-led programs. The deal would see Malawi receive $180 million in 2026, $164 million in 2027, $148 million in 2028, $132 million in 2029, and $116 million in 2030.
But critics warn the costs may outweigh the benefits. The agreement could allow US authorities access to sensitive health data, including HIV status, tuberculosis treatment history, vaccination records, and other personal medical information. Such access could last up to 25 years, according to warnings from 57 African civil society organisations, including those in Malawi.
Centre for Human Rights and Rehabilitation executive director Michael Kaiyatsa said, "Allowing personal medical data to be viewed or managed outside the country creates a serious risk of breaching constitutional protections of privacy and confidentiality. Government must clearly explain what data will be shared, who will have access, and how personal records will be protected. Malawi must retain full control over its health data and systems."
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Kamuzu University of Health Sciences public health expert Adamson Muula echoed concerns, warning that sharing personal health data without consent would be highly problematic. He referenced US privacy laws such as HIPAA, which strictly protect individuals' medical information from third parties.
Legal experts also caution that the deal could conflict with Malawi's Constitution. Clement Ng'ong'ola, dean of law at the Catholic University of Malawi, noted that constitutional rights can only be limited under strict conditions that are "reasonable, recognised by international human rights standards, and necessary in an open and democratic society." He warned that some US demands may not meet these standards.
Civil society organisations are demanding transparency and participation in the negotiations. Gift Trapence, chairperson of the Malawi Civil Society Advocacy Forum, said, "CSOs are calling for meaningful participation during the development of Memoranda of Understanding and implementation plans." Maziko Matemba of the International Coalition on Health Financing Advocacy added that the US must allow Malawi enough space to engage its citizens and stakeholders.
Similar deals in other countries have faced resistance. In Kenya, a $2.5 billion US health aid package was suspended by the courts over data privacy concerns, highlighting the challenges Malawi could face if it proceeds without careful safeguards.
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Malawi's health authorities, led by Ministry of Health Principal Secretary Dan Namarika, say they are carefully negotiating the deal to protect national interests, privacy, and sovereignty. "We are discussing what we can do to protect our people while still benefiting from the funding," he said.
As the December 31 deadline looms, Malawi faces a difficult choice: secure crucial funding for health programs or risk compromising citizens' privacy and constitutional protections.
