This is a moment to think clearly. The United States has said, in plain words, that its global health spending now serves American security and prosperity first. The familiar programmes HIV, TB, malaria, disease surveillance, pandemic readiness will continue, but funding will be channelled mainly through country-specific agreements with strict performance targets, co-financing by governments, and wide access to national data. In effect, aid is being used as a strategic asset. For Botswana and the region, that is not a reason to panic; it is a reason to plan. This article explains the change, links it to Africa’s New Public Health Order (NPHO), draws lessons from past donor practice, and sets out a practical path that protects Botswana’s sovereignty while improving services. What does this look like in practice?
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