• Zimbabwe has withdrawn from negotiations on a proposed $367m, five-year US-Zimbabwe health MOU, and the US Embassy says it has begun process of winding down health assistance, with no public response yet from Zimbabwe
• The collapsed deal was a structural shift to a co-funding, shared-accountability model intended to sustain 95-95-95 gains and transition away from donor-dependency
• The central risk is continuity of care: an estimated 1.2m Zimbabweans are on HIV treatment through US-supported programmes, while domestic financing and system capacity  remains insufficient to absorb a rapid funding retreat

Harare - The Government of Zimbabwe has withdrawn from negotiations on a proposed bilateral health Memorandum of Understanding with the United States, ending talks over a $367 million, five-year agreement that would have funded HIV/AIDS treatment and prevention, tuberculosis, malaria, maternal and child health, and disease outbreak preparedness.

The U.S. Embassy in Harare confirmed the development on Tuesday in a formal statement. The Zimbabwean government has yet to issue a public response.

The breakdown marks a significant shift in one of the region's most consequential health partnerships  one built over two decades and worth more than $1.9 billion in cumulative U.S. investment since 2006.

The proposed agreement was not a continuation of existing aid arrangements. It represented a structural evolution in how the United States and Zimbabwe would manage their health partnership going forward.

At its core was a co-funding model: the U.S. would provide the larger share of financing while Zimbabwe would incrementally increase its own domestic health spending alongside it. The goal was to move the relationship away from a traditional donor-dependency dynamic and toward a model of shared ownership, with measurable targets and mutual financial accountability built in from the start.

The $367 million on offer over five years would have covered HIV/AIDS, tuberculosis, malaria, maternal and child health, and outbreak response. According to the U.S. Embassy, the package represented "the largest potential health investment in Zimbabwe by any international funder."

It was also, by design, the final stage of a longer journey. Two decades of American health funding in Zimbabwe  channelled largely through PEPFAR, the U.S. President's Emergency Plan for AIDS Relief  helped the country achieve the UNAIDS 95-95-95 targets.

The global benchmark requiring that 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment achieve viral suppression. Those are targets that define a mature, well-functioning HIV response. The MOU was meant to lock in and sustain that progress.

The MOU was not a one-off arrangement designed specifically for Zimbabwe. It is part of a broader U.S. initiative that has now been signed by sixteen African countries, representing a combined commitment of over $18.3 billion in new health funding more than $11.2 billion from the United States and $7.1 billion in co-investment from the recipient governments themselves.

The framework has been accepted across a wide cross-section of the continent, from countries with stronger economies to those with comparable or greater fiscal constraints than Zimbabwe. The terms  co-funding requirements, accountability mechanisms, shared ownership of outcomes were not presented to Zimbabwe alone. They are the standard terms of the new partnership model.

An estimated 1.2 million Zimbabweans  men, women, and children  are currently receiving HIV treatment through U.S.-supported programs. Their continuity of care is now the central question as the U.S. begins what Ambassador Tremont described as "the difficult and regrettable task of winding down our health assistance in Zimbabwe."

HIV has shaped Zimbabwe for a generation. Adult prevalence  estimated at between 11 and 13% remains among the highest in the world. The epidemic has hit women of reproductive age and children hardest.

The country's journey from near-collapse in the early 2000s to meeting UNAIDS targets today is one of the more remarkable turnarounds in African public health, and it happened on the back of sustained international, primarily American, investment.

The infrastructure that makes that progress possible  community clinics, supply chains, testing programs, treatment centres  has not yet developed the domestic financing to sustain itself independently.

The U.S. Embassy statement leaves room for the situation to evolve. The phrase winding down implies a process rather than an immediate cut, and no timeline has been specified. That matters for patients currently enrolled in treatment programs, and it may also reflect the practical reality that unwinding two decades of integrated health programming cannot happen overnight without significant humanitarian consequence.

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