The Trump administration is striking bilateral deals with countries affected by deep cuts in U.S. foreign aid.

The administration of U.S. President Donald Trump has signed an agreement pledging $480 million in public health assistance to Côte d’Ivoire.

The agreement, signed on Tuesday in the West African nation’s capital Abidjan, is the latest twist in the Trump administration’s “America First” global health strategy.

plan Imagine Bilateral agreements with dozens of countries to receive U.S. health assistance Internal strife in the executive branch of the United States Agency for International Development (USAID).

The Trump administration insists that U.S. foreign aid policy is ineffective and wasteful and says bilateral agreements will create more accountability, oversight and ultimately self-sufficiency.

Experts have questioned the effectiveness of this approach and warned of its transactional nature.

At Tuesday’s signing ceremony, U.S. Ambassador to Côte d’Ivoire Jessica Davis Ba said the U.S. government was “moving beyond traditional aid to a model focused on trade, innovation and shared prosperity.”

“Today, our bilateral cooperation is entering a new phase. We are implementing the America First global health strategy,” the ambassador said.

As part of the deal, Côte d’Ivoire has committed to eventually provide up to $292 million in health funding by 2030, Prime Minister Robert Beugre Mambe said.

The agreement is the largest of more than a dozen other arrangements the Trump administration has struck so far under the new strategy.

Cut USAID

Deep cuts to the US Agency for International Development earlier this year disrupted public health services around the world, with Africa being hit particularly hard.

This raises concerns about potential growth spread of HIV On the African continent, falling maternal and child healtha surge in malaria cases and reduced early detection of new infectious diseases.

While the Ivory Coast agreement and other new bilateral agreements seek to address issues in these areas, public health experts have been cautious about the government’s approach.

An analysis earlier this month by the Center for Global Development said the new strategy outlines several potentially beneficial changes to foreign health aid delivery.

However, the changes “pose significant risks to service delivery and hard-won public health gains,” senior analyst Jocilyn Estes and policy researcher Janeen Madan Keller wrote.

The pair identified several potential areas of risk, including public health priorities that could be affected by “deal pressure”, oversight issues and clarity on how services will be protected if partner countries fail to meet their commitments.

Experts further questioned what the strategy would mean for aid in areas without “credible or stable governments.”

“The implementation of a reconfiguration approach to U.S. global health assistance, particularly direct government assistance, at this scale and speed is unprecedented,” they wrote, adding that “lives are at risk at every potential point of failure.”