The healthcare partnership between the United States and Madagascar is taking a new turn. The United States is encouraging Madagascar to build a more autonomous health system. Steve Bremner, US Chargé d'Affaires (at the microphone). The United States is pushing Madagascar to gradually reduce its reliance on foreign support. US Chargé d'Affaires Steve Bremner reiterated the new doctrine of foreign aid within the framework of the "America First" policy during a medical equipment handover ceremony to the Malagasy government at Filatex in Ankadimbahoaka yesterday. "This is a tool for strategic engagement, not an act of global charity. Every dollar spent by American taxpayers must produce measurable results, reduce long-term dependence on American taxpayer resources, and promote greater autonomy for beneficiary countries," he emphasized in his speech. Gone are the days when American aid was purely unilateral. Now, Madagascar actively participates in financing its own health system. The bilateral memorandum of understanding on global health (MoU), signed on December 22, 2025 by the Ministry of Public Health and the United States, emphasizes co-investments. This protocol seals a financial commitment from both parties, with 134 million dollars provided by the United States against 41 million dollars contributed by the Malagasy state. Temporary Aid "Our objective is not to provide permanent support," Steve Bremner insisted, recalling that this aid will remain temporary and targeted to guide the country toward financial autonomy. This new American requirement for co-investment indirectly pushes Madagascar to review its budget priorities. Until now, the share allocated to health has stagnated at only 6% of the state budget, a figure that has barely changed since 2024, according to successive finance laws. Present at the event, Colonel Michaël Randrianirina, president of the Refoundation of the Republic of Madagascar, warmly thanked the American government for its unwavering support. He also reaffirmed Madagascar's position: "The State remains fully open to any cooperation aimed at supporting the health system for the well-being of the Malagasy population." Miangaly Ralitera