INTRODUCTION:
The Accra Reset advances a Global South–led framework for reforming global health cooperation. It emphasizes health sovereignty, national ownership, domestic financing, institutional reform, and more equitable partnerships while safeguarding global public goods. In parallel, the United States is pursuing Memoranda of Understanding (MOUs) under its America First Global Health Strategy. This study examines the extent to which U.S. health MOUs operationalize Accra Reset principles.

METHODS:
We conducted qualitative content analysis of three MOUs (Kenya, Uganda, and Liberia); other MOU texts were not finalized or available and were excluded. Five Accra Reset domains were assessed: (i) sovereignty; (ii) financing; (iii) integration; (iv) partnership; and (v) public goods. Alignment within each domain was categorized as strong, moderate, or weak based on the presence of explicit commitments, operational specificity, and governance or accountability mechanisms. AI-assisted analysis supported initial categorization; all findings were reviewed and validated by the authors.

RESULTS:
Across all three agreements, the MOUs demonstrate weak alignment with Accra Reset principles related to partnership and substantive national stewardship. Alignment is strongest in procedural system integration; however, expectations for increased domestic financing are unevenly matched to fiscal space realities, raising risks of service disruption. Data and specimen access provisions represent a major divergence: the MOUs emphasize extensive, often one-directional data flows, with limited safeguards for genomic sovereignty, benefit-sharing, technology transfer, or countermeasure access. Governance arrangements prioritize coordination and implementation oversight but rarely confer binding authority or reciprocal accountability sufficient to shift power balances.

CONCLUSIONS:
Early U.S. health MOUs reflect weak and procedural uptake of Accra Reset principles but fall short in data governance, financing feasibility, and equitable accountability. Stronger alignment will require embedding Accra Reset indicators into future health plans, establishing reciprocal data governance and benefit-sharing provisions, linking transition expectations to realistic fiscal pathways, and strengthening parliamentary and multi-stakeholder oversight.