Christian Nigerians will receive American funding to boost their faith-based health care services in what the State Department describes as a reward to the Nigerian government for prioritizing protecting Christian populations from a surge in Islamic jihadi violence in the nation’s northern states. 

The $2.1 billion, five-year deal, part of the Trump administration’s newly declared “America First Global Health Strategy,” will be used to expand essential preventative and curative services for HIV, TB, malaria, maternal and child health, and polio. Nigeria is also committing nearly $3 billion to its domestic health expenditures in what the State Department calls “the largest co-investment any country has made to date” under the new program.

Nigeria has 900 faith-based clinics and hospitals that serve 30 percent of Nigeria’s 220-million population. Despite a three-tiered public health system, only 0.5 percent of Nigeria’s $2.25 trillion annual GDP goes to health care, Nigeria Magazine reports, below the 5 percent recommendation of the World Health Organization, and compared to America’s 17.6 percent. With 3.89 percent of GDP spending on health care, exorbitant out-of-pocket costs for many citizens puts health care out of reach. 

Nigeria health care system ranks 187th out of 191 for performance, according to the World Health Organization. Average life expectancy at birth reaches just 54.7 years compared to 78.4 years for Americans while infant and maternal mortality rates put Nigeria in the top three for worst outcomes in the world.

The decision to up support for Nigeria aligns with a Trump administration carrot-and-stick approach to global relations. Last week, the State Department added Nigeria to a list of countries whose residents are banned from receiving U.S. visas to enter America while also threatening to cut off aid if Christian populations are not protected. The president last month scolded the presidency of Bola Tinubu and said he may send U.S. military forces into Nigeria if Christians continue to be targeted by Muslim extremists. 

The president’s threat was welcomed by some analysts who say the country has been ransacked by terror since 2009. A watchdog group, International Society for Civil Liberties and the Rule of Law, Intersociety, reported in August that more than 30 Christians are murdered by jihadists per day in the religiously segregated nation, totaling more than 7,087 so far this year. 

That’s on top of a reported 125,009 Christians killed since 2009 by 22 Islamic terror groups operating in Nigeria. More than 19,100 churches have been burned to the ground and 600 clerics abducted, Intersociety reported.

Nigerian security officials call the 16-year insurgency an “existential threat.” In June, the nation launched a new national counterterrorism strategy, but so far the flow of attacks has not abated.

The assistance to Nigeria’s faith-based health care agencies comes after the Trump administration closed the U.S. Agency for International Development. In September, the president launched his America First Global Health Strategy, which includes bilateral agreements for aid going directly to government’s front-line health care workers, bypassing nongovernmental organizations that the president says filter aid dollars through extortion and theft. 

The State Department has now signed four deals this month under the new global health strategy, with Nigeria following five-year agreements with Kenya, Rwanda, and Cameroon. The State Department said in its announcement that it retains the right to pause or end any programs that do not align with American national interests. 

“The Trump administration expects Nigeria to continue to make progress ensuring that it combats extremist religious violence against vulnerable Christian populations,” reads the statement.