In April 2018, the agoa and MCA modernization laws gave MCC the power to enter into parallel pacts to promote cross-border economic integration, trade and cooperation. In December 2018, the MCC`s Board of Directors selected five West African countries for parallel pacts: Benin, Burkina Faso, Côte d`Ivoire, Ghana and Niger. In response to the Ghanaian government`s decision to terminate the concession agreement between Electric Company of Ghana Ltd (ECG) to private operator Power Distribution Services Ghana Ltd (PDS), the MCC Board of Directors did not select Ghana for regional investments in 2019. Since 2004, MCC has provided more than $14 billion in assistance through its compact and threshold agreements. Most MCC credits were obtained by compacts (96%) 18 pacts are biennial agreements between the CCC and an eligible country to finance specific poverty reduction and economic growth-boosting programmes. MCC`s unique model for the development of compact programs reflects the principles that characterized the creation of the Agency in 2004. These include the principle of country responsibility, the belief that aid is most effective when it is based on a partnership (or pact) in which recipient countries assume greater responsibility for their own economic development. The MCC, once seen as a new approach to U.S. foreign aid, is now well established and well beyond its second decade of operation. The sustainability of MCC funding is a challenge, as the level of funding has been halved from the peak reached more than a decade ago.
While MCC stated that it recognized the value of health for development, only a small portion of its funding was spent on health/water and sanitation projects. Most of these funds were for water infrastructure projects, while only a small portion was spent on health-related projects. Nevertheless, the Agency has demonstrated a commitment to coordinate activities with those of the U.S. global health effort, such as PEPFAR. In 2018, agoA and the MCA Modernization Act were signed by President Trump and gave MCC new power to use cross-border regional investments that address economic challenges, expand regional markets to increase the impact on poverty reduction, and allow for more trade and investment. Health projects (except water and sanitation) were included in four pacts and four threshold agreements with seven countries. Funding for these projects represented a different share of the overall funding of each agreement, Ranging from 0.4% of Namibia`s compact funding to 36% of Indonesian threshold funding (see Table 2).22 Some examples of health-related projects, 13 A legislative amendment adopted in April 2018 allows MCC to pursue, in addition to its standard bilateral agreements, regional investment agreements (i.e. neighbouring countries), in addition to its standard bilateral agreements; To date, no regional investment has been approved.14 First funded by Congress with $994 million in 2004, MCC appropriations peaked at $1.75 billion in 2006 and 2007 in the GJ.