Kenya is among the top ten biggest recipients of US funding for HIV medicines.
The United States has launched a sweeping overhaul of its global health programmes that will dramatically alter the way Kenya receives billions in health assistance.
The new “America First Global Health Strategy” promises to bypass the large network of non-governmental organisations (NGOs) that have long dominated health aid delivery in Kenya and in the other 70 countries supported by the US.
The US said it will instead send money directly to governments and faith-based organisations, which it said are more trustworthy.
“Many of the NGOs that support these programmes have committed many times to helping transition the work to local governments, but little progress has been made. This is often not because of a lack of willingness on behalf of recipient countries but rather because of our broken foreign aid system and the perverse incentives that encourage NGOs to self-perpetuate,” said US Secretary of State Marco Rubio.
The America First Global Health Strategy marks the most radical rethinking of American health aid since the launch of the US President’s Emergency Plan for Aids Relief (Pepfar) more than 20 years ago.
Kenya, one of the top ten recipients of Pepfar funding, will feel the change almost immediately.
More than one million Kenyans are on HIV treatment today, mainly through drugs bought by Pepfar and the Global Fund.
But Washington now says too much money has gone to conferences, workshops, and layers of consultants.
“Our health foreign assistance programmes have become inefficient and wasteful,” the document, published last week on Thursday, declares. “Less than 40 per cent of funding goes to frontline supplies and healthcare workers.”
The rest, it says, disappears into “technical assistance, program management, and other forms of overhead.”
In Uganda alone, for instance, 57 implementing partners and more than 300 sub-recipients shared the work in one year, creating “fragmentation and duplication of resources.”
The strategy praises faith-based organisations as cost-efficient and trusted by communities.
“Faith-based providers represent over 40 per cent of delivery capacity in Kenya,” the document notes.
Unlike NGOs dependent on grants, churches and religious groups can draw on tithes and private donations, making them less reliant on US funds. The plan says faith-based clinics are well placed to continue services even if aid levels fall.
Kenya is already a test case for the new aid-delivery model. In recent years, the US transitioned some HIV funding and technical support from NGOs to county governments. Marco Rubio said results suggest there is a better outcome when you bypass NGOs.
“In Kenya, the United States transitioned funding and site-level technical assistance from implementing partners to county government staff in multiple counties. In these counties, technical assistance costs decreased by 70 per cent as a result of this transition. At the same time, the proportion of patients who interrupted treatment was reduced by over 50 per cent, and the number of people on treatment increased more than fivefold from 20,000 to over 100,000,” the strategy says.
The new strategy promises the US will continue to fund HIV, tuberculosis, malaria and polio medicine and the salaries of health workers directly delivering health services to patients.
It was not accompanied by a new budget, but media houses that attended the press conference at the launch quoted one official explaining: “There’s not a change today in terms of how much we’re spending. All of the amount, all of the money that we’re going to spend on health is going to be programmed in this manner.”
The strategy also clarifies Pepfar will not be closed but will be restructured. The US is the biggest funder of HIV activities in Kenya, and last year Kenya received $322 million (Sh43 billion) for HIV response between October 2024 and September 2025.
The US said it will negotiate and sign an agreement with each beneficiary country, based on disease burden, current dependence on US government assistance, and current health system capacity.
“Most agreements will include requirements around co-financing from recipient governments, and all agreements will include requirements around developing data systems and setting program benchmarks for relevant diseases, including HIV/Aids, TB, malaria, and polio,” the strategy says.
The strategy has set a target of completing bilateral agreements with the countries [such as Kenya] receiving the vast majority of US health foreign assistance by December 2025, and implementation of those deals is required to begin by April 2026. During the six-month transition, “bridge funding” will keep services alive while new contracts are negotiated.
Recipient governments will have to meet targets on co-financing, data systems, and programme benchmarks. If they fall short, the US reserves the right to withhold money.
At the same time, US officials have hinted that the Western Hemisphere and Asia-Pacific regions will be prioritised in early negotiations.
Africa, which currently receives the bulk of Pepfar funding, could find itself waiting in line.
Agreements for the majority of the 71 US-supported countries will include a full transition to country self-reliance over the timeframe of the agreement.
Critics point out gaps. Irene Koek, a former senior official at the US Agency for International Development, wrote that she was “struck by the absence of discussion of child and maternal health,” long a pillar of American aid.
The new plan is largely silent on nutrition, family planning, and broader primary healthcare.
The strategy also links health to geopolitics saying one of its pillars is to “leverage US global health leadership to compete with China,” especially in Africa.
Another is to promote American companies abroad.
“The United States will continue to use health foreign assistance funds to procure supplies from US companies,” it says, citing diagnostics firms like Abbott and Hologic.
Africa’s healthcare market is projected to exceed $250 billion by 2030, and Washington is clear that US firms should benefit.
Health Cabinet Secretary Aden Duale met Jeffrey Graham, the US Acting Global Aids Coordinator, where he was briefed on the changes.
The talks were attended by Dr Mamadi Yilla (Deputy Coordinator for Health Diplomacy, GHSD), Dr Ouma Oluga (PS, Medical Services), Dr Bashir Isaak, Eng Anthony Lenayara (CEO, Digital Health Agency), and Dr James Nyikal (Chairman, National Assembly Departmental Committee on Health).
“CS Duale underscored the importance of safeguarding these gains as the partnership enters a new phase under the America First Global Health Strategy. He welcomed the shift toward country ownership and sustainability, noting Kenya’s commitment to reforms that strengthen health systems, enhance transparency, and mobilise domestic resources,” the Ministry of Health said in a statement.
“Discussions focused on continuity of care, funding visibility, technology transfer, local manufacturing, and the establishment of a Kenya–US Technical Coordination Mechanism to guide the transition.”
Unaids welcomed the strategy.
“Unaids will work closely together with the US Government in this historic effort to end AIDS—one that saves lives, strengthens global partnerships, makes the world safer and stronger, and brings us all closer to a world without Aids,” the agency said in a statement.