US Secretary of State Marc Rubio speaks during the signing of the Sh208 billion Health partnership./PCS
Kenya and the United States on Thursday signed a five-year
agreement that will replace the health funding previously channelled through
the defunct USAID.
The deal, signed by US Secretary of State Marco Rubio and
Prime Cabinet Secretary Musalia Mudavadi, commits the United States to provide
up to $1.6 billion (Sh207 billion) over five years.
In return, Kenya must raise about $850 million in domestic
resources over the same period.
Kenya will receive a large portion of the Sh207 billion
grant first, but the amount will reduce each year until 2031, when Kenya should
fully finance its HIV treatment, prevention and other health services.
This grant replaces all Pepfar (US President’s Emergency
Plan for Aids Relief) funding to Kenya and all the other health financing that
came to Kenya each year through USAID.
President Ruto promised that “every shilling and every
dollar will be spent efficiently, effectively and accountably.”
“The framework we sign today adds momentum to my
administration’s universal health coverage that is focused on supply of modern
equipment to our hospitals, efficient and timely delivery of health commodities
to our facilities, enhancement of our health workforce and health insurance for
all, leaving no Kenyan behind. This
facility will also boost disease surveillance and emergency preparedness,” he
said during the signing ceremony.
The agreement is part of the America First Global Health
Strategy (AFGHS), and Kenya was only the first of 50 countries expected to sign
by the end of December.
The US is slowly reducing its health funding through AFGHS
and wants countries like Kenya to take over most of the costs. The US will
still help, but with smaller and more targeted support.
Rubio said they will help countries build their own health
systems over the next five years and stop being too reliant on donations.
“That money is not just going to be spent to provide
medicine and care; it’s going to be spent to improve the domestic
infrastructure, health care infrastructure, so that in five or six or seven or
eight years countries will say we no longer need this much assistance,” he
said.
The funding will be spread over five years from April 2026.
UNaids welcomed the agreement, calling it a major shift in
global health cooperation.
The agency said, “It builds on decades of shared commitment
between the US and Kenya through the US President’s Emergency Plan for Aids
Relief (Pepfar) and represents a renewed demonstration of shared solidarity,
co-investment, self-reliant systems and resolve to save lives, reduce new HIV
infections and advance progress towards ending Aids in Kenya,” UNaids said in a
statement.
The US deal marks the end of Pepfar as the main external
funder of the national HIV programme. Pepfar has been the backbone of Kenya’s
response for two decades, supporting antiretroviral treatment for more than 1.3
million people and financing critical health workers, commodities and community
programmes.
In the most recent cycle, Pepfar provided approximately Sh43
billion, roughly US$322 million, in a single year. It also supported tens of
thousands of health workers across all 47 counties and financed large segments
of the supply chain, laboratory systems, prevention programmes and data
infrastructure.
Those funds traditionally flowed through USAID and partner
organisations, rather than directly through Kenya’s own systems.
The new agreement ends that model. Funding will now move
more directly through government systems under a government-to-government
framework.
UNaids described the pact as “a milestone in the future of
global health cooperation, bringing renewed momentum to advance Kenya’s
outstanding response to HIV and US leadership in the global HIV response.” It
also highlighted that the agreement with Kenya is the first in a series of 50
similar bilateral arrangements the US intends to sign with other countries.
Kenya is now expected to assume growing responsibility—
though not immediately — for drug procurement, salaries for health workers
historically funded by Pepfar, data systems, outreach programmes and the supply
chain that delivers lifesaving commodities.
This transition comes at a sensitive time. Several analyses
over the past year have shown that Kenya’s HIV response remains heavily
donor-dependent, with foreign funders supporting more than half of annual
programme costs.
A government assessment earlier in 2024 estimated that Kenya
needs an additional Sh128 billion each year to fully finance its HIV services
without donors. The Pepfar and USAID phaseout therefore exposes Kenya to
serious financial pressure unless domestic funding rises sharply.
President Ruto, during the signing ceremony, attempted to
reassure both governments and the public. His promise was that “every shilling
and every dollar will be spent efficiently, effectively and accountably.”
He added, “Let me say this for the record, that already we
are mobilising our own domestic resources to the tune of $3 billion to support
the health deployment of health infrastructure in Kenya.”