Kenya has been put on a list of 24 countries classified as high risk environments for donor funds.
Kenya will now have to comply with new highly stringent conditionality on accessing and spending donor monies.
Some of the reforms, proposed by the Global Fund for example include a ‘zero cash’ policy. With this, fund recipients will not receive lump-sum disbursements in advance.
Instead, funds will only be made available after appropriate documentation has been provided to the donor.
Alternatively money will be paid directly to suppliers and not through third parties, a system which has been exploited by government bureaucrats.
Such a system is expected to cure happenings such as exposed last year in the Sh5 billion Ministry of Health scandal.
The US government and GAVI Alliance (for vaccines) both which have suspended funding to the Ministry of Health have also demanded stringent accounting measures be put in place to protect their grants.
On Tuesday, David Garmaise of the Global Fund Observer, a publication tracking the workings of Global Fund explained how new safeguards are being effected.
All the suggested measures, the Observer says will be in place by year-end, on time to safeguard the $356 million, Global Fund has awarded to Kenya for the 2017-2019 season.
This will put Kenya among top 10 recipients of Global Fund financing for the period though a slight drop from the ended 2014-2016 tranche where Kenya had received about $495 million.
The bulk of Kenya’s money will go to HIV, $247 million, malaria $63 million and TB $46 million.
The heightened vigilance by Global Fund is informed by a 2015 audit which put Kenya in a list of 47 high and very high risk countries.
This classification has since been adjusted to list Kenya among 24 countries described diplomatically as having ‘challenging operating environments (COEs).
Other countries in the list are Southern Sudan, Nigeria, and Ukraine are described to face challenges from armed conflict to financial integrity issues.
In a January report, detailing how the Fund wants its grants managed, Kenya is reported to have data and supply chain integrity issues in its malaria, HIV and tuberculosis programmes.
Global Fund is also concerned on low utilisation of treated bed nets in Kenya and its quality of coordination with the local club of donors called Development Partners in Health -Kenya (DPHK).
Recently GAVI Alliance and the US government, both members of the DPHK cut funding to the country, all citing weak accounting systems at the Ministry of Health.
A source privy to sentiments among donors says there is serious apprehension over growing corruption in the health docket.
But the actors in charge remain optimistic things will change.
“Working with implementing partners we will deliver on our commitment to eliminate new HIV infections in Kenya by 2030,” says Dr Jackson Kioko Director of Medical Services at the Ministry of Health.
Similar promises were made recently by the Ministry of Health in Narok during the World Malaria Day.
“While nobody here is surprised by suspension of aid by the US to the Ministry of Health the timing is of concern,” said our source.
The suspension of about Sh2.1 billion by the US to the Ministry of Health early this month, came days after the launch of a Sh30 billion HIV prevention programme driven by the US.
The project targets at reaching half a million healthy Kenyans in five years between now and 2022.
The project document, ‘Framework for the Implementation of Pre-exposure Prophylaxis of HIV in Kenya 2017,’ prepared through the health ministry estimates this will cost about Sh30.5 billion for the first five years.
The bulk of the money, Sh29 billion will largely go to the purchase of the drug Truvada manufactured by the American firm Gilead Sciences.
Disruption of the initiative could also hurt the pharmaceutical manufacturers Hetero and Aurobindo of India who have understandably registered Truvada generic versions in Kenya.
“Two version of Truvada generics have already been registered with the Pharmacy and Poisons Board by some Indian manufacturers,” says Dr Kipkerich Koskei, the outgoing registrar at the Pharmacy and Poisons Board.
These generics are only possible with the express participation of Gilead Sciences who hold the patent for the Truvada version of PrEP.
The patent expires in July 2017. Truvada is an only prescription drug with possible serious side effects to be dispensed by doctors, clinical officers, nurses, pharmacists and pharmaceutical technologists.