Kenya explores local funding for health as Trump regime dithers on funding freeze

When Kiambu County procured an endoscopy machine. [File, Standard] The decision by the Trump administration to rescind an earlier directive to pause federal loans, grants and other financial assistance may come as a reprieve for many countries that depend on the programme to boost health systems. The decision came ahead of a ruling by a federal judge in Rhode Island following a court order to pause the implementation of the directive. Trump's directive before a change of mind is largely seen as a ruse, Trump's attempt at curtailing this critical aid is causing jitters in Kenya's public health sector, with players now exploring local funding options to sustain the country's healthcare system. The US, through USAID and PEPFAR, has played a critical role in strengthening Kenya's healthcare sector by supporting malaria treatment, supplying essential drugs such as ARVs and antimalarials, distributing vaccines, and training healthcare providers. Programmes supported by foreign aid have since been suspended. Deputy Director General at the Ministry of Health, Dr Sultani Matendechero, emphasizes that U.S. support remains crucial for the smooth operation of Kenya's healthcare system. He notes that the US is a key supplier of essential medical commodities -including ARVs, malaria drugs, and vaccines - as well as a significant contributor to healthcare workforce training. "As a country, we must contribute to the global effort to petition the U.S. to reinstate its support for the World Health Organization (WHO) and foreign aid. WHO has officially petitioned for the reversal of the decision, Congress has weighed in, and humanitarian organizations have also voiced their concerns," says Matendechero. "How can we, as a country, add our voice to this effort and push for the U.S. to reconsider its support for the WHO and our healthcare programs?" he adds. While the grants remain safe for now, Democrats argue that the president's intention is illegal, as it overrides Congress's authority. They assert that the impact of the freeze has already been felt in the U.S. and in countries dependent on foreign aid. The Democratic Attorney General contends that halting foreign aid violates the U.S. Constitution and could have devastating consequences for states and nations that rely on the funding. Kenya is among the countries already feeling the impact of the withdrawal of foreign aid, creating anxiety among individuals and organisations that rely on U.S. support through PEPFAR and USAID. This support has been instrumental in reducing the prevalence of HIV in the country, which has declined from 13 per cent to 7 per cent over the past decade. Additionally, AIDS-related deaths have decreased, and mother-to-child transmission of HIV now stands at 7 per cent, just 2 per cent shy of the global target of below 5 per cent, "Cutting off support from the US might lead to a spike in HIV cases in the country," the official warned. Similarly, malaria cases in endemic regions such as Nyanza and Western Kenya have dropped due to initiatives like malaria vaccination for infants, mass mosquito net distribution, and the training of community healthcare providers to support disease elimination efforts. Data reveals that at least 1,000 malaria-related deaths are reported in Kenya annually, a significant drop from more than 5,000 over the past decade. However, health rights lawyer, Allan Maleche, argues that reliance on aid is unsustainable. "It doesn't matter whether Kenya, Uganda, and other countries petition the US at the end of the day, foreign aid belongs to the American people, and they decide what to do with it," says Maleche, also the Executive Director of the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) While acknowledging the critical support Kenya has received from the US and other donors, he emphasized the need for the government to develop a long-term plan to guarantee healthcare as a fundamental right for its citizens. "As you rush to petition, what is your plan? Will you forever be petitioning? Will you forever have your begging bowls out?" he poses. He further notes that this is not the first time PEPFAR has signalled the possibility of withdrawing support. "They have told us several times before. GAVI has also indicated that it will end vaccine supplies." According to Maleche, the government's priority should be reassuring citizens that they will continue to receive ARVs and other essential treatments, regardless of foreign aid decisions. "The U.S. has the right to make its own decisions on whether to support or not," he concluded. "We should stop blaming America and making it seem as if the U.S. has failed us. The US has been doing us a favour. It is the government's responsibility to plan and determine how to manage healthcare," stresses Maleche. This is a position taken by former president, Uhuru Kenyatta, who called on African governments to strengthen their healthcare systems instead of lamenting the withdrawal of donor support. To address the gap left by the withdrawal of foreign aid, the Ministry of Health is now focusing on domestic resource mobilisation. Key strategies include attracting local philanthropists to invest in healthcare, encouraging local manufacturers to embrace corporate social responsibility programmes, and increasing budgetary allocation to health. Matendechero emphasises that the government aims to boost healthcare funding in line with the Abuja Declaration, which recommended that at least 15 per cent of the country's GDPs be allocated to health. Additionally, he acknowledges the need for external support, noting that as a developing country, Kenya still requires assistance from the Global North. "Even after implementing all local financing mechanisms, we still cannot fund 100% of our healthcare needs. Unlike the Global North, we lack the capacity to fully support our social expenditures. We must establish strong partnerships with external funders to bridge the funding gap," he says. However, Maleche pokes Matendechero's sentiments saying establishing a local manufacturer and philanthropists is not a lasting situation. He says individuals may as well decide to withdraw their support, leaving health in a wanting state. On the US withdrawal from WHO, Dr Matendechero stresses the importance of global collaboration in safeguarding public health. He cites the Marburg virus outbreak in Tanzania, where WHO's rapid response was crucial in containing the disease. "Failure to manage such outbreaks can pose a public health threat to any country, including the US," he warns. He emphasises that WHO remains the only organisation with the strategic capability to coordinate global health security. "The world cannot function without WHO. Even if the U.S. pulls out, it will still rely on the rest of the world to sustain WHO so that it can continue coordinating global health efforts." Meanwhile, the Ministry of Health is mapping out programmes run by USAID and PEPFAR to assess their scope, regional coverage, workforce, and overall impact. This exercise will help determine funding gaps left during the suspension period and inform necessary interventions. Despite the uncertainty, Dr Matendechero reassures Kenyans that the government is capable of sustaining the healthcare system. "Whatever happens, even if the U.S. pulls out completely, healthcare remains a critical sector. We will make the necessary adjustments. We are not going to die like chickens," he asserts.

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