Kenya's delayed global fund pledge threatens treatment of HIV, malaria and TB

Activists, university students and AHF-Aids Health Care Found staff hold a procession in a campaign to petition China to step up its contribution to the Global Fund in the fight against HIV and Aids, TB and malaria in Nairobi Wedesday. [James Wanzala,Standard] People living with HIV and health advocates are urging the Kenyan government to fulfil its financial commitment to the Global Fund (GF). The country has yet to honour its pledge of USD 10,000 to the donor, a delay that could jeopardize vital HIV, malaria, and Tuberculosis (TB) activities including treatment and programs. Eliminating and treating the three top-killer diseases have long relied on donor support. This comes as the Global Fund is faced with a significant funding shortfall, announcing that it will now focus only on life-saving interventions. Global Fund's move to support life-saving interventions is largely due to a reduction in contributions from the U.S. government, historically one of the Fund's largest donors. Nelson Otwoma, Executive Director of the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), stressed the critical role the Global Fund plays in sustaining Kenya's health system. "We call on donor countries to honour their commitments. Kenya's previous administration pledged USD 10,000, and we expect the current administration to not only honour that pledge but consider increasing it," Otwoma said in an interview with The Standard. Early this year, NEPHAK and health organisations met the former Health Cabinet Secretary Dr Deborah Barasa who promised action was to be taken. "During a meeting with the Health Cabinet Secretary, we were assured the government would honour the pledge. We hope the country will increase revenue and remit the funds before the end of the year. This money comes back to benefit our citizens. "The Global Fund receives money from countries like Kenya, which is then replenished to support low- and middle-income countries," Otwoma said. At least 40 per cent of HIV treatment is supported by the Global Fund, which further supports 30 per cent of TB activities and malaria. "In Kenya, about 40 per cent of people living with HIV are on treatment because of Global Fund. TB medicines and diagnostics are also procured through the Fund, including malaria interventions like mosquito net procurement and distribution that heavily depend on it". Some 1, 378,457 people are living with HIV in Kenya, of them, 1,336,681 on ARVS with the latest data showing that at least 16, 752 new infections were reported last year with 20, 489 AIDS-related deaths. Otwoma said that the Global Fund did not raise enough during its last replenishment round, and Kenya's allocation was reduced by 30 per cent in February. "The Global Fund is one of the most transparent funds we have globally. But if we lose U.S. support and the Global Fund's strength weakens, we foresee a disaster," he said. According to the Fund's eighth replenishment investment case, launched on February 18, 2025, it seeks US$18 billion under the 2026-2028 cycle to fight malaria, TB and HIV, in addition to strengthening health systems. Replenishment aims at saving millions of lives and preventing new infections. Although the Fund has shown flexibility by not setting a strict deadline for new commitments, the uncertainty in the global donor landscape remains a concern. "We hope Kenya will remit its commitment before the end of the year," said Otwoma. South Africa and Botswana have already honoured their pledges, but other states including the United Kingdom (UK) and Kenya are yet to fulfil their commitments. UK and other European countries have been getting their support from the US government, but support has since been cut following the stop work order, signed by President Donald Trump. "The bulk of Global Fund contributions come from Europe. But with the U.S. pulling back under the Trump administration, and delays from other countries like the UK, the Global Fund is struggling. We need global solidarity to ensure essential health services continue without interruption," said Otwoma. Jactone Chilo, NEPHAK chairman on his part, said nobody should be disengaged on treatment because of cuts in funding by the U.S. government and Global Fund. "We need to sit with county governments to structure HIV components in it. We are a sovereign nation and the government should be able to take care of us," he said. Reduced support is however, likely to cause a spike in HIV infections, as preventive services are not part of the waiver provided by the Global Health Security and Diplomacy under the U.S. Department of State. The limited waiver includes HIV testing for all populations, HIV care and treatment for all people living with HIV. Laboratory support, and supply chain management for procurement of HIV medicines and other commodities to prevent stockouts. Pre-exposure Prophylaxis (PrEP) is limited to only pregnant and breastfeeding mothers. Mentor mothers who have been working closely with health providers and the Ministry of Health to reduce the mother-child transition of HIV have since been sent parking as they were fetching stipends directly from the U.S. government. "ARVS are bought by PEPFAR Global Fund and the government. We need to sustain the game so that we do not draw back," said Chilo. "We need to sustain the gains that we have made. Sustaining means that we do not lower the momentum, we keep where we are, and if not, enhance better," The official added: "We need to have a candid discussion with the government to ensure we do domestic resource mobilisation in the country. We need to enhance private partnership."

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