Health hard hit by Trump's radical policies

Members of the pharmacology department take inventory of the last boxes of drugs delivered by the now-dismantled United States Agency for International Development (USAID) amid medical supply shortages in a pharmacy storeroom at Lodwar County Referral Hospital in Lodwar on April 1, 2025. (Photo by Luis TATO / AFP) When Donald Trump assumed office as United States President on January 20, 2025, the health sector both locally and globally, faced major policy shifts. One of the most notable was a stop-work order that disrupted the operations of the US Agency for International Development (USAID). For decades, USAID has been a key pillar of global health support, including in Kenya and across Africa. Through initiatives like the President's Emergency Plan for AIDS Relief (PEPFAR), USAID funded essential health programs, including Kenya's HIV response The suspension of foreign aid, particularly from PEPFAR and USAID, caused widespread confusion and disruption in Kenya's healthcare system, hitting HIV advocacy and service delivery hardest. The funding cuts led to the layoff of about 45,000 health workers whose salaries had been supported by US government funds. As a result, Comprehensive Care Clinics (CCCs) across the country were shut down. Treatment default HIV services were moved to general outpatient departments, a shift that many people living with HIV say increased stigma and led to higher treatment default rates. Despite these setbacks, under the current Country Operational Plan (COP23) for 2023-2025, PEPFAR aims to help Kenya reduce mother-to-child HIV transmission to below 5 percent by 2025. The Country Operational Plan (COP) is an annual strategic framework that guides PEPFAR's priorities, budgets and areas of funding. In the current financial cycle (2023-2025), Kenya received $322 million to support HIV programmess. However, the latest COP report shows that 32 percent of mother-to-child HIV transmissions result from treatment drop-off among HIV-positive women. The stop-work order has further set back prevention efforts. For instance, Pre-Exposure Prophylaxis (PrEP)-a drug that helps prevent HIV-is now available only to pregnant and breastfeeding women under a limited waiver from the Global Health Security and Diplomacy office. Additionally, funding cuts have excluded mentor mothers from programmes, heightening the risk of mother-to-child transmission. Support from the US Government and other donors, such as the Global Fund, has significantly strengthened Kenya's response to HIV and maternal health care, including the prevention of mother-to-child transmission (PMTCT). Funding gap Since 2010, Kenya has made notable progress in reducing new HIV infections by more than 67 percent, from 101,000 cases in 2010 to approximately 16,752 in 2024. Currently, an estimated 1,378,457 Kenyans are living with HIV, with 1,336,681 on treatment. The country has achieved a mother-to-child transmission rate of 7 percent, just 2 percentage points shy of the global target of below 5 percent. The stop-work order issued by the US Government left a Sh30.9 billion funding gap, which the Kenyan government has yet to bridge. Whether the government will fully compensate for the lost funding in HIV and broader health programmes remains uncertain. Prior to the stop-work order, support from the US Government and other donors like Global Fund has strengthened Kenya's response to HIV, maternal healthcare, including prevention of mother-to-child transmission. Apart from HIV, the US supports malaria programmes in poor countries such as Kenya, through Presidential Malaria Initiative (PMI). However, experts anticipate an increase in malaria cases and deaths with a cut for malaria funding by the US. In the US 2026 budget request, Trump's administration proposes cutting PEPFAR funding by $1.8 billion and allocating just $424 million to the President's Malaria Initiative. The budget further excludes funding for the Global Fund (GF) that helps eliminate HIV/AIDS, TB and malaria, with the administration plan of contributing only one fifth of total funding from one third in the previous financial years. Domestic financing Further, the drop in budget allocation omits findings from Gavi, the Vaccine Alliance that supports purchase and distribution of newborn vaccines. Trump's proposed cuts contrast sharply with President Joe Biden's earlier pledge to allocate $1.58 billion to support Gavi's 2026-2030 replenishment cycle. Although donor funding-including from the US government-was expected to decline gradually, the abrupt stop-work order caught many by surprise. Dr Daniel Mwai, a health economist and presidential health advisor, told The Standard that the support was expected to taper off slowly as Kenya increased domestic financing to fully take over. "Donor funding has been declining for years, even before the US issued the stop-work order," he said. "The transition plan was never meant to be abrupt; it was supposed to be gradual. What we are seeing now is a radical shift." To fill the gap, the government is integrating health services, moving away from the donor-driven model of verticalised care. "What we need is for the government to prioritize funding for key strategic health areas," said Dr Mwai. "That way, if donors return, their support can focus on less critical areas, making the system more sustainable." Nelson Otwoma, Executive Director of the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), echoed the call for stronger domestic investment. "While US support has helped, it is ultimately the Kenyan government's responsibility to fund its health services," he said. "In my opinion, US funds haven't always been used effectively in Kenya." Gender identity Beyond health funding, Trump's administration also took a hardline stance on gender identity, declaring official recognition of only male and female genders-reversing inclusive policies introduced under President Biden. Trump rescinded anti-discrimination protections for sexual and gender minorities and cut funding for agencies supporting LGBTQ+ communities, despite their focus on promoting equality and combating discrimination. He also rolled back racial equity policies and imposed restrictions on certain medical treatments for transgender individuals, marking a sharp shift from the previous administration's approach to diversity and inclusion. As a result of these policy changes, many organisations were forced to revise their documentation and data systems to comply with new directives from the Trump administration. Some even took down entire datasets. According to several US-funded programmes, terms such as gender, discrimination, key populations, criminalized, and equity were deemed sensitive or unacceptable under the new guidelines. "All the data systems and the data highway have been pulled down because some indicators are considered offensive to Trump," said a senior official from a Kenyan health organization. Fearing loss of U.S. funding, many organisations have reworked their documentation to align with the revised requirements. "So, even when USAID grants began to return, some data could not be restored," the official added. "That's because Trump listed specific terms that are now unfundable under US government support." In January, a new stop-work order was issued, with a 30-day extension granted in April. As of now, the full resumption of health program funding remains uncertain, with limited communication from Washington, DC.

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