Kenya moves to stabilise HIV, TB services after funding shock

HIV/AIDS drug test. [Courtesy, iStock] Kenya's health system is slowly finding its footing after a funding shock earlier this year nearly reversed decades of progress in the fight against HIV and tuberculosis (TB). A new assessment by the National Syndemic Diseases Control Council (NSDCC) has revealed that Kenya has previously heavily relied on external support. With external funding, the report titled , and how quickly they can collapse without it. When the U.S. government froze foreign aid in January, hundreds of health facilities were thrown into crisis. Medicine stock-outs, service interruptions, and staff shortages followed, leaving thousands of patients stranded. Among the hardest hit were babies born to HIV-positive mothers, some of whom missed crucial doses of nevirapine syrup, a lifesaving drug that prevents HIV transmission during breastfeeding. The report also reveals that nearly 14 per cent of health facilities ran out of preventive TB therapy for children, fuelling a surge in paediatric TB cases in counties like Turkana and Marsabit, where infection rates were already among the country's highest. "This country came dangerously close to reversing decades of gains," said NSDCC Chief Executive Officer Douglas Bosire. The funding freeze, he said posed serious risks, particularly for mother-to-child HIV transmission prevention services and TB treatment for children. At the height of the crisis, health facilities reported running out of essential commodities, including cotrimoxazole, a key drug used to prevent opportunistic infections in people living with HIV, and HIV test kits. Stock-outs of antiretroviral drugs (ARVs) were also reported in several counties, raising fears of treatment interruptions that could have triggered drug resistance. The situation was worsened by the suspension of donor-supported staff under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Nurses, clinical officers, and laboratory technologists stayed home after their contracts were put on hold, leaving many health facilities with too few staff to attend to patients. But swift intervention by the national and county governments averted what could have been a full-blown health catastrophe. "The government moved quickly to integrate services, supply commodities, and lift the stop-work order for health staff," Bosire told the Standard in an interview. Bosire added, "Counties redeployed and absorbed staff into their payrolls to bridge the gap and keep clinics open." Comprehensive clinics which combine HIV, TB, family planning, and other primary health services under one roof are now running again in most counties. The Ministry of Health has rolled out training for county health teams to strengthen their ability to manage HIV and TB programmes locally, ensuring that services are no longer fully dependent on donor funding. Communities played a crucial role in calming panic that had gripped patients in February, when reports of drug shortages prompted stockpiling and hoarding of medicines. With immediate threats now contained, Kenya is focusing on the bigger challenge - funding its HIV and TB programmes domestically. "The Ministry of Health, Parliament, and the Council of Governors are working on a transition plan to ensure Kenya takes full ownership of HIV service delivery," Bosire said. A key plank of this strategy is the ongoing review of the Social Health Authority (SHA) essential benefits package to ensure HIV treatment, viral load monitoring, and TB services are fully integrated into Kenya's universal health coverage (UHC) plan. People living with HIV have already met with the Principal Secretary for Health and are preparing a memorandum to strengthen patient representation in decision-making. Health experts say the crisis was a wake-up call, forcing Kenya to confront its over-reliance on donors. For nearly two decades, programmes like PEPFAR have funded up to 80 per cent of Kenya's HIV response, covering treatment, testing, and health worker salaries. But with shifting global priorities and competing crises worldwide, the country now faces growing pressure to build self-sufficient systems. "This is about building a health system that cannot collapse because of a decision made thousands of miles away," said a senior Ministry of Health official involved in the response. Nearly 40 per cent of health facilities reported severe staff shortages at the peak of the crisis, with nurse-to-patient ratios in some counties doubling from 1:50 to 1:120. Youth, sex workers, and other key populations disengaged from care when drop-in centres closed, worsening stigma and creating gaps in prevention efforts. For many affected families, the cost of care has become a heavy burden. Two-thirds of patients surveyed reported paying out-of-pocket for services that were previously free, with some resorting to selling household assets to buy medicines. Advocates warn that this situation underscores the urgency of including HIV and TB care in the SHA benefits package to prevent catastrophic health spending. Despite these setbacks, experts are cautiously optimistic that Kenya is emerging stronger from the crisis. The combined effort by the government, counties, civil society, and communities has created momentum for a more integrated, resilient health system. "The goal is not just to recover from this crisis," Bosire said. "It is to make sure no baby, no mother, no patient ever misses treatment because of a funding freeze." Kenya is working towards eliminating HIV infections by 2030.

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