Health services on the brink after US support halted

US Secretary of State Marco Rubio and Prime CS Musalia Mudavadi participate in a Health Framework of Cooperation signing ceremony at the State Department in Washington, DC on December 4, 2025. [AFP] The High Court order halting all American-run health programmes in the country, has thrust health into looming crisis, as temporary bridge funding meant to keep services running is set to end in March 2026. Interventions for malaria, tuberculosis (TB), and HIV/AIDS, previously supported by PEPFAR through USAID, remain uncertain amid stalled actualisation of the newly signed Sh322 billion U.S.-Kenya health cooperation framework. The PEPFAR bridge funding was part of an earlier $1.6 billion (Sh 206 billion) package that the Kenyan government was set to receive from the U.S. Under the bilateral Government-to-Government (G2G) agreement, Kenya is expected to raise $850 million (Sh109 billion), through a co-financing model. Court battles over the framework sparked by concerns about data sharing and disease surveillance have led to the suspension of all U.S.-supported health programmes, including the implementation of the new agreement. People living with HIV/AIDS have expressed concern over possible stock-outs of essential medicines should the programmes remain suspended. However, some activists have welcomed the ruling, arguing that it offers the government an opportunity to strengthen domestic financing and take full ownership of critical health initiatives. The court had initially scheduled a ruling for January this year. However, Busia Senator Okiya Omutata, who filed the petition, returned to court, arguing that current activities mirrored those that should have been stopped. In response, the court ordered all American-run programmes to cease operations. "The fear is that Kenya will run out of medicine ARVs and TB treatment by April if the next batch is stopped," said NEPHAK Executive Director Nelson Otwoma. Otwoma added, "USAID went and went without return. What has been in place is PEPFAR. PEPFAR was to end in September 2025 but was extended to December. The new agreement has since been signed, but it is yet to be implemented, regardless of the bridge funding coming to an end." As the legal wrangles continue, other countries continue to sign the U.S. health cooperation framework. Kenya was the first African country to sign, followed by Rwanda. In Rwanda, the G2G arrangement was not new, as President Paul Kagame had refused parallel funding from the outset. Beatrice Kairu, a health economist and public policy expert, defended the court ruling, noting that it does not reject health cooperation with the U.S., but reaffirms that large-scale health financing and data arrangements must comply with constitutional governance, fiscal discipline, and public trust. "Policy certainty comes from strong processes, whereas weak processes create expensive policy failures," Kairu told The Standard in an interview. She observed that health funding that bypasses fiscal modelling and parliamentary scrutiny risks becoming unsustainable, and that sustainability is the fastest way to undermine Universal Health Coverage (UHC). Once health data leaves the system or governance norms are broken, courts cannot undo the damage, she emphasised. "Data harm is not like budget harm. You can reallocate money, but you cannot retrieve privacy. The government argued that the framework is non-binding, but the court did not accept this at face value. In public policy, substance matters more than labels. If a framework creates detailed obligations, timelines, institutional commitments, and fiscal expectations, it has real-world binding effects whether or not it is called a treaty," Kairu explained. She also noted that centralising health employment decisions without county concurrence undermines devolution and creates long-term wage bill risks. "The court paused implementation to protect constitutional review. This creates space to address governance gaps," she said. Kairu acknowledged that the government is correct that Kenya cannot absorb epidemic shocks alone, and that the sudden withdrawal of donor funding poses real risks. However, she stressed that urgency does not suspend the Constitution. She observed that emergency logic must still respect lawful process. One lesson from global health history according to her is that decisions taken without local participation even when well-funded often reproduce dependency and mistrust. "This ruling interrupts that cycle. Justice Mwita's ruling is not anti-health funding or anti-cooperation, it is pro-Constitution, pro-accountability, and pro-sustainability," she maintained. According to her, the court recognised that large health financing and data arrangements can cause irreversible harm if implemented without public participation, parliamentary oversight, and fiscal discipline. "As a health economist, I see this pause as an opportunity to design a better, more legitimate, and more sustainable partnership-one that strengthens UHC without trading away governance, trust, or sovereignty," says Kairu. But Otwoma dismissed wrangling on data sharing, saying there is misinformation surrounding it. "I am not a government official, but I joined some sessions of the Kenya-US bilateral negotiations and I can assure everyone that the issue of data sharing was intensely discussed and agreement reached that the Kenyan laws and policies that govern data shall be adhered to," revealled Otwoma. The official noted that for 20 years, the American government has funded Kenyan health programs through PEPFAR, USAID and Presidential Malaria Initiative and there has never been any breaches. With a partnership agreement anchored on the country laws, there will be no breaches, he observed. "Our concern is that for many years, Kenya has faced financing challenges and which deepened when the US government issued a Stop Work Order in February and no civil society or politician or activist commented upon,' added Otwoma. He regretted that when stop work order came into force, everyone went silent even as the country faced stock out of HIV and TB medicines and vaccines for children. Now that the US is showing signs of coming back to fill the gap, civil society and politicians are coming up to block it, he said. "In our opinion, the issues being raised can be discussed even as the cooperative agreement is implemented so that people in lifelong medication are not forced to interrupt treatment,' said Otwoma. He added, "The ideal solution would be to get the government to fund the entire health budget, a situation that is not tenable at the moment" Kenya has historically depended heavily on donor funding, a reliance greatly affected the health system that was supported by USAID, following a stop work order that was issued by President Donald Trump.

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