How to transition our HIV response funding

Sh86.37 billion is spent annually on Kenya’s HIV response. [iStockphoto]

In 1999, the government declared HIV a national disaster, paving the way for multi-sector action and large-scale interventions to create awareness and curb its spread.

In 2003, President Mwai Kibaki declared ‘total war on HIV/AIDS,’ deepening collaboration with international development partners and funding agencies, including the US government through its President’s Emergency Plan For AIDS Relief (PEPFAR) and USAID, the Global Fund to Fight AIDS, Tuberculosis and Malaria among others.

Through multi-sector partnerships, technical assistance and ground-breaking innovations in prevention, testing and treatment, a lot has changed.

The National AIDS Control Council (NACC) reported that Sh86.37 billion is spent annually on Kenya’s HIV response, financed at 63 per cent from international aid, 17 per cent through government budget and 10 per cent through household contributions. Of this expenditure, more than 50 per cent is allocated to antiretroviral therapy (ART).

This shows Kenya’s HIV response is still significantly dependent on donor funding. While HIV is still a public health concern, emerging global health priorities (as seen with the Covid-19 pandemic) call for reallocation of resources to address these emerging threats.

According to the WHO, climate change is the single biggest health threat facing humanity, and it projects that between 2030 and 2050, it is expected to cause 250,000 additional deaths  yearly from malnutrition, malaria and diarrhoea.

With these pressing concerns, developing countries like Kenya will continue to see shrinking resources from traditional funding sources and look into innovative ways of funding the HIV response locally. This calls for strategies that rely on local country ownership and developing countries’ leadership. One such strategy is a systems approach that promotes synergies with primary health care through people-centred services and considers social determinants of health, such as climate change.

This calls for a multi-sectoral approach to align and collaborate with more local partners, including the private sector, for maximum impact. This way, diverse needs of people will be met no matter where they interact with health services or the social determinants of health, ensuring no one is left behind. 

As funds shrink, future funding cycles are expected to shift into a government-to-government model. Funders want to reduce management costs that clinical implementers (such as NGOs and FBOs) bear.

This is to ensure more resources go directly to meet needs of HIV patients. While the government is well placed and has structures to absorb these resources for direct service delivery at national and sub-national levels, there is a need to continue building management capacity within the health structures for stewardship and accountability for these resources.

There is also an opportunity to advocate for policy change and adoption to increase and optimise primary health care financing. We have seen several counties, including West Pokot, pass bills to ring-fence funds collected at health facilities to ensure they are ploughed back into the facility.  The Facility Improvement Fund allows health (FIF) facilities to manage the funds they generate to improve services.

In HIV service delivery, this would go a long way to cover costs of services that HIV patients may have to pay outside of the free antiretroviral therapy or TB medication, and support facility pharmacies stock other essential drugs that HIV patients may need. The call is for civil society organisations and community advocates to engage their leaders and have more counties supported to pass the FIF Bills.

These advocates are critical in holding duty-bearers accountable for the prudent use of resources.

-Dr Wanyama is programme director, HIV/TB/Malaria and NCDs at Amref Health Africa in Kenya and Dr Osembo is Acting Chief of Party, Amref Health Africa in Kenya