What Next for Kenyan Health System Amid the Freezing of Donor Funding?
Despite efforts in improving health outcomes in the past 3 decades, there has been heavy dependence on donor funding especially in financing key developmental health programs predisposing the country to external funding shocks. HIV, TB, Malaria, Maternal and Child Health as well as immunization and vaccination are among the programs that have been entirely reliant on donor funding primarily supported by PEPFAR, USAID and the Global Fund.[1] The immediate unprecedented funding halt by the United States has sent cold chills through Kenya’s health system, with fears of stalled programs, inadequate access to essential services, and a possibility of escalating public health crises. [2] Don’t put your eggs in one basket―well in this case, neither the eggs nor the basket were ours. First, let’s examine how donor funding has influenced different aspects of Kenya’s healthcare sector over the years.
Health Financing in Kenya and Trends in Donor Funding
In the 2024-2025 FY, Kenya has a total budgetary allocation of 9.7% to health with the total contribution from donors ranging from 18 to 26%. This is contrary to the commitment in the Abuja Declaration of allocating 15%[1] of total government budget to health which is echoed in the Kenya Health Financing strategy 2020-2030 further compounding the crisis.
Over time in the recent past, there has been an evident significant decrease in donor funding and not specifically donor dependency. A contextual analysis of the 2009-2010 FY[2] and 2018-2019 FY[3], shows that donor funding accounted for 35% and 19.1% respectively of Kenya’s health sector financing illustrating a substantial decline in donor contributions over the years. This, however, doesn’t point to a shift from donor dependency to more sustainable financing approaches, rather a reflection on the reduction of financial support provided by the donor leaving gaps for the country’s domestic resourcing which are yet to be filled even as at now.
Courtesy: DW News. ‘US Freezes Almost All Foreign Aid’. Thumbnail image. YouTube, January 25, 2025. https://www.youtube.com/watch?v=JJWJ_p-z7Z4
Underlying and Unprecedented Challenges
The increased vulnerability to major health threats and compromised health security fueled by donor withdrawal stems from several systemic and contextual issues including: The increased vulnerability to major health threats and compromised health security fueled by donor withdrawal stems from several systemic and contextual issues including:
- Service delivery inefficiencies with the new social health insurance fund- other than the implementation challenges posed by SHIF, in the process of calculating the essential benefit packages, major donor funded programs such as TB and HIV, were overlooked and not sufficiently integrated into the fund, which now poses sustainability concerns for these programs.
- Inadequate Policy Reforms for Health Financing– there has been slow progress in the realization and translation of the commitments made in policy and framework documents as well as the full implementation and adoption of these policies. The Kenya Health financing strategy 2020-2030 aims for more sustainable funding in health but there has been no significant domestic financing increases or effective implementation.
- Weakened response to pandemics and major health emergencies– the COVID 19 on its own serves as a stark example with how it exposed the vulnerability of Africa’s health systems in urgent public health crises. The current domestic funding base in Kenya is weak and fragile and cannot sustain shockwaves or further strains from a major public health emergency which may come with any sudden surge in cases.
- Other structural challenges in the health system including weak health infrastructure, insufficient health workforce and unavailability of major drugs and commodities. Notably, most of the donors and developmental partners in the health programs have been taking care of their own resources from health human resource to commodities which now leaves a gap to be filled by the Kenya MOH.
The sudden halt in donor funding presents Kenya with an opportunity to reimagine its health financing strategy and take a paradigm shift towards more sustainable health financing approaches. The future of Kenya’s health security will heavily depend on its ability to address and counter the systemic challenges and prioritizing more resilient and self-sustaining systems domestically funded.
