Kenya gets Sh43bn Pepfar funding to fight HIV in 2025

Kenyans with HIV have welcomed the one-year extension of funding to the US President’s Emergency Plan for Aids Relief, which is the biggest buyer of antiretroviral drugs for Kenyans.

The US Congress granted Pepfar a one-year extension, unlocking about Sh43 billion one-year funding for Kenya.

Kenya is currently utilising a Pepfar grant of Sh45.8 billion until September. The team that plans for the grants in Kenya will meet in Nairobi on Monday to budget for the grant for 2024-25.

The 2024-2025 grant was expected to be approved but was caught up in campaigns by extremist US Republicans to defund Pepfar, claiming its funds promote abortion.

Since Pepfar was founded by President George W Bush in 2003, it has received a five-year extension until 2022 when it was extended for only one year.

The new one-year extension for the programme was part of the huge 2024 spending bill that the US Congress unveiled on Thursday.

Kenyan advocacy groups said they were happy to see the programme renewed, even if it was only for a year. 

“It’s a welcome move because there was a lot of anxiety. Hundreds of thousands of Kenyans with HIV rely on Pepfar funding to stay alive and in good health,” said Nelson Otwoma, head of the Nephak, the national body that unites people with HIV and those affected by TB and HIV/Aids.

The cost of maintaining one patient with HIV with drugs and associated expenses is about Sh20,000, according to the Ministry of Health.

Kenya has 1.4 million people living with HIV and about 1.2 million are on antiretroviral therapy.

Foreign donors currently finance at least 66 per cent of the HIV budget in Kenya, mostly buying ARVs and related supplies.

Pepfar contributes over 50 per cent of total HIV/Aids funds in Kenya every year.

The the last few years, the US has been asking Kenya to diversify its donors and improve domestic financing.

“The need for significantly greater domestic financing for the health sector, including for the national HIV programme, has become more urgent,” a policy paper on Kenya commissioned by Pepfar last year said.

It cited the expected decline in donor funding as Kenya transitions into a lower-middle-income country.

“The government of Kenya should prioritise strategies that can potentially secure and sustain increased government financing for health and HIV,” said the paper.

It was titled, 'Trends in Public Sector Investments in HIV in Kenya'.

It was produced for Pepfar and USAid by policy think tank Health Policy Plus.

According to the disease control council, the country has been increasing its domestic financing and hopes to reach at least 50 per cent by 2027. 

Dr Mutinda Mutuku, a health economist and health financing specialist at the council, last year told The Star this move is gradual so that gains made in addressing HIV, other diseases and strengthening the health system are not reversed.

“It should be progressive. That is, the proportion of domestic (national, county government, NHIF and private sector) contributions should be increasing with time, and as the economy grows,” he said.

Mutuku said donor financing is declining, while more than 1.4 million Kenyans living with HIV require lifelong treatment, and infections are still spreading.

“Partner financing is subject to sudden change, causing shocks and endangering lives,” he said.

“Donor financing does not always align to Kenya’s strategic priorities, and sometimes funds parallel systems, creating inefficiencies.”

Mutuku said as the country matures into an upper middle-income economy, it is expected to contribute more than 50 per cent of funding from domestic sources.

In 2020-21, public funds accounted for about 39 per cent of Kenya’s HIV-related expenditure. Pepfar contributed 47.1 per cent, followed by Global Fund at 9.5 per cent, other donors at 5.1 per cent and 0.07 per cent from local non-governmental sources.

In August 2023, the Ministry of Health said some key donors had agreed to continue buying ARVs and HIV test kits for Kenya until 2030.

Medical Services PS Harry Kimtai said the country was expected to transition out of most donor support by 2027.

He said Kenya now has seven years to start footing its HIV-related activities bill.

“By 2027, funders were to be packing and going away,” Kimtai said at the Maisha Maisha HIV-Aids conference in Mombasa.

We requested them to stay until 2030. It's only seven years away. Are we ready as a nation?”

The biannual meeting is Kenya’s flagship conference on HIV, bringing together government officials, researchers, development partners, civil society and the private sector