This year, Kenya received Sh43 billion to buy HIV drugs, test kits, and related supplies. The funding came from the US President’s Emergency Plan for Aids Relief (Pepfar), which is the biggest financier of HIV response in Kenya.
The annual funding to Kenya has been reduced substantially since 2017. Still, Pepfar is widely cited as one of the United States’ most successful foreign assistance initiatives.
However, while it has traditionally been funded on five-year tranches, this year it only got funds to last one year. This makes planning difficult and creates uncertainty. Kenya's National Aids and STIs Control Programme has now moved to cut costs by planning the integration of HIV clinics with other services in hospitals. The Star's John Muchangi had a chat with BRIAN RETTMANN, the Pepfar coordinator in Kenya. Here are the excerpts:
Pepfar’s HIV financing to Kenya has been going down the last five years. How do you see this affecting HIV response?
You know, the government strategy for Universal Health Coverage is really going to help us to realign the way we do HIV services and bring down costs. And instead of having a Pepfar response, we're going to have a Kenyan response that may be differentiated based on whether you're from Homa Bay or from Marsabit or from Turkana. Response that really is based on the epidemic that's within those counties and the populations.
What we have seen as we've started to do some integration of services within facilities, is that we've been able to reduce the costs substantially. So as Pepfar continues to reduce year to year, and Kenya takes more responsibility, they're able to do so with a smaller envelope. We're going to work with the government to make sure that it really is a sustainable approach in the long term. And so we're going to develop this sustainability roadmap with the government that was announced at the state visit [by President Ruto] in Atlanta.
Nascop has announced integration of HIV clinics with other health services to cut costs and reduce stigma, whereby standalone HIV clinics will end. Has your team projected the savings that can be made?
I don't have a specific amount there. I think it will depend upon the models that are developed within each of the counties. Some counties where you have smaller populations, the per person cost might be a little bit higher and where you have larger populations of people living with HIV, it might be smaller, but those savings are going to be bigger because you have a lot more people. So it's really going to be differentiated upon the service levels that are defined.
Aside from cost saving, what other benefits come with integration of services?
There are many. The first one really is having a Kenyan response rather than an imposed response to reduce costs. It also makes sure that you have a response that is much more integrated within the communities where we work. It also will help reduce some of the stigma. When you have a much more integrated HIV programme within the facility, people aren't identified as 'Oh, that one is going over to the Comprehensive Care Clinic, they must be HIV positive'. If everyone's seeing the same doctors, it may reduce stigma substantially.
Pepfar last year introduced a two-year planning cycle instead of the annual cycle. What informed it and how is that helping HIV programming?
So we still do an annual process, but we were able to give a two-year projection with the last two years. We are going to continue that process because it gives a longer term projection. And then hopefully within that sustainability roadmap, we’ll actually be able to match things out for a few more years so that government knows what they need to take not just in the next coming year, but in the future years as well.
Throughout Pepfar’s history, US congress has reauthorised and fully funded the initiative on a bipartisan basis every five years. But this year it reauthorised Pepfar for one year only until March 2025. This may create unnecessary uncertainty, preventing long-term planning and potentially jeopardising the considerable progress already achieved. Are you concerned?
You know, Pepfar has received really great bipartisan support for 21 years. Right now, there is some discussions around the reauthorisation, which gives us a five-year projection for a US government budgeting, or whether it should be a one-year, or two-year. We're going to continue to push our Congress to look at that five-year reauthorisation, because we believe it really gives us the best possibility to understand how these transition should take place, and how sustainable our programmes can be. If we're programming just one year to one year, it makes it much more difficult to say, Okay, can you put in more? And to really understand the landscape.